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Granulomatous lobular mastitis (GLM) is an uncommon condition that typically occurs in parous, reproductive-aged women and can simulate malignancy on the basis of clinical and imaging features. A distinctive histologic pattern termed cystic neutrophilic granulomatous mastitis (CNGM) is seen in some cases of GLM and has been associated with Corynebacterium infection. We sought to further characterize the clinical, imaging, and histopathologic features of CNGM by studying 12 cases and attempted to establish the relationship of this disease with Corynebacterium infection. Patients were women ranging in age from 25 to 49 years (median: 34 y), and all presented with a palpable mass that was painful in half of the cases. In 2 of 9 cases, imaging was highly suspicious for malignancy (BI-RADS 5). CNGM was characterized by lobulocentric granulomas with mixed inflammation and clear vacuoles lined by neutrophils within granulomas. Gram-positive bacilli were identified in 5/12 cases. In 4 patients, the disease process worsened after the diagnostic core biopsy, with the development of a draining sinus in 2 cases. No growth of bacteria was seen in any microbial cultures. No bacterial DNA was identified by 16S rDNA polymerase chain reaction for 1 case that showed gram-positive bacilli on histology. Patients were treated with variable combinations of surgery, antibiotics, and steroids. The time to significant resolution of symptoms ranged from 2 weeks to 6 months. Similar to other forms of GLM, CNGM can mimic malignancy clinically and on imaging. When encountered in a needle core biopsy sample, recognition of the characteristic histologic pattern and its possible association with Corynebacterium infection can help guide treatment.

OBJECTIVE. The purpose of this article is to assess prospectively the value of concordant versus discordant gestational age (GA) calculations in predicting subsequent embryonic demise in embryos with a slow heart rate, as determined on early first-trimester ultrasound. SUBJECTS AND METHODS. Thirty-six consecutive singleton pregnancies with slow embryonic heart rate (< 100 beats/min) measured on a 5.0- to 6.1-week ultrasound were prospectively identified. Pregnancies were defined as “discordant” if there was more than 5 days' difference between GA determined by biometrics compared with GA determined by last menstrual period and were defined as “concordant” if there was less than 5 days' difference between the GA measurements. RESULTS. Of the 36 embryos with heart rate less than 100 beats/min at 5.0–6.1 weeks' GA, 16 went on to demise and 20 survived. Of the 16 that went on to demise, 14 were discordant (88%) and two were concordant (12%). Of the 20 that survived, 16 were concordant (80%) and four were disc...