Search

Purpose of review: Alternatives to surgical management of breast disease is desired by patients wishing to avoid an operation or those who are not a candidate for surgery. The role of cryoablation for treatment of benign and malignant tumors is reviewed to determine optimal candidacy. Recent findings: Cryoablation is safe, effective, and well tolerated by patients. Cryoablation is being increasingly utilized to treat a subset of patients with primary breast cancer and is most effective when treating small lesions without extensive intraductal component. Combination with immunotherapy can enhance response to treatment. Summary: Further studies are needed to determine if cryoablation is sufficient as de-escalation of other adjuvant treatments continues for patients with early-stage breast cancer. Combination of cryoablation with immunotherapy or treating the primary tumor in the presence of metastatic disease may optimize systemic therapies and patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Cystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment. Case presentation A 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement. Conclusion Cystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation.

U-Net and its variants have showcased exceptional performance in the domain of breast medical image segmentation. By employing a fully convolutional network (FCN) structure for semantic segmentation, the symmetrical structure of U-Net offers remarkable flexibility and adaptability. It can be tailored to diverse image segmentation tasks and challenges by adjusting network depth and incorporating new modules, leaving a significant impact on subsequent network designs. This paper aims to delve into the application of U-shaped convolutional networks in breast medical image segmentation, categorizing and summarizing U-shaped convolutional networks used for this purpose in recent years. It outlines the widely used breast medical image datasets and evaluation metrics, discusses common data augmentation techniques, and provides a detailed introduction to the network structure of the U-Net model along with traditional segmentation methods for breast medical images. Furthermore, it summarizes the improvements made to the U-Net network structure for breast medical image segmentation, including modifications like residual structures, multi-scale features, dilation mechanisms, attention mechanisms, skip connection mechanisms, and integration with Transformers. Finally, it addresses the current challenges and problems encountered in breast medical image segmentation and offers insights into future research directions.

Copyright of Journal of Frontiers of Computer Science & Technology is the property of Beijing Journal of Computer Engineering & Applications Journal Co Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Cystic neutrophilic granulomatous mastitis is a rare subtype of inflammatory mastitis characterized by a distinct histopathologic pattern, often associated with Corynebacterium species. This entity has been recently distinguished and should be differentiated from other types of chronic idiopathic mastitis due to its specific treatment. Case presentation: A 44-year-old North African female patient, gravida 2, para 2, with no significant past medical history, presented with a 4-month history of a painful palpable mass in her left breast, with no history of trauma. Ultrasound imaging showed three lesions in the lower quadrant of the left breast, communicating with a superficial areolar abscess collection, creating a fistulous path to the skin. This ultrasound appearance was suspicious for suppurative mastitis; although, a necrotic tumor could not be ruled out. An ultrasound-guided needle biopsy revealed inflammatory and abscess features of the breast parenchyma without histological signs of malignancy. Steroid therapy and empirical antimicrobial treatment were started, and surgical excision was performed. Histologic features confirmed the diagnosis of cystic neutrophilic granulomatous mastitis. The patient recovered and was discharged due to clinical improvement. Conclusion: Cystic neutrophilic granulomatous mastitis is a recently defined entity, and its association with infection by Corynebacterium species can be detected by Gram stain and/or microbiological culture. Various treatment modalities are suggested, but the optimal treatment still requires further investigation. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) is defined as the simulation of human intelligence by a digital computer or robotic system and has become a hype in current conversations. A subcategory of AI is deep learning, which is based on complex artificial neural networks that mimic the principles of human synaptic plasticity and layered brain architectures, and uses large-scale data processing. AI-based image analysis in breast screening programmes has shown non-inferior sensitivity, reduces workload by up to 70% by pre-selecting normal cases, and reduces recall by 25% compared to human double reading. Natural language programs such as ChatGPT (OpenAI) achieve 80% and higher accuracy in advising and decision making compared to the gold standard: human judgement. This does not yet meet the necessary requirements for medical products in terms of patient safety. The main advantage of AI is that it can perform routine but complex tasks much faster and with fewer errors than humans. The main concerns in healthcare are the stability of AI systems, cybersecurity, liability and transparency. More widespread use of AI could affect human jobs in healthcare and increase technological dependency. AI in senology is just beginning to evolve towards better forms with improved properties. Responsible training of AI systems with meaningful raw data and scientific studies to analyse their performance in the real world are necessary to keep AI on track. To mitigate significant risks, it will be necessary to balance active promotion and development of quality-assured AI systems with careful regulation. AI regulation has only recently included in transnational legal frameworks, as the European Union’s AI Act was the first comprehensive legal framework to be published, in December 2023. Unacceptable AI systems will be banned if they are deemed to pose a clear threat to people’s fundamental rights. Using AI and combining it with human wisdom, empathy and affection will be the method of choice for further, fruitful development of tomorrow’s senology.

The Flood is the first pictorial scene that Michelangelo Buonarroti painted on the ceiling of the Sistine Chapel in the Vatican. On the right side of the fresco a woman with abnormal breast morphology is presented and the nature of her disease is considered using the Guidelines for Iconodiagnosis. A team of experts covering art history, art expertise, medicine, genetics, and pathology undertook the process and concluded that the pathology shown is probably breast cancer, most likely linked to the symbolic significance of an inevitable death as expressed in the Book of Genesis.

We aimed to construct and validate a multimodality MRI combined with ultrasound based on radiomics for the evaluation of benign and malignant breast diseases. The preoperative enhanced MRI and ultrasound images of 131 patients with breast diseases confirmed by pathology in Aerospace Center Hospital from January 2021 to August 2023 were retrospectively analyzed, including 73 benign diseases and 58 malignant diseases. Ultrasound and 3.0 T multiparameter MRI scans were performed in all patients. Then, all the data were divided into training set and validation set in a 7:3 ratio. Regions of interest were drawn layer by layer based on ultrasound and MR enhanced sequences to extract radiomics features. The optimal radiomic features were selected by the best feature screening method. Logistic Regression classifier was used to establish models according to the best features, including ultrasound model, MRI model, ultrasound combined with MRI model. The model efficacy was evaluated by the area under the curve (AUC) of the receiver operating characteristic, sensitivity, specificity, and accuracy. The F-test based on ANOVA was used to screen out 20 best ultrasonic features, 11 best MR Features, and 14 best features from the combined model. Among them, texture features accounted for the largest proportion, accounting for 79%.The ultrasound combined with MR Image fusion model based on logistic regression classifier had the best diagnostic performance. The AUC of the training group and the validation group were 0.92 and 091, the sensitivity was 0.80 and 0.67, the specificity was 0.90 and 0.94, and the accuracy was 0.84 and 0.79, respectively. It was better than the simple ultrasound model (AUC of validation set was 0.82) or the simple MR model (AUC of validation set was 0.85). Compared with the traditional ultrasound or magnetic resonance diagnosis of breast diseases, the multimodal model of MRI combined with ultrasound based on radiomics can more accurately predict the benign and malignant breast diseases, thus providing a better basis for clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The Canadian Association of Radiologists (CAR) Breast Disease Expert Panel consists of breast imaging radiologists, a high-risk breast clinician, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 20 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 30 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 69 recommendation statements across the 20 scenarios. This guideline presents the methods of development and the recommendations for referring asymptomatic individuals, symptomatic patients, and other scenarios requiring imaging of the breast. [ABSTRACT FROM AUTHOR]

Asian Society of Mastology (ASOMA) is an international body of experts from disciplines of surgery, radiology, pathology, medical and radiation oncology, plastic surgery, and breast support group dedicated to improving the care of patients with breast diseases. The clinical breast assessment (CBA) of patients with a focused history and clinical breast examination (CBE) is an essential and initial component of triple assessment in the evaluation of patients presenting with breast diseases. CBE is also an affordable method of screening for breast cancer. It adds to breast imaging by providing additional information about the breast lesion and providing a sense of reassurance to the patients. CBA needs to be implemented in a systematic and uniform fashion throughout the world by all the clinicians involved in breast care. The optimal method for CBE has not yet been fully established. This article highlights the importance of CBE and discusses the studies comparing various methods of CBE on breast models and human subjects to provide the evidence to support the most valid and reliable method of CBE. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) is defined as the simulation of human intelligence by a digital computer or robotic system and has become a hype in current conversations. A subcategory of AI is deep learning, which is based on complex artificial neural networks that mimic the principles of human synaptic plasticity and layered brain architectures, and uses large-scale data processing. AI-based image analysis in breast screening programmes has shown noninferior sensitivity, reduces workload by up to 70% by pre-selecting normal cases, and reduces recall by 25% compared to human double reading. Natural language programs such as ChatGPT (OpenAI) achieve 80% and higher accuracy in advising and decision making compared to the gold standard: human judgement. This does not yet meet the necessary requirements for medical products in terms of patient safety. The main advantage of AI is that it can perform routine but complex tasks much faster and with fewer errors than humans. The main concerns in healthcare are the stability of AI systems, cybersecurity, liability and transparency. More widespread use of AI could affect human jobs in healthcare and increase technological dependency. AI in senology is just beginning to evolve towards better forms with improved properties. Responsible training of AI systems with meaningful raw data and scientific studies to analyse their performance in the real world are necessary to keep AI on track. To mitigate significant risks, it will be necessary to balance active promotion and development of quality-assured AI systems with careful regulation. AI regulation has only recently included in transnational legal frameworks, as the European Union's AI Act was the first comprehensive legal framework to be published, in December 2023. Unacceptable AI systems will be banned if they are deemed to pose a clear threat to people's fundamental rights. Using AI and combining it with human wisdom, empathy and affection will be the method of choice for further, fruitful development of tomorrow's senology. [ABSTRACT FROM AUTHOR]

Background and Objectives: The association between endometriosis and breast cancer still remains controversial. The aim of this study was to investigate the different subtypes of breast cancer, immunohistochemical markers, hormone receptors, and ki67 proliferation indexes in patients with and without endometriosis and/or adenomyosis. Materials and Methods: All patients with endometriosis and breast cancer were enrolled. Women with endometriosis and breast cancer (Group BC+EN+) were compared to patients with breast cancer without endometriosis (group BC+EN−) and those with endometriosis without breast cancer (group BC-EN+). General population characteristics and histological and immunohistochemical subtypes of breast cancer were compared between groups. Results: Our study included 41 cases affected by both endometriosis and/or adenomyosis and breast cancer (Group BC+EN+) that were matched (1:2) with 82 patients affected only by breast cancer (group BC+EN−) and 82 patients affected only by endometriosis and/or adenomyosis (group BC-EN+). Group BC+EN+ presented a higher percentage of ER receptor expression (83% vs. 70%, p = 0.02), as well as lower values of Ki 67% (15% vs. 24%, p < 0.0001) and HER2+ (9.8% vs. 28%, p = 0.022). These findings were more evident when comparing patients with premenopausal status, while in postmenopausal patients, this difference was no longer significant. Regarding endometriosis, no statistical differences were observed in type or specific localization of the disease among the groups with and without breast cancer. Conclusions: Patients with endometriosis presented lower aggressive breast cancer rates with higher values of ER% and lower values of Ki 67 and HER2neu+. The type and severity of endometriotic diseases seemed not to influence breast cancer occurrence. [ABSTRACT FROM AUTHOR]

Objective To assess the differential diagnostic performance of spectral characteristic parameters of radio-frequency （RF） signal time series based on ultrasonic RF flow for benign and malignant breast lesions. Methods Two dimensional B-mode ultrasound images and RF data of 137 breast lesions were collected. All ultrasonic RF data were quantitatively analyzed with a software developed by our laboratory for ultrasonic RF time series analysis. Finally，nine spectral characteristic parameters were obtained，including SMR fractal dimension，Higuchi fractal dimension，slope，intercept，mid-band fit，S1，S2，S3，and S4. All of the 116 breast lesions were pathologically diagnosed. 86 lesions were confirmed to be malignant，30 lesions were benign and 21 lesions were diagnosed as benign after follow-up. The sensitivity，specificity，accuracy，positive and negative predictive values of individual parameter of RF time series spectral characteristic parameters and combined parameters of regression models were calculated，as well as Logistic regression model was established. The receiver operating characteristic （ROC） curve and the area under ROC curve （AUC） were obtained to evaluate the differential diagnostic values of these parameters for benign and malignant breast lesions. Results Multivariate regression analysis showed that the parameters finally included into the Logistic model were Higuchi fractal dimension，S2，and S4. The highest sensitivity，specificity，accuracy，positive and negative predictive values of RF time series spectral characteristic parameters in the diagnosis of breast lesions were 90.7% （S2） and 92.2% （Higuchi fractal dimension，S4），86.1% （regression model），93.9% （S4） and 79.6% （regression model），respectively. The AUCs could reach up to 0.910 （S4） and 0.930 （regression model），and there was no statistical significance between them （P > 0.05）. Conclusions The characteristic parameters of RF signal time series based on ultrasonic RF flow provide quantitative data on the sub-resolution tissue microstructure in terms of physical properties，which yields high differential diagnostic efficiency for benign and malignant breast lesions.

Tuberculosis (TB) remains a significant global health concern and kills millions of people every year. While TB can affect any organ in the body, breast TB is relatively uncommon. This study presents a comprehensive review of literature spanning 23 years, with a focus on cases of breast TB in Iran. Among the 96 cases found, the majority (89.6%) fell within the age range of 20–60, with a striking prevalence among women (98.9%). Common symptoms included pain and palpable mass, each presenting in approximately 60.4% of cases. Notably, only a quarter of patients had a confirmed history of exposure to a known TB case. Left breast involvement was more prevalent (58.3%), with ipsilateral lymph node enlargement observed in 40.6% of cases. Given the clinical presentation of breast TB, which often leads to misdiagnosis, a significant proportion of cases (68.7%) were diagnosed through excisional biopsy. Following a standard 6-month regimen of anti-TB drugs, relapse occurred in only 4.2% of cases. This study highlights the need for heightened awareness and vigilance in diagnosing breast TB, especially in regions with a high burden. Although breast TB poses diagnostic challenges, with prompt identification and treatment, the prognosis is generally favorable, with a low incidence of relapse.

Breast UltraSound (BUS) imaging is a commonly used diagnostic tool in the field of counter fighting breast diseases, especially for early detection and diagnosis of breast cancer. Due to the inherent characteristics of ultrasound images such as blurry boundaries and diverse tumor morphologies, it is challenging for doctors to manually segment breast tumors. In recent years, the Convolutional Neural Network (CNN) technology has been widely applied to automatically segment BUS images. However, due to the inherent limitations of CNNs in capturing global contextual information, it is difficult to capture the full context. To address this issue, the paper proposes a novel BGRD-TransUNet model for breast lesion segmentation, based on TransUNet. The proposed model, first, replaces the original ResNet50 backbone network of TransUNet with DenseNet121 for initial feature extraction. Next, newly designed Residual Multi-Scale Feature Modules (RMSFMs) are employed to extract features from various layers of DenseNet121, thus capturing richer features within specific layers. Thirdly, a Boundary Guidance (BG) network is added to enhance the contour information of BUS images. Additionally, newly designed Boundary Attentional Feature Fusion Modules (BAFFMs) are used to integrate edge information and features extracted through RMSFMs. Finally, newly designed Parallel Channel and Spatial Attention Modules (PCSAMs) are used to refine feature extraction using channel and spatial attention. An extensive experimental testing performed on two public datasets demonstrates that the proposed BGRD-TransUNet model outperforms all state-of-the-art medical image segmentation models, participating in the experiments, according to all evaluation metrics used (except for few separate cases), including the two most important and widely used metrics in the field of medical image segmentation, namely the Intersection over Union (IoU) and Dice Similarity Coefficient (DSC). More specifically, on the BUSI dataset and dataset B, BGRD-TransUNet achieves IoU values of 76.77% and 86.61%, and DSC values of 85.08% and 92.47%, respectively, which are higher by 7.27 and 3.64, and 5.81 and 2.54 percentage points, than the corresponding values achieved by the baseline (TransUNet).

Summary: Migration of tattoo pigment to axillary lymph nodes mimicking calcifications is a recognized phenomenon, however, pigment in an intra‐mammary node masquerading as a breast mass is a rare complication of cosmetic tattoos. As the prevalence of tattooing increases among women presenting to Breastscreen, radiologists may expect to encounter this lesion mimicking a breast neoplasm. We present a 50‐year‐old female with extensive tattoos on her arms, chest wall and abdomen, recalled for a small calcified breast mass on her first screening mammogram. Tomosynthesis‐guided vacuum‐assisted biopsy demonstrated intra‐mammary lymph node with abundant tattoo pigment. [ABSTRACT FROM AUTHOR]

Objective To assess the differential diagnostic performance of spectral characteristic parameters of radiofrequency (RF) signal time series based on ultrasonic RF flow for benign and malignant breast lesions. Methods Two dimensional B-mode ultrasound images and RF data of 137 breast lesions were collected. All ultrasonic RF data were quantitatively analyzed with a software developed by our laboratory for ultrasonic RF time series analysis. Finally, nine spectral characteristic parameters were obtained, including SMR fractal dimension, Higuchi fractal dimension, slope, intercept, mid-band fit, S1, S2, S3, and S4. All of the 116 breast lesions were pathologically diagnosed. 86 lesions were confirmed to be malignant, 30 lesions were benign and 21 lesions were diagnosed as benign after follow-up. The sensitivity, specificity, accuracy, positive and negative predictive values of individual parameter of RF time series spectral characteristic parameters and combined parameters of regression models were calculated, as well as Logistic regression model was established. The receiver operating characteristic (ROC) curve and the area under ROC curve (AUC) were obtained to evaluate the differential diagnostic values of these parameters for benign and malignant breast lesions. Results Multivariate regression analysis showed that the parameters finally included into the Logistic model were Higuchi fractal dimension, S2, and S4. The highest sensitivity, specificity, accuracy, positive and negative predictive values of RF time series spectral characteristic parameters in the diagnosis of breast lesions were 90.7% (S2) and 92.2% (Higuchi fractal dimension, S4), 86.1% (regression model), 93.9% (S4) and 79.6% (regression model), respectively. The AUCs could reach up to 0.910 (S4) and 0.930 (regression model), and there was no statistical significance between them (P > 0.05). Conclusions The characteristic parameters of RF signal time series based on ultrasonic RF flow provide quantitative data on the sub-resolution tissue microstructure in terms of physical properties, which yields high differential diagnostic efficiency for benign and malignant breast lesions. [ABSTRACT FROM AUTHOR]

Radiotherapy is an essential treatment of more than 50% of oncohematological patients. Pericardial disorders and valvular heart disease are two common radiotherapy complications. Acute pericarditis is infrequent and usually underdiagnosed. Therefore, diagnostic suspicion and early treatment are mandatory to avoid the evolution to constrictive pericarditis. The prevalence of radiation-induced valvular heart disease is common in patients with a history of Hodgkin's lymphoma and breast cancer. It has distinctive characteristics from other etiologies and, thus, different therapeutic approaches. We present two cases of unusual complications of radiotherapy; the first one in the acute setting and the second one during the follow-up in the chronic phase. A multidisciplinary and individualized approach with specific considerations is decisive in the management of these patients. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To (a) develop a preconditioned water–fat–silicone total field inversion (wfsTFI) algorithm that directly estimates the susceptibility map from complex multi‐echo data in the breast in the presence of silicone and to (b) evaluate the performance of wfsTFI for breast quantitative susceptibility mapping (QSM) in silico and in vivo in comparison with formerly proposed methods. Methods: Numerical simulations and in vivo multi‐echo gradient echo breast measurements were performed to compare wfsTFI to a previously proposed field map‐based linear total field inversion algorithm (lTFI) with and without the consideration of the chemical shift of silicone in the field map estimation step. Specifically, a simulation based on an in vivo scan and data from five patients were included in the analysis. Results: In the simulation, wfsTFI is able to significantly decrease the normalized root mean square error from lTFI without (4.46) and with (1.77) the consideration of the chemical shift of silicone to 0.68. Both the in silico and in vivo wfsTFI susceptibility maps show reduced shadowing artifacts in local tissue adjacent to silicone, reduced streaking artifacts and no erroneous single voxels of diamagnetic susceptibility in proximity to silicone. Conclusion: The proposed wfsTFI method can automatically distinguish between subjects with and without silicone. Furthermore wfsTFI accounts for the presence of silicone in the QSM dipole inversion and allows for the robust estimation of susceptibility in proximity to silicone breast implants and hence allows the visualization of structures that would otherwise be dominated by artifacts on susceptibility maps. [ABSTRACT FROM AUTHOR]

The functional capacity of organisms declines in the process of aging. In the case of breast tissue, abnormal mammary gland development can lead to dysfunction in milk secretion, a primary function, as well as the onset of various diseases, such as breast cancer. In the process of aging, the terminal duct lobular units (TDLUs) within the breast undergo gradual degeneration, while the proportion of adipose tissue in the breast continues to increase and hormonal levels in the breast change accordingly. Here, we review changes in morphology, internal structure, and cellular composition that occur in the mammary gland during aging. We also explore the emerging mechanisms of breast aging and the relationship between changes during aging and breast-related diseases, as well as potential interventions for delaying mammary gland aging and preventing breast disease.

The nippleareolar complex is a specific anatomical and histological structure. Normal structure and pathological process variabilities and the complexity of diagnostic imaging cause difficulties for radiologists and physicians. Breast magnetic resonance imaging is highly sensitive for structural features and nipple-areolar complex cancer detection. Magnetic resonance imaging is a useful diagnostic tool when mammography and ultrasound findings are inconclusive. It allows visualization of the retroareolar region, suitable for the diagnosis of papillomas, adenomas, Pagets disease, ductal carcinoma in situ, and invasive ductal carcinoma. This is a case report on identifying the pathology and anomalies of the nipple-areolar complex, which may benefit radiologists, gynecologists, and residents.

Background and Objectives: The association between endometriosis and breast cancer still remains controversial. The aim of this study was to investigate the different subtypes of breast cancer, immunohistochemical markers, hormone receptors, and ki67 proliferation indexes in patients with and without endometriosis and/or adenomyosis. Materials and Methods: All patients with endometriosis and breast cancer were enrolled. Women with endometriosis and breast cancer (Group BC+EN+) were compared to patients with breast cancer without endometriosis (group BC+EN−) and those with endometriosis without breast cancer (group BC-EN+). General population characteristics and histological and immunohistochemical subtypes of breast cancer were compared between groups. Results: Our study included 41 cases affected by both endometriosis and/or adenomyosis and breast cancer (Group BC+EN+) that were matched (1:2) with 82 patients affected only by breast cancer (group BC+EN−) and 82 patients affected only by endometriosis and/or adenomyosis (group BC-EN+). Group BC+EN+ presented a higher percentage of ER receptor expression (83% vs. 70%, p = 0.02), as well as lower values of Ki 67% (15% vs. 24%, p < 0.0001) and HER2+ (9.8% vs. 28%, p = 0.022). These findings were more evident when comparing patients with premenopausal status, while in postmenopausal patients, this difference was no longer significant. Regarding endometriosis, no statistical differences were observed in type or specific localization of the disease among the groups with and without breast cancer. Conclusions: Patients with endometriosis presented lower aggressive breast cancer rates with higher values of ER% and lower values of Ki 67 and HER2neu+. The type and severity of endometriotic diseases seemed not to influence breast cancer occurrence.

Background: Most patients suffering from pathological nipple discharge (PND) undergo local surgical procedures because standard radiological imaging often fails to reveal the cause. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization and can avoid unnecessary diagnostic surgical procedures. Hence, patients with recurrent or persistent PND after an unsuccessful ductoscopy procedure still undergo unnecessary surgery. This study describes the experience of a second ductoscopy procedure in patients with recurrent or persistent PND without suspicious radiological findings. Methods: Patients with recurrent or persistent PND who underwent two ductoscopy procedures between 2010 and 2017 were retrospectively analyzed. The second ductoscopy was performed when the first ductoscopic attempt was unsuccessful due to technical problems. The primary outcome was the number of preventable surgical procedures. Results: A total of 17 patients underwent two ductoscopy procedures. The first ductoscopy showed a polypoid lesion in 10 patients (58.8%), no abnormalities in 3 patients (17.6%), and in 4 patients (23.5%), it was not possible to visualize the ductal tree. Post-procedure, all patients suffered from PND. After two ductoscopic attempts, PND stopped in 10 patients (58.8%), and 7 patients (41.2%) still suffered from PND and were operated on. Pathology of the resection specimens showed no abnormalities in 1 patient, a papilloma in 5 patients, and ductal carcinoma in situ in 1 patient. Conclusion: A second ductoscopy procedure can be considered in the diagnostic work-up of patients suffering from persistent or recurrent PND after an unsuccessful first ductoscopic attempt to avoid unnecessary surgery in about 59% of the cases. [ABSTRACT FROM AUTHOR]

Introduction: Despite the fact that Fine Needle Aspiration Cytology (FNAC) has been widely utilised in the preoperative diagnosis of breast lumps, the Conventional Smears (CS) have drawbacks, including difficulty in understanding the pattern or architecture of the lesion, determining invasiveness, Immunohistochemistry (IHC), false positives, and false negatives. Cytologists advise using Cell Blocks (CB) to increase the diagnostic precision of FNAC. In this study, the significance of using Plasma Thromboplastin Cell Block (PTCB) routinely as an addition to CS in FNAC of palpable breast lesions. Aim: To determine the significance of PTCB as an adjunct in addition to CS to diagnose breast lesions. Materials and Methods: The present prospective observational study was conducted in the Department of Pathology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India, between July 2021 and June 2022 on 30 samples of palpable breast lesions. From the fine needle aspirates, smears were prepared and stained with Leishman and Papanicolaou stains. The residual material in the hub was rinsed in saline. The plasma-thromboplastin method was used to prepare CB, and Haematoxylin and Eosin (H&E) sections were made. A point scoring system was used and findings were compared to histopathology. IHC markers namely Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER2), Proliferation marker Ki-67 was utilised wherever appropriate. The results were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Out of total 30 subjects, majority (n=9, 30%) were in the age group of 41-50 years. The mean scores of CS {background (0.93±0.25), cellularity (1.7±0.55), morphology (1.7±0.47) and architecture (1.03±0.32)} and PTCB {background (1.77±0.43), cellularity (1.77±0.48), morphology (1.8±0.48) and architecture (1.5±0.57)} were compared using the point scoring system. Though the mean scores of all four parameters were higher in PTCB than in CS, the statistically significant difference was seen in background (p-value=0.001) and architecture categories (p-value=0.0001). The PTCB finding as a screening test for predicting histopathological diagnosis showed a sensitivity of 94.44%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 92.3%, and 96.67% accuracy. IHC staining was feasible in CB and findings were comparable to biopsy. Conclusion: The routine use of PTCB technique in FNAC of breast lesions, along with smears, will aid in IHC, reducing diagnostic pitfalls, thereby reducing misdiagnosis and invasive procedures, particularly in suspicious for malignancy cases, which can lead to inappropriate radical treatment causing physical and psychological stress to patients. [ABSTRACT FROM AUTHOR]

(1) Introduction: Erdheim–Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition. [ABSTRACT FROM AUTHOR]

Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. An extensive PubMed search of the literature in English up until August 2022 was performed. In addition, a rare case of a gigantic fibroadenoma in an 11-year-old premenarchal girl who was referred to our adolescent gynecology center is presented here. Eighty-seven cases of giant juvenile fibroadenomas have been reported in the literature along with our case. Patients with giant juvenile fibroadenoma presented at a mean age of 13.92 years and usually after menarche. Juvenile fibroadenomas are usually unilateral, occurring either in the right or the left breast; the majority of them are diagnosed when they are already more than 10 cm in size, and they are most frequently treated with total lump excision. Differential diagnosis includes phyllodes tumors and pseudo-angiomatous stromal hyperplasia. Conservative management is feasible, but surgical excision is recommended to patients with suspicious imaging features or when the mass grows rapidly. [ABSTRACT FROM AUTHOR]

The purpose of this presentation is to show the ultrasonography findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex. Many of which have unspecific clinical and radiological presentations that can present a challenge for medical specialists. Experienced specialists need to know the different imaging modalities used to study the nipple-areolar complex and the aspect not exactly senology, as well as dermatologist who approach the ultrasound must know the anatomy of this complex area. We will show you a combined clinical and radiological approach to evaluate the nipple-areolar complex, the findings for the normal morphology and the most common benign and malignant diseases that can affect this region. We discuss the characteristics of the different ultrasonography findings and provide guidance on how to avoid artifacts and pitfalls. [ABSTRACT FROM AUTHOR]

Objective:We evaluated the beneficial effect of Ormeloxifene (Centchroman) versus a combination of Gamma Linolenic acid (GLA), methylcobalamine and vitamin C on mastalgia in a three-arm, open-label, placebo-controlled trial.Materials and Methods:Patients aged above 18 years with mastalgia were recruited between January 2019 and July 2021. Patients were divided in three arms: Ormeloxifene arm, GLA arm and Placebo arm. Response was evaluated using visual analogue scale (VAS) and score below 3/10 was defined as complete relief.Results:A total of 113 consecutive women with mastalgia were randomized to the GLA group (Group 1, n = 39 women), Ormeloxifene (Group 2, n = 36) and Placebo (Group 3, n = 38). Complete response was observed in 94% patient in Group 1, 96% in Group 2 and 87% in Group 3 at the end of 12 weeks and it was not significant (p = 0.49). Adverse events were reported by eleven patients taking Ormeloxifene, compared to none in the other two groups. Conclusion:In this study Ormeloxifene and GLA were not superior to placebo for pain relief in mastalgia. Furthermore, there were concerning side effects associated with Ormeloxifene therapy. The role of Ormeloxifene in mastalgia needs further evaluation before recommending it as preferred therapy.

Introduction: Despite the fact that Fine Needle Aspiration Cytology (FNAC) has been widely utilised in the preoperative diagnosis of breast lumps, the Conventional Smears (CS) have drawbacks, including difficulty in understanding the pattern or architecture of the lesion, determining invasiveness, Immunohistochemistry (IHC), false positives, and false negatives. Cytologists advise using Cell Blocks (CB) to increase the diagnostic precision of FNAC. In this study, the significance of using Plasma Thromboplastin Cell Block (PTCB) routinely as an addition to CS in FNAC of palpable breast lesions. Aim: To determine the significance of PTCB as an adjunct in addition to CS to diagnose breast lesions. Materials and Methods: The present prospective observational study was conducted in the Department of Pathology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India, between July 2021 and June 2022 on 30 samples of palpable breast lesions. From the fine needle aspirates, smears were prepared and stained with Leishman and Papanicolaou stains. The residual material in the hub was rinsed in saline. The plasma-thromboplastin method was used to prepare CB, and Haematoxylin and Eosin (H&E) sections were made. A point scoring system was used and findings were compared to histopathology. IHC markers namely Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER2), Proliferation marker Ki-67 was utilised wherever appropriate. The results were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: Out of total 30 subjects, majority (n=9, 30%) were in the age group of 41-50 years. The mean scores of CS {background (0.93±0.25), cellularity (1.7±0.55), morphology (1.7±0.47) and architecture (1.03±0.32)} and PTCB {background (1.77±0.43), cellularity (1.77±0.48), morphology (1.8±0.48) and architecture (1.5±0.57)} were compared using the point scoring system. Though the mean scores of all four parameters were higher in PTCB than in CS, the statistically significant difference was seen in background (p-value=0.001) and architecture categories (p-value=0.0001). The PTCB finding as a screening test for predicting histopathological diagnosis showed a sensitivity of 94.44%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 92.3%, and 96.67% accuracy. IHC staining was feasible in CB and findings were comparable to biopsy. Conclusion: The routine use of PTCB technique in FNAC of breast lesions, along with smears, will aid in IHC, reducing diagnostic pitfalls, thereby reducing misdiagnosis and invasive procedures, particularly in suspicious for malignancy cases, which can lead to inappropriate radical treatment causing physical and psychological stress to patients.

Breast disease is a significant health concern, with varying clinical presentations and diagnostic challenges. This study aims to assess the accuracy and utility of ultrasonography (USG) as an adjunct component to the Modified Triple Assessment Test (MTT) in the screening and diagnosis of breast diseases. A total of 40 patients with breast complaints, including lumps, nipple discharge, or retraction, were included. The MTT, consisting of clinical examination, mammography, fine-needle aspiration cytology (FNAC), and histopathological examination (HPE), was performed on all patients under informed consent. USG was added as a fourth component. Data on age distribution, parity, menstrual status, side of breast lump, location of tumors, and histopathological findings were collected and analyzed. In the 30-39 age group, breast lumps were common, with nulliparous women showing more malignant cases. Pre-menopausal women had benign lumps, while perimenopausal and post-menopausal women had more malignancies. Left-sided lumps prevailed, and the upper outer quadrant was the common location. Clinical examination had high accuracy, as did ultrasonography (USG). This study underscores the importance of personalized breast health approaches, considering age, parity, and menstrual status. The combination of clinical examination, mammography, FNAC, and USG (MTT) provides a reliable diagnostic tool for breast disease, with MTT serving as a valuable modality for breast carcinoma diagnosis and treatment planning. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The new Mg(II) cysteindithiocarbamate complex drug has been synthesized by the in-situ method and tested for its anticancer activity in vitro. METHOD: Mg(II) cysteindithiocarbamate complexes were characterized using Ultra Violet Visible, Infra-Red, melting points, and molar conductivity. RESULTS: The UV-Vis data of cysteindithiocarbamate Mg(II), shows that at 296 nm and 385 nm was occurred the electronic transitions π → π* and n → π* for CS2 and N =C =S. Whereas the IR data at wavelengths in the 393–540 cm−1 shows that there has coordinated between Mg(II) with Sulfur (S), Nitrogen (N), and Oxygen (O) atoms from cysteinedithiocarbamate ligands. CONCLUSION: The cytotoxicity test results showed that the Mg complex's cytotoxicity was higher than that of the cytotoxicity of the Mg metal without ligands, which means that the Mg complex can be developed as a potential new anticancer drug. [ABSTRACT FROM AUTHOR]

Synopsis: Gestational gigantomastia involving axillary breast tissue can be safely resected during pregnancy; early management is paramount in preventing progression and limiting impact on pregnancy. [ABSTRACT FROM AUTHOR]

The Flood is the first pictorial scene that Michelangelo Buonarroti painted on the ceiling of the Sistine Chapel in the Vatican. On the right side of the fresco a woman with abnormal breast morphology is presented and the nature of her disease is considered using the Guidelines for Iconodiagnosis. A team of experts covering art history, art expertise, medicine, genetics, and pathology undertook the process and concluded that the pathology shown is probably breast cancer, most likely linked to the symbolic significance of an inevitable death as expressed in the Book of Genesis., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Unilateral virginal hypertrophy of the breast is a rare condition with an unknown etiology, though it is thought to result from hypersensitivity of the end organs to normal levels of gonadal hormones. We present the case of a 17-year-old girl who initially showed gradual growth after thelarche; however, in the last three to four months, there was a rapid increase in size, leading to psychological and physical problems that also impacted her social life. A clinical examination revealed that her left breast was markedly enlarged compared to the right, and she exhibited a drooping posture. Radiological investigations and a true-cut biopsy were performed to detect any underlying pathology, which revealed normocellular stroma consistent with virginal breast hypertrophy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kirdat Patil et al.)

Purpose: High prevalence, unreliable risk discrimination and poor clinical outcomes are observed in malignant and benign breast diseases (BD). The involvement of microbial communities in the development of BD has become topical, and distal influences of microbial dysregulation in the breast have been well established. Despite advances, the role of the breast skin microbiota in BD remains unclear. Interactions between the skin microbiota and the underlying mucosal immune system are complex. In homeostasis, the skin offers a physical barrier protecting underlying breast tissue from skin commensals and noxious environmental triggers. Our review aims to illuminate the role of the skin microbiota in the development of BD. Methods: Adhering to the PRISMA protocol, a systematic review was conducted utilising the Medline and Embase search engines. Results: Through a comprehensive search of the last ten years, twenty-two studies satisfied the inclusion criteria. Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes were identified as the most prevalent phyla of both breast tissue and skin in healthy controls and BD. High abundance of skin commensals, specifically some species of Staphylococcus, have been linked in breast cancer and metastases. Similarly, dysregulated microbial abundance is also seen in inflammatory and implant-associated BD. These findings raise the hypothesis that the skin microbiota plays a role in tissue homeostasis and may contribute to a range of breast pathologies. Several mechanisms of microbial transfer to underlying tissue have been proposed, including retrograde transfer through ductal systems, breakdown of the skin barrier, and migration through nipple-aspirate fluid. Conclusion: Our review provides preliminary insights into the skin microbiota as a modifiable risk factor for BD. This raises opportunities for future studies in antimicrobials/probiotics as an adjunct to, or replacement of surgery; a diagnostic and/or prognostic tool for BD; and the possibility of conditioning the microbiota to manage BD.

Benign breast disease is a group of all noncancerous mammary lesions with a risk of breast cancer (BC) development. BC is the most common cancer in the world; therefore, it is necessary to find new biomarkers and targets for early diagnosis, treatment, prediction of prognosis and survival. Long non-coding RNA SRA could play this role, thus further studies of its impact on the precancerous lesion pathogenesis are needed. The aim. To analyze the association between SRA1 rs801460 and rs10463297 SNPs and the occurrence of gynecological pathology among Ukrainian women with the proliferative type of benign breast disease without atypia. Materials and methods. This study included 115 patients with proliferative type of benign breast disease without atypia: 55 – with gynecological pathology and 60 – without it. Polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) was used for polymorphism genotyping. Hematoxylin and eosin, toluidine blue and van Gieson’s picrofuchsin methods were applied for staining of sections. Statistical analysis was carried out using Statistical Package for the Social Sciences software (SPSS, version 25.0, Chicago, IL, USA). Results. Significant differences were found in the rs10463297 frequency of alleles (P = 0.032), but not in the rs801460 (P > 0.05), in groups with and without gynecological pathology, while the distribution of both single nucleotide polymorphism (SNPs) genotypes was similar between these groups (P > 0.05). Statistically significant association was detected between SRA1 rs10463297 polymorphism and gynecological pathology occurrence in both dominant (Pa = 0.023; ORa = 2.638, 95 % CI = 1.145–6.076) and additive (Pa = 0.034; ORa = 2.489, 95 % CI = 1.069–5.794) models of inheritance. No association was found between SRA1 rs801460 SNP and gynecological pathology development among Ukrainian women with proliferative type of benign breast disease without atypia (P > 0.05). Conclusions. It was revealed that SRA1 rs10463297 TT carriers had 2.6 times higher risk of gynecological pathology development than C allele carriers and 2.48 times than TC carriers.

Introduction: Pyoderma gangrenosum is a rare inflammatory disease characterized by the presence of ulcerated lesions. The etiology is unknown but apparently relates to immunological factors. The authors report a case of pyoderma gangrenosum in the postoperative period of a reduction mammoplasty, treatment, and the importance of early diagnosis to obtain a good aesthetic result. Methods: This is an 18-year-old patient who developed pyoderma gangrenosum after a reduction mammoplasty. The initial symptoms were the formation of violet blisters and ulcerated lesions in both breasts. The disease was suspected, and the patient was promptly treated with prednisolone. Cultures, biopsies and blood tests were performed. Hyperbaric therapy and nutritional support were performed. Daily dressings with epidermal growth factors were performed. After 60 days of follow-up, it was possible to achieve adequate wound healing and good aesthetic results. Results: Early diagnosis associated with systemic immunosuppressive therapy and rigorous local care were fundamental for disease stabilization. The association with hyperbaric therapy and nutritional support contributed to the lesion's epithelialization and the clinical picture control. The approximation of the wound edges with subdermal suture and the subsequent intradermal suture was possible due to the recovery of the dermis and stabilization of the disease. Conclusion: Early diagnosis of pyoderma gangrenosum is essential to achieve stabilization of the disease. It is possible to achieve good aesthetic results based on four elements: early systemic corticosteroids, daily local dressings with epidermal growth factor, nutritional support, and hyperbaric therapy.

Objective: We evaluated the beneficial effect of Ormeloxifene (Centchroman) versus a combination of Gamma Linolenic acid (GLA), methylcobalamine and vitamin C on mastalgia in a three-arm, open-label, placebo-controlled trial. Materials and Methods: Patients aged above 18 years with mastalgia were recruited between January 2019 and July 2021. Patients were divided in three arms: Ormeloxifene arm, GLA arm and Placebo arm. Response was evaluated using visual analogue scale (VAS) and score below 3/10 was defined as complete relief. Results: A total of 113 consecutive women with mastalgia were randomized to the GLA group (Group 1, n = 39 women), Ormeloxifene (Group 2, n = 36) and Placebo (Group 3, n = 38). Complete response was observed in 94% patient in Group 1, 96% in Group 2 and 87% in Group 3 at the end of 12 weeks and it was not significant (p = 0.49). Adverse events were reported by eleven patients taking Ormeloxifene, compared to none in the other two groups. Conclusion: In this study Ormeloxifene and GLA were not superior to placebo for pain relief in mastalgia. Furthermore, there were concerning side effects associated with Ormeloxifene therapy. The role of Ormeloxifene in mastalgia needs further evaluation before recommending it as preferred therapy. [ABSTRACT FROM AUTHOR]

Background: The value of combined dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) histogram analysis for the diagnosis of breast cancer has not been evaluated in previous studies. Purpose: To investigate the diagnostic value of DCE-MRI combined with ADC in benign and malignant breast lesions. Material and Methods: The clinicopathological imaging data included 168 patients (177 lesions) with breast lesions who underwent convention breast MRI, DCE-MRI, and diffusion-weighted imaging (DWI); they were divided into the benign lesion group (n = 39) and malignant lesion group (n = 129) based on pathology. Results: Using the type III outflow curve as a diagnostic criterion for malignant breast lesions, the diagnostic sensitivity was 76.9%, the specificity was 80%, the correct rate was 72.2%, and its area under the curve (AUC) was 0.823. Using an enhancement ratio > 100% as a diagnostic criterion for malignant breast lesions, the sensitivity was 61.5%, specificity was 80%, and AUC was 0.723. Using > 3 ipsilateral vessels as a diagnostic criterion for malignant lesions in the breast resulted in a diagnostic sensitivity of 81.6%, a specificity of 80.8%, and an AUC of 0.805. Conclusion: The type of time intensity curve DCE-MRI, the early enhancement rate in the first phase, the number of ipsilateral vessels, and the ADC full volume histogram of the blood supply score and DWI are valuable in the diagnosis of benign and malignant breast lesions. [ABSTRACT FROM AUTHOR]

Background: Idiopathic granulomatous mastitis (IGM) is one of the uncommon benign relapsing diseases of the breast and the imaging features of IGM can be indistinguishable from invasive or inflammatory breast carcinoma. Therefore, the assessment of the ultrasound features could be diagnostically helpful. Material and Methods: This retrospective research involved a total of 26 patients who had a final pathologic diagnosis of IGM and who underwent high-resolution ultrasound (US) and color Doppler evaluation. Results: Overall, 26 patients met the inclusion criteria. The age range of the patients was between 24 and 52 years old with an average of 34.81. About half of the patients (53.8%) reported pain as a presenting symptom and the most common physical finding was a palpable mass in 53.8% of the cases. Ultrasonography revealed the most common mass shape to be oval and irregular both with a frequency of 47.1%. Mass margins were mostly indistinct (70.6%) while angular and circumscribed margins were also seen. Heterogeneous echogenicity was observed in 71.4%, increased echogenicity of perilesional fat in 84.6%, posterior acoustic enhancement in 57.7%, peripheral vascularity in 30.8%, and subcutaneous collections in 19% of the patients., Internal vascularity was seen in 7% of the cases. Conclusion: In the US of IGM, increased echogenicity of subcutaneous and perilesional fat were a common ultrasound feature (84.6%) while perilesional fat edema has not been mentioned in previous studies. In this study, other ultrasound features of IGM such as tubular extension, subcutaneous collection, indeterminate irregular masses, and collections were observed. They may contribute to the diagnosis of granulomatous mastitis in a proper clinical setting. [ABSTRACT FROM AUTHOR]

Objective:To perform a retrospective review of the clinical characteristics, microbiological data, and clinical outcomes in patients with granulomatous mastitis (GM) who were treated at our institution with a unique strategy of prolonged antibiotic therapy as the primary treatment modality.Materials and Methods:A retrospective case series was performed on patients (n = 42) with GM seen at the breast specialty clinic of our institution between the years 2004 and 2014. Patients were primarily treated with lipophilic antibiotics, and steroids and surgery were reserved for refractory cases.Results:Bacteria were identified in 34 samples from 22/42 patients (52.3%). Diphtheroids (presumptive Corynebacterium spp.) were most commonly identified, followed by Corynebacterium spp. and Propionibacterium acnes (now Cutibacterium acnes). Antibiotics were our preferred first-line medical therapy and were used in 33/36 (91.7%) patients. The mean duration of antibiotic therapy was 7.0±4.5 months. Clarithromycin was our antibiotic of choice and was the initial antibiotic used in 15 of the 33 patients (45.5%) treated with antibiotics. Eleven patients required adjunctive therapy with prednisone. The mean duration of steroid therapy was 4.3±2.5 months. Surgery for therapeutic purposes included incision and drainage in seven patients, fine needle aspiration in eight patients, and excision of the fistulous tract in one patient. No patients had large-volume excisions. The average time from the first breast clinic visit to clinical resolution was 8.0±4.6 months.Conclusion:GM may be the result of a bacterial process that induces a unique form of inflammatory response. Clinicians should consider special requests to microbiology laboratories to attempt to isolate Corynebacterium spp. in the evaluation of samples sent to the laboratory for analysis. An extended course of a lipophilic antibiotic is a largely unexplored but potentially effective treatment option with low associated morbidity. More research is needed in this area.

Abstract Background Conventional dynamic contrast enhanced (DCE) magnetic resonance (MR) hardly achieves a good imaging performance of arteries and lymph nodes in the breast area. Therefore, a new imaging method is needed for the assessment of breast arteries and lymph nodes. Methods We performed prospective research. The research included 52 patients aged from 25 to 64 between June 2019 and April 2020. The isotropic e-THRIVE sequence scanned in the coronal direction after DCE-THRIVE. Reconstructed images obtained by DCE-THRIVE and the coronal e-THRIVE were compared mainly in terms of the completeness of the lateral thoracic artery, thoracodorsal artery, and lymph nodes. We proposed a criterion for evaluating image quality. According to the criterion, images were assigned a score from 1 to 5 according to the grade from low to high. Two board-certified doctors evaluated images individually, and their average score was taken as the final result. The chi-square test was used to assess the difference. Results The coronal e-THRIVE score is 4.60, which is higher than the DCE-THRIVE score of 3.48, there are significant differences between the images obtained by two sequences (P = 1.2712e−8). According to the score of images, 44 patients (84.61%) had high-quality images on the bilateral breast. Only 3 patients’ (5.77%) images were not ideal on both sides. The improved method is effective for most patients to get better images. Conclusions The proposed coronal e-THRIVE scan can get higher quality reconstruction images than the conventional method to visualize the course of arteries and the distribution of lymph nodes in most patients, which will be helpful for the clinical follow-up treatment.

Abstract Background Mondor’s disease of the breast (MDB) is a rare and benign disorder of the breast. It is characterized by thrombophlebitis of the superficial veins of the chest wall. Clinically, it manifests as a cord-like induration of the breast area. MDB resolves spontaneously without sequela. Case presentation We report cases of three Caucasian African patients aged 29, 40 and 34, respectively. One patient was under progestative contraception. All the patients had a cord-like induration on the chest wall. Ultrasonography was performed in all patients and was normal in two cases and showed a thrombotic vein in one case. All the patients had symptomatic treatment with total resolution of symptoms within 1 to 4 weeks. No relapse was observed. Conclusion MDB is benign in most cases. However, it is not to be taken lightly, because it can be the manifestation of an underlying disease such as breast cancer. The diagnosis is based on clinical findings; ultrasonography can be helpful for the diagnosis. Treatment is based on analgesic and anti-inflammatory drugs.

(1) Introduction: Erdheim–Chester disease (ECD) is a life-threatening condition and often a diagnostic challenge. It has recently been classified as a hematopoietic tumour, and the cases of ECD reported in the literature has dramatically increased during the last 15 years. (2) Methods: We describe the case of a 57-year-old male patient with severe gynecomastia, with a detailed description of his diagnostic iter and consequent surgical operation. We provide the first systematic review of the literature of breast involvement in ECD, following PRISMA guidelines, including 13 studies and 16 patients. (3) Results: Our report resulted to be the first case of gynecomastia as a single clinical and imaging feature of ECD described in English literature. A total of 81.3% of patients included were female. Among them, 76.9% had unilateral and nodular presentation, while male patients presented bilateral heterogeneous breast enlargement. Globally, 87.5% expressed breast alterations as their first manifestations of ECD. Only 50% presented skeletal involvement. (4) Conclusion: The reported case represents a unique addition to the literature. We found two different patterns in ECD-related breast involvement between male and female patients, an unusual M/F ratio, and a lower rate of bone involvement. Breast involvement is frequently the first clinical feature; therefore, breast caregivers should be aware of this dangerous and most likely underestimated condition.

Abstract Background and aim Breast tuberculosis is a rare disease, even in endemic areas. The diagnosis can be challenging, as it can mimic breast cancer. We aim to report our experience and discuss diagnoses and management modalities. Results We encountered twelve cases of breast tuberculosis in our institution from 2004 to 2019. The average age of our Caucasian North African patients was 42 years old (22–63). The classic presentation was a breast lump found in half of the cases. On physical examination, we suspected breast carcinoma in seven patients. The average size of the tumors was 39 mm (15–80 mm). Nine patients had a mammogram. In five cases, there was a suspicious breast mass mimicking a malignant tumor with an average size of 33 mm (25–60 mm). A ultrasonography was performed in 6 cases and revealed a suspicious ill-circumscribed nodule in four patients with an average size of 37.5 mm (10–60 mm). Five patients had a lumpectomy, and seven women underwent drainage of the abscess and the biopsy of its hull. The association of epithelioid cell granulomas and caseous necrosis was mandatory for the histological diagnosis of tuberculosis. All of them had an antitubercular therapy. The median period of follow-up was of 43 months (3–156 months). One patient presented with a recurrent abscess of the breast. Conclusion Our study found that clinical examination and radiological imaging were not specific. Positive cultures for Koch bacillus or histological confirmation are mandatory for the diagnosis. A meta-analysis of the existing cases is needed.