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Wang J, Yan M, Bomeisl P, Cherian SS, Gilmore H, Khattab R, Harbhajanka A. Cat Scratch Disease of the Breast/Axilla: Recognition of a Rare Disease and Approaches for Differential Diagnosis. Int J Surg Pathol 2024:10668969241228296. [PMID: 38327174 DOI: 10.1177/10668969241228296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Cat scratch disease rarely presents as a breast or axillary mass mimicking carcinoma both clinically and radiologically. Diagnosing breast/axillary cat scratch disease is challenging due to its rarity and nonspecific findings. Here, we reported 2 patients with breast cat scratch disease and reviewed 14 patients with cat scratch disease involving breast/axilla from the past 30 years. It mainly affects women (median age: 48), consistently presenting as axillary lymphadenopathy, and demonstrates ipsilateral breast mass in half of patients (50%, 8/16). The breast mass was most commonly located in the upper outer quadrant (88%, 7/8), indicating the possibility of disease extension from axillary adenopathy. Around half of patients (56%, 9/16) reported cat exposure. Histologically, most patients (93%, 14/15) presented as necrotizing granulomas, with characteristic stellate-shaped necrosis in 5 patients. Although pathologic differential diagnoses between cat scratch disease and cancer are straightforward, distinguishing cat scratch disease from other granulomatous mastitis poses diagnostic challenges. Silver stains should be included in the diagnostic workup panel when highly suspecting cat scratch disease clinically. However, they were only able to highlight the causative microorganism in 54% (7/18) patients, and the gram stain was negative in all 12 tested patients. In contrast, polymerase chain reaction (PCR) for the causative microorganism was consistently positive in all 3 tested patients, while serologic test confirmed diagnosis in 85% (11/13) patients; 1 patient with negative serology showed a positive PCR result. Therefore, upfront PCR tests with or without serologic study should be considered to confirm the diagnosis of cat scratch disease in a timely manner.
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Affiliation(s)
- Jing Wang
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mingfei Yan
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Philip Bomeisl
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah Sree Cherian
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Hannah Gilmore
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ruba Khattab
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Aparna Harbhajanka
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Costa Morais Oliveira V, Cubas-Vega N, López Del-Tejo P, Baía-da-Silva DC, Araújo Tavares M, Picinin Safe I, Cordeiro-Santos M, Lacerda MVG, Val F. Non-lactational Infectious Mastitis in the Americas: A Systematic Review. Front Med (Lausanne) 2021; 8:672513. [PMID: 34422853 PMCID: PMC8378399 DOI: 10.3389/fmed.2021.672513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/05/2021] [Indexed: 10/29/2022] Open
Abstract
Background: Non-lactational infectious mastitis (NLIM) is an inflammatory breast disease with broad clinical presentation. Inadequate treatment can lead to chronic infections that cause breast deformities. NLIM information is limited, especially in the Americas. A systematic review and meta-analysis have been conducted here. Methods: Literature search was conducted in three databases (Lilacs, PubMed, and Scielo) on NLIM cases in the Americas. Demographic, epidemiological, clinical, radiological, and laboratory data were extracted. The main characteristics and results were also compared according to the country's gross national income. Results: A total of 47 articles were included, resulting in 93 cases. The etiological agent was described in 86 (92.5%) patients. Bacteria were the most prevalent etiology (73; 84.8%). Amongst bacterial diagnoses, more frequent cases were Mycobacterium tuberculosis (28; 38.4%); Corynebacterium spp. (15; 20.5%); non-tuberculous mycobacteria (13; 17.8%). The cases were reported in eight different countries, with the USA being the country with the highest number of cases (35; 37.6%). Patients from high-income countries group presented a shorter diagnostic time when compared to low, low-middle, and upper-middle-income countries. A greater number of radiographic studies with pathological findings were described in high-income countries. Conclusion: Non-lactational infectious mastitis is a complex public health problem with diagnostic and treatment challenges. Hence, multi-professional approach-based additional studies are recommended on its epidemiology, diagnosis, treatment, and control.
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Affiliation(s)
- Victor Costa Morais Oliveira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Fundação Hospital Adriano Jorge, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Nadia Cubas-Vega
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Paola López Del-Tejo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Djane C Baía-da-Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | | | | | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Departamento de Ensino e Pesquisa, Universidade Nilton Lins, Manaus, Brazil
| | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Rede de Pesquisa em Malária, Instituto Leônidas and Maria Deane, Fiocruz-Amazonas, Manaus, Brazil
| | - Fernando Val
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Medicina Tropical, Universidade Do Estado Do Amazonas, Manaus, Brazil
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Cheng L, Reddy V, Solmos G, Watkins L, Cimbaluk D, Bitterman P, Ghai R, Gattuso P. Mastitis, a Radiographic, Clinical, and Histopathologic Review. Breast J 2015; 21:403-9. [DOI: 10.1111/tbj.12430] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Lin Cheng
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Vijaya Reddy
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Gene Solmos
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Latanja Watkins
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - David Cimbaluk
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Pincas Bitterman
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Ritu Ghai
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Paolo Gattuso
- Department of Pathology; Rush University Medical Center; Chicago Illinois
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Abstract
Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.
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A human immunodeficiency virus-positive infant with probable congenital histoplasmosis in a nonendemic area. Pediatr Infect Dis J 2010; 29:1055-7. [PMID: 20526228 DOI: 10.1097/inf.0b013e3181e691ed] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 5-week-old infant presented with a fever, and was diagnosed with congenital human immunodeficiency virus and histoplasmosis. Both infections were likely transmitted vertically. The child was effectively treated with antifungal medications and highly active antiretroviral therapy. This represents the first case of delayed presentation of vertically transmitted histoplasmosis, and the first case in a nonendemic area.
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