Gangrenous mastitis in sheep caused by multidrug-resistant Staphylococcus haemolyticus / Mastite gangrenosa em ovinos causada por Staphylococcus haemolyticus multirresistente

Mastitis is a multifactorial disease and considered one of the most critical problems in the dairy industry worldwide. The condition is characterized by reduced milk and several abnormalities in the mammary gland. This study aimed to report an outbreak of gangrenous mastitis caused by multidrug-resistant Staphylococcus haemolyticus in a Santa Inês sheep herd. Eighteen sheep were affected, and five of them with severe clinical pictures were examined. The clinical and pathological picture were variable and characterized by apathy, anorexia, emaciation, opaque and brittle hair, apparent and congested episcleral vessels, and hyperthermia. These ewes had enlarged, firm, and painful mammary glands. Macroscopically, these lesions consisted of severe gangrenous mastitis, and microscopically, the primary lesions consisted of necrosis, thrombosis, and fibrosis of the mammary parenchyma. Milk samples from one of the five severely affected ewes were collected and cultured under aerobic or microaerophilic incubation at 37°C for 24 hours on sheep blood agar. The obtained colonies were then submitted to MALDI-TOF for speciation. The colonies were also submitted to an antimicrobial susceptibility test, genotyping of virulence factors and resistance genes were also performed. The isolates showed antimicrobial multiresistance since they were resistant to seven out of 13 tested antibiotics. The isolates were also positive for two staphylococcal enterotoxigenic genes (sec and see) and fibronectin-binding protein B (fnbB).(AU)

A mastite é uma doença multifatorial e é considerada um dos problemas mais importantes na indústria de laticínios no mundo todo. A condição é caracterizada pela redução de leite e várias anormalidades na glândula mamária. O objetivo deste estudo foi relatar um surto de mastite gangrenosa causada por Staphylococcus haemolyticus multirresistente em um rebanho ovino Santa Inês. Dezoito ovelhas foram afetadas e cinco delas com quadro clínico severo foram examinadas. O quadro clínico-patológico era variável quanto a severidade e consistia em apatia, anorexia, magreza, pelos opacos e quebradiços e vasos episclerais aparentes e ingurgitados. As ovelhas apresentavam glândulas aumentadas, firmes e dolorosas. Macroscopicamente, as principais lesões consistiam em mastite gangrenosa e microscopicamente havia necrose do parênquima glandular, trombose e fibrose. Amostras de leite de uma das cinco ovelhas severamente afetadas foram coletadas e cultivadas sob incubação aeróbica ou microaerofílica a 37°C por 24 horas em ágar sangue de ovelha. As colônias obtidas foram então submetidas ao MALDI-TOF para especiação. Além disso, as colônias foram submetidas a um teste de suscetibilidade antimicrobiana e foi realizada a genotipagem de fatores de virulência e genes de resistência. Os isolados apresentaram multirresistência antimicrobiana por serem resistentes a sete dos 13 antibióticos testados. Os isolados também foram positivos para dois genes enterotoxigênicos estafilocócicos (sec e see) e proteína B de ligação à fibronectina (fnbB).(AU)

Mastitis in dairy goats from the state of Minas Gerais, Brazil: profiles of farms, risk factors and characterization of bactéria / Mastite em cabras de leite no estado de Minas Gerais: perfil de propriedades, fatores de risco e caracterização de bactérias

ABSTRACT: The Zona da Mata of Minas Gerais has a specialized goat milk production chain. Goat milk is superior in quality compared with milk of other domestic species, and the demand for milk and milk products for the public has increased. Data on dairy goat breeding in Minas Gerais are scarce and relatively old, and this lack of information has limited the implementation of prophylactic measures, especially for mastitis, which represents the biggest sanitary problem for dairy herds. The objective of this work was to characterize mastitis and bacteria associated with it in milking goats in the Zona da Mata of Minas Gerais. It also causes socioeconomic problems and market issues for dairy goat farming. A total of 539 lactating goats were examined and 268 individual samples (one for teat) were collected from animals positive for strip cup test and/or the California Mastitis Test (CMT). Microbiological cultures were carried out on blood agar medium and the bacteria were subjected to phenotypic, genotypic and antimicrobial susceptibility tests. The prevalence of subclinical mastitis was 28.0% and the clinical prevalence was 2.8%. Bacterial multiplication was obtained in 62% of samples. One hundred eighty seven total bacteria were identified. The most common species identified was Staphylococcus aureus (60%), followed Staphylococcus epidermidis (9.1%,), Escherichia coli (6.9%), Staphylococcus saprophyticus (5.9%) e Staphylococcus caprae (4.3%). Bacteria of the genus Staphylococcus presented a profile of resistance to antimicrobials belonging to the beta-lactam class (penicillin, ampicillin and oxacillin) in addition to tetracycline, in contrast to the other antimicrobials tested. Twelve percent of multidrug resistence (MDR) was found in five microregions. Among the bacteria with the highest prevalence of MDR, 38.5% were E. coli and 10.6% were S. aureus. The producers of the Zona da Mata of Minas Gerais are technicians who work with specialized dairy breeds and practise good management. However, some measures related to prophylaxis and control of diseases, such as vaccination, have low adherence or are not performed due to a lack of veterinary assistance. This is the first study focusing on this region, which is highly prominent in goat milk production in Brazil. It provides important information that can help in the implementation of measures for the prophylaxis and control of diseases, and for maintenance of a constant supply of products in sufficient quantities and of a quality suitable for the consumer population.

RESUMO: A Zona da Mata de Minas Gerais possui uma cadeia especializada de produção de leite de cabra. O leite de cabra é superior em qualidade em comparação com o leite de outras espécies domésticas, e a demanda por leite e produtos lácteos do público tem aumentado. Os dados sobre o sistema de criação de cabras leiteiras em Minas Gerais são escassos e relativamente antigos, e essa falta de informação limita a implementação de medidas profiláticas, especialmente para a mastite, que representa o maior problema sanitário nos rebanhos leiteiros. Isso também causa problemas socioeconômicos e problemas de mercado para a criação de cabras leiteiras. O objetivo deste trabalho foi caracterizar a mastite e as bactérias associadas em cabras leiteiras na Zona da Mata de Minas Gerais. Um total de 539 cabras em lactação foi examinado e 268 amostras individuais (uma por teto) foram coletadas de animais positivos no teste da caneca de fundo escuro e/ou Califórnia Mastitis test (CMT). As culturas microbiológicas foram realizadas em meio Agar sangue e as bactérias foram submetidas a testes fenotípicos, genotípicos e testes de susceptibilidade antimicrobiana. A prevalência de mastite subclínica foi de 28,0% e a prevalência clínica foi de 2,8%. A multiplicação bacteriana foi obtida em 62,0% das amostras. Cento e oitenta e sete bactérias foram identificadas. As espécies mais identificadas foram: Staphylococcus aureus (60,4%), seguida de Staphylococcus epidermidis (9.1%,), Escherichia coli (6.9%), Staphylococcus saprophyticus (5.9%) e Staphylococcus caprae (4,3%) em ordem decrescente. As bactérias do gênero Staphylococcus apresentaram um perfil de resistência aos antimicrobianos pertencentes à classe de beta-lactâmicos - penicilina, ampicilina e oxacilina - além da tetraciclina, em contraste com os outros antimicrobianos testados. Doze por cento dos isolados apresentaram resistência múltipla a antibióticos (MDR) e foram encontrados em cinco microrregiões. Entre as bactérias com maior prevalência de MDR, 38,5% foram E. coli e 10,6% S. aureus. Os produtores da Zona da Mata de Minas Gerais são tecnificados, trabalham com raças leiteiras especializadas praticam e possuem bom manejo. No entanto, algumas medidas relacionadas à profilaxia e ao controle das doenças, como a vacinação, têm baixa adesão ou não são realizadas por falta de assistência veterinária. Este é o primeiro estudo com foco nesta região, que possui grande relevância na produção de leite de cabra no Brasil, fornecendo informações importantes que podem auxiliar na implementação de medidas de profilaxia e controle das doenças, e na manutenção de um fornecimento constante de produtos em quantidade e qualidade suficientemente adequada para a população consumidora.

Fine-needle aspiration cytology to identify a rare mimicker of breast cancer: plasma cell mastitis / Citologia de aspiração com agulha fina para identificar um simulador raro de câncer de mama: mastite celular plasmática

Abstract There are rare benign diseases that can mimic malignant breast neoplasms in the clinical exam and in mammography. We evaluated the contribution of an accessible procedure to most clinicians, the fine-needle aspiration cytology, to identify a rare mimicker of malignant breast neoplasms. A type 2 diabetic 85-year-old female presented with a 6-month history of a left breast lump. The physical exam and mammography were compatible with breast cancer. Nevertheless, after fine-needle aspiration cytology, the diagnosis was plasma cellmastitis. Once this rare diagnosis was established, the tumor was extirpated, and the final histologic diagnosis corroborated chronic plasma cellmastitis. The patient's postoperative evolution was uneventful, and no other treatment was needed. Fine-needle aspiration cytology could be a valuable tool to identify rare mimickers of malignant breast neoplasms.

Resumo Existem doenças benignas raras que podem mimetizar neoplasias malignas de mama no exame clínico e na mamografia. Avaliamos o valor de um procedimento acessível para a maioria dos clínicos, a citologia por aspiração com agulha fina, para identificar um imitador raro de neoplasias malignas de mama. Uma mulher de 85 anos com diabetes tipo 2 apresentou histórico de 6 meses de um nódulo no seio esquerdo. O exame físico e a mamografia foram compatíveis com câncer de mama. No entanto, após realizar uma citologia por aspiração com agulha fina, o diagnóstico foi mastite celular plasmática. Uma vez que este diagnóstico raro foi estabelecido, o tumor foi extraído e o diagnóstico histológico final corroborou a mastite crônica das células plasmáticas. A paciente teve uma boa evolução pós-operatória, e nenhum outro tratamento foi necessário. A citologia por aspiração com agulha fina pode ser uma ferramenta valiosa para identificar os raros mimetizadores de neoplasias malignas da mama.

Mastite lactacional grave: particularidades da internação à alta / Mastitis de la lactancia severa: particularidades desde el ingreso hasta el alta / Severe lactational mastitis: particularities from admission

RESUMO Objetivo: identificar as características de mulheres que sofreram mastite lactacional grave. Método: estudo descritivo, retrospectivo e documental, com abordagem quantitativa. Os dados foram coletados de registros da assistência nos prontuários de 114 mulheres internadas no período de janeiro de 2009 a dezembro de 2013. Análise mediante estatística descritiva. Resultados: constatou-se maior porcentagem de mastite lactacional grave em mulheres jovens, primíparas, com ensino médio completo, que não tinham companheiro e não trabalhavam fora do lar; 96,5% das mulheres tiveram alguma intercorrência mamária antes da internação e permaneceram internadas em média 4,4 dias; na alta hospitalar 23,7% das mulheres desmamaram. Conclusão: este estudo mostrou que a mastite lactacional grave pode causar grandes danos à mulher e ao bebê.

RESUMEN Objetivo: identificar las características de las mujeres que sufrieron mastitis severa de la lactancia. Método: se realizó investigación descriptiva, retrospectiva y documental con enfoque cuantitativo. Datos eran recogidos procedentes de los registros de hospitalización de las 114 mujeres ingressadas de enero de 2009 a diciembre de 2013. El análisis mediante estadística descriptiva Resultados: encontrado una mayor proporción de mastitis de la lactancia severa en mujeres jóvenes, primíparas, que habían completado la escuela secundaria, que no tenían pareja, y que no trabajan fuera de casa, el 96,5% de las mujeres tenía alguna complicación de mama antes de su ingreso al hospital y permanecieron hospitalizados un promedio de 4,4 días, al momento del alta 23,7% de las mujeres renunció a la lactancia materna. Conclusión: este estudio mostró que la mastitis de la lactancia severa puede causar un gran daño a la mujer y el bebé.

ABSTRACT Objective: to identify characteristics of women who have suffered severe lactational mastitis. Method: a descriptive, retrospective, documentary, quantitative study was performed. Data were collected from patient records of 114 hospitalized women from January of 2009 to December of 2013. Data were analyzed by using descriptive statistics. Results: a higher percentage of severe lactational mastitis was found in young, primiparous women who had completed high school, who had no partner, and did not have a job; 96.5% of women had breast complications before admission and remained hospitalized an average of 4.4 days; at discharge, 23.7% of women had weaned their infants. Conclusion: this study showed that severe lactational mastitis can cause great harm to the woman and the baby.

Bubaline mastitis etiology in Northeast of Brazil / Etiologia da mastite bubalina no Nordeste do Brasil

Este estudo teve como objetivo avaliar a frequência de mastite clínica e subclínica e descrever os micro-organismos envolvidos no processo inflamatório da glândula mamária nos rebanhos de búfalos leiteiros no Nordeste do Brasil. Foram analisadas 1.896 amostras de leite provenientes de 474 búfalos em quatro propriedades localizadas nos Estados de Alagoas, Bahia, Ceará e Pernambuco. Após o exame físico da glândula mamária, as amostras de leite de cada teto foram submetidas aos testes da caneca do fundo preto e CMT (California Mastitis Test). As amostras que apresentaram scores ++ e +++ no CMT e as positivas para a caneca do fundo preto foram submetidas ao exame microbiológico. Do total de amostras estudadas, 90/1.896 (4,74%) apresentaram mastite clínica. Com relação ao CMT, observou-se que 802/1.896 (42,2%) das amostras demonstraram mastite subclínica. Staphylococcus spp. foram os micro-organismos mais frequentes, seguidos de Corynebacterium spp. e bactérias gram-negativas. Os resultados obtidos neste trabalho demonstram uma elevada prevalência de mastite subclínica em rebanhos bubalinos no Nordeste do Brasil, especialmente causadas por Staphylococcus coagulase negativa (SCN). Recomenda-se que o processo de ordenha seja aprimorado, incluindo melhorias na higiene e treinamento de ordenhadores, a fim de reduzir a frequência da doença nos rebanhos.

Mastitis tuberculosa / Tuberculosis of the breast

Se informa un caso de mastitis granulomatosa causada por Mycobacterium tuberculosis en una paciente inmunocompetente con lesiones inflamatorias crónicas de la mama, diagnosticada por la detección de ADN de la micobacteria mediante la técnica de reacción en cadena de la polimerasa de la secuencia de inserción IS6110 presente en el complejo M. tuberculosis , en una biopsia de mama embebida en parafina. La tuberculosis primaria de la mama es rara, incluso en países con alta prevalencia de tuberculosis, y debe sospecharse en pacientes con mastitis granulomatosa crónica de causa no clara. El pilar del tratamiento es la quimioterapia antituberculosa y, ocasionalmente, la cirugía.

We report a case of granulomatous mastitis caused by Mycobacterium tuberculosis in an immunocompetent woman with chronic inflammatory lesions of the breast. It was diagnosed by detection of mycobacteria DNA using polymerase chain reaction technique targeting IS6110 insertion element of M. tuberculosis complex in a paraffin-embedded histological specimen. The primary breast tuberculosis is rare, even in countries where the incidence and prevalence of pulmonary and extra pulmonary tuberculosis are high. It should be suspected in female patients with chronic granulomatous mastitis with no apparent cause. The cornerstone of treatment is antituberculous chemotherapy, and surgery is rarely required.

Bactérias envolvidas nas mastites subclínicas de cabra da região de Salvador, Bahia / Bacteria involved in subclinical mastitis in goats in the region of Salvador, Bahia, Brazil

A mastite é uma infecção frequente da glândula mamária, sendo a principal doença que afeta o úbere das fêmeas e responsável pelos maiores prejuízos à produção leiteira em caprinos, reduzindo em quantidade e depreciando a qualidade do leite e seus derivados. Nesse estudo foram colhidas amostras de leite de cabras com reação positiva ao CMT, em propriedades localizadas em Bonfim de Feira, Barra do Pojuca, Feira de Santana, Camaçari, Anguera e Antônio Cardoso, todas próximas à Cidade de Salvador, Bahia. Do material coletado foi realizado cultivo bacteriológico em ágar sangue de ovino a 10%, ágar McConkey e também enriquecido em caldo BHI. O Staphylococcus spp. foi a bactéria de maior prevalência (90,3%), seguida de Streptococcus (4,8%), Micrococcus (1,6%) e Enterobacter (1,6%). Todas as bactérias foram submetidas ao teste de sensibilidade aos antimicrobianospelo método de difusão em disco, sendo que 54,1% das estirpes estudadas apresentaram sensibilidade a todas as drogas testadas, e 45,9% das estirpes identificadas apresentaram resistência a pelo menos um dos antimicrobianos. O presente estudo confirmou o Staphylococcus spp. como a principal bactéria envolvida na etiologia das mastites subclínicas caprinas.

Bacteria involved in subclinical mastitis in goats in the region of Salvador, Bahia, Brazil. Mastitis is a common infection of the mammary gland, the main disease affecting the udder of females, and responsible for major losses in milk production in goats, decreasing the quantity and quality of the milk and its derivatives. In this study milk samples were collected from goats with positive reaction to CMT in properties located in Bonfim de Feira, Barra do Pojuca, Feira de Santana, Camaçari, Anguera and Antônio Cardoso, all of which are places surrounding the city of Salvador, Bahia, Brazil. The samples were submitted to bacteriological culture carried out in agar with 10% sheep blood, McConkey agar, and agar enriched with BHI broth. Staphylococcus spp. bacteria was the most prevalent (90.3%), followed by Streptococcus (4.8%), Micrococcus (1.6%) and Enterobacter (1.6%). All bacteria were subjected to antimicrobial susceptibility testing by the disc diffusion method, revealing that 54.1% of the strains studied were sensitive to all drugs tested, while 45.9% of identified strains showed resistance to at least one of antimicrobials. The present studyconfirmed Staphylococcus spp. as the main bacteria involved in the etiology of subclinical goat mastitis.

Principais alterações no leite por agentes causadores de mastite no rebanho caprino dos estados de Minas Gerais e Rio de Janeiro / Major changes in milk by mastitis causative agents in goat herd from the states of Minas Gerais and Rio de Janeiro, Brazil

A mastite subclínica caprina ocasiona prejuízos econômicos em decorrência do descarte, dos gastos com medidas terapêuticas e da redução da quantidade e qualidade do leite e seus derivados.Nesse estudo, 129 amostras de leite de cabra in natura, provenientes de 11 propriedades foram avaliadas pelo teste da caneca telada, California Mastitis Test (CMT), exame bacteriológico, pesquisa de Mycoplasma spp. e pela determinação dos parâmetros físico-químicos. No teste da caneca telada e no CMT, 3,1% e 4,6% das amostras foram positivas, respectivamente. No exame bacteriológico, 57,4% das amostras foram positivas e o patógeno mais frequente foi Staphylococcus coagulase negativa com 56% das cepas resistentes à penicilina e 100% de sensíveis à gentamicina. Mycoplasma spp. não foi identificado nas amostras. O diagnóstico da mastite subclínica pelo CMT e pelo exame bacteriológico diferiu de forma significativa e não houve associação entre o número de UFC/mL obtidas no exame microbiológico e o resultado do CMT (Qui-quadrado p 0,05). Com base nos resultados obtidos, recomenda-se a associação do exame bacteriológico quando na utilização do CMT para diagnóstico da mastite subclínica caprina.

Major changes in milk by mastitis causative agents in goat herd from the states of Minas Gerais and Rio de Janeiro, Brazil. Goat mastitis causes significant economic losses due to the discarding of milk, costs of drugs and veterinary care, reducing the quantity and quality of milk and dairy products. In this study, 129 raw milk samples from 11 goat farms were investigated by the Tamis test, California mastitis test (CMT), bacteriological exam, presence of Mycoplasma spp. and physicochemical parameters. Seven (4.6%) and four samples (3.1%) were positive by CMT and Tamis test respectively. Bacteriological exam was positive from 57.4% of samples and coagulase-negative Staphylococcus was the most frequent bacteria isolated showing 56% of the strains resistant to penicillin and no resistance to gentamicin. Negative results were obtained from traditional culture as well as by PCR for Mycoplasma spp. The diagnosis of mastitis, the bacteriological exam and the CMT results differed significantly and no association was observed (chi squared, p 0.05). The physicochemical parameters differed significantly (ANOVA, Tukey-Kramer, p < 0.05) among the herds. These results indicate the need to associate microbiological exam when the CMT is used for the diagnosis of goat mastitis.

Granulomatous mastitis: a case series

To find out the clinical and management profile of granulomatous mastitis [GM]. A case. This study was carried out at Civil Hospital and Dow University of Health Sciences, Karachi and Tuberculosis Clinic at Bantwa Hospital, Karachi, from January 1999 to January 2009. Histopathologically diagnosed cases of GM were studied. Data included, detailed history, examination, clinical diagnosis, ultrasound, mammogram and fine needle aspiration cytology [FNAC]. All patients were initially given antibiotics and corticosteroid for a period of 10 days. All patients were followed for a period of 6 months. Recurrent cases were managed by wide excision and followed for another period of 6 months. Percentage, mean and range values were determined on SPSS version 10. The mean age of the 22 patients was 37.6 years [range=22-52 years]. Right breast was affected in 54.5% and left breast in 45.5% patients. Eighteen [82%] were non-lactating. Patients presented clinically with painful breast lump in 54.5%, painless lump in 45.5% and additional discharging sinuses in 18%. Clinical diagnosis was chronic mastitis in 40.9%, tuberculosis of breast in 36.3% and malignancy in 22.7% patients. Mammography showed an ill-defined mass in 45.5% and asymmetrical density in 31.8%. Diagnosis was confirmed in all patients on histopathology. Recurrence was noted in 2 patients, managed by wide excision, and followed for another period of 6 months without evidence of complications. GM is an uncommon chronic inflammatory disease of the breast. Usually involving a single non-lactating breast in reproductive age group. It clinically mimics tuberculosis and carcinoma. Mammography remains non-conclusive. Excision and wide excision biopsy are both diagnostic and therapeutic in majority of cases. Treatment includes short course of steroids and antibiotic along with close regular surveillance

Mastite granulomatosa em mulher jovem / Granuloneatous mastitis in young woman

Mulher de 26 anos apresentou tumor de crescimento rápido em mama esquerda, doloroso. Odiagnóstico da lesão, que simulava câncer de mama, só foi possível após biópsia do tecido mamárioque diagnosticou mastite granulomatosa.

A woman, 26-years old, was attended complaining of increased and painful enlargement of the left breast.The clinic diagnosis was breast cancer. The definitive diagnosis (histopathology) was granulomatosismastitis.

Tuberculosis of the breast: report of 4 clinical cases and literature review

Nearly 18% of tuberculosis [TB] cases have only extrapulmonary manifestations. Breast tuberculosis is a rare type of extrapulmonary TB. This paper reports 4 cases of breast TB confirmed either pathologically or mycobacteriologically or both. These reports showed that TB should always be considered first in the differential diagnosis of granulomatous mastitis in TB-endemic areas. Therapy included at least 6 months of anti-TB medication and surgery when indicated

Thick-needle vacuum-assisted biopsy technique for inflammatory breast carcinoma diagnosis

PURPOSE: Inflammatory breast carcinoma (IBC) is a rare clinicopathological cancer type with unique clinical features and a poor prognosis. In this disease, there is generally no palpable mass in the breast. IBC can be mistakenly diagnosed as mastitis and patients may receive a delayed diagnosis and treatment, since these two disorders cause similar pathological appearences on the breast. Clinical suspicion of the disease followed by histopathological observation of occluded dermal lympthatics by tumor emboli leads to definitive diagnosis of IBC. METHODS: Here, we report our experiences in diagnosing IBC using Thick-Needle Aspiration Biopsy (TNAB). RESULTS: Eight patients having clinically suspected IBC, received TNAB. IBC was definitively diagnosed upon observation in histopathological examination of occluded dermal lymphatics by tumor emboli since TNAB allowed adequate tissue sampling. CONCLUSION: In this study, we showed that IBC can be reliably diagnosed using TNAB.

OBJETIVO: O carcinoma inflamatório da mama (CIM) é um raro tipo histopatológico do câncer mamário, com características clínicas especiais e prognóstico reservado. Nesta doença, geralmente não se palpa nódulos mamários. O CIM pode equivocadamente ser diagnosticado como mastite e gerando um retardo no diagnóstico e tratamento, visto que ambas as doenças tem apresentação semelhante. A suspeita clínica da doença seguida da observação histopatológica de embolia tumoral com oclusão dos linfáticos da derme conduz ao diagnóstico definitivo de CIM. MÉTODOS: Relata-se o procedimento no diagnóstico de CIM utilizando a biópsia de aspiração por agulha de grosso calibre (BAAGC). RESULTADOS: Oito pacientes com suspeita clínica CIM foram submetidos a BAAGC. Todos os casos receberam diagnóstico definitivo de CIM após caracterização histopatológica da biópsia. BAAGC permitiu a amostragem adequada do tecido. CONCLUSÃO: O CIM pode ser diagnosticado utilizando BAAGC.

Mastite granulomatosa idiopática: aspectos clínicos, radiológicos e ultra-sonográficos / Idiopathic granulomatous mastitis: clinical, mammography and ultrasound findings

O objetivo deste estudo é descrever as características clínicas, mamográficas e ultra-sonográficas de três casos de mastite granulomatosa idiopática. Esta afecção pode simular câncer de mama nos exames clínico e mamográfico, porém os achados ultra-sonográficos de múltiplas imagens tubulares hipoecóicas, contíguas e confluentes em mulheres jovens com história de lactação recente sugerem o diagnóstico de mastite granulomatosa idiopática.

Mastitis granulomatosa idiopática y mastitis de células plasmáticas: experiencia de tres años / Granulomatous mastitis and plasmatic cell mastitis: three-year experience

Se evaluó el manejo de 13 pacientes con mastitis granulomatosa idiopática y mastitis de células plasmáticas, tratadas en el Hospital Félix Bulnes, por un período de tres años. Se estudió la relación con la edad, anticoncepción, embarazo, lactancia y la atopia. Se evaluaron las limitaciones de la mamografía y de la ecotomografía mamaria y el uso de la biopsia trucut. Se compararon los resultados del tratamiento médico y quirúrgico.

Tuberculous mastitis

To find out the different clinical presentations of breast tuberculosis and its treatment outcome. Design: An observational study. Surgical ward 3 of Jinnah Postgraduate Medical Centre, Karachi from June 2001 to November 2003. Fifty consecutive female patients above 13 years presenting with breast lump, multiple sinuses, axillary lymphadenopathy, and cold abscess were included in the study. Medical records of the patients presented were reviewed and analyzed. Data was collected regarding the patient's name, age and marital and lactational status. Clinical Examinations and investigations were carried out by triple assessment i.e. clinical, radiological and histological / cytological evaluation. The commonest presentation was a solitary breast lump in 30 [60%] patients, breast lump with axillary lymphadenopathy in 13 [26%]. Four [8%] patients presented with generalized breast swelling [edema] with ipsilateral axillary lymphadenopathy. Two [4%] presented with breast abscess and axillary lymphadenopathy and one [2%] with axillary sinus and breast lump. Upper outer quadrant was most frequently involved in 29 [58%] of patients. Thirty two [64%] cases were secondary to tuberculosis in other sites, mostly [40%] from tuberculous axillary lymphadenitis. Forty eight [96%] patients responded well to one year antituberculous treatment with complete disappearance of the lumps except 2 patients who had shrinkage of lump size only, underwent excision of lump. Solitary lump and enlarged lymph nodes are the commonest presentation of mammary tuberculosis. Early diagnosis and treatment is necessary to prevent disfigurement of breast. Antituberculous therapy is the treatment of choice. Surgery should be reserved for unresponsive lumps

Fine needle aspiration diagnosis of tuberculous mastitis.

Fine needle aspiration cytology has become the first choice in diagnostic procedures in the management of a variety of breast diseases. The technique can be successfully used to diagnose granuloma in breast aspirates and to demonstrate the presence of acid-fast bacilli. Tuberculosis is rampant in developing countries and patients are prescribed antituberculous therapy on the basis of finding granuloma in breast aspirates without a culture report. In our practice, this principle has been followed with excellent results. In our experience, this technique was reliable and reproducible in diagnosing tuberculous mastitis. We report on the cytomorphological findings of this uncommon but important disorder.

magnetic resonance image findings of idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis is a rare disease of the breast. Clinically and radiologically it may mimic breast carcinoma. We report a case of a 34-year-old female patient with this diagnosis, concentrating on magnetic resonance image MRI findings and its clinical application. There have been other reports on MRI findings in this entity in the radiological literature, but in our case report, clinical, cytological, pathological, and radiological correlations are also provided

Idiopathic granulomatus lobular mastitis. A forgotten clinical diagnosis

To review clinicopathological features of all cases diagnosed as idiopathic granulomatous lobular mastitis [IGLM] in our hospital and compare them with other data from the Kingdom of Saudi Arabia. Reports of all breast specimens received in histopathology laboratory in Qatif Central Hospital, Kingdom of Saudi Arabia over a 14 year period [1988 through to 2002] were collected and those diagnosed as IGLM were selected for analysis of both pathological material and clinical data. Eleven patients representing 1.6% of all breast specimens were diagnosed as IGLM. The mean age was 35 years [range 25-50]. Both breasts were equally affected. The most frequent presenting symptom was a breast mass of 2-22 weeks duration. The most common clinical diagnosis was chronic abscess [5 patients]. Relation to pregnancy, lactation or oral contraceptives pills was elicited in 4 patients. Recurrence at different time intervals occurred in 3 patients. Microscopically there was an evident granulomatous inflammation mostly in lobular distribution. Ductal inflammation with epithelial changes was noted in most cases. Staining and cultures were negative for both mycobacterium and fungal organisms. Granulomatous mastitis is not unheard of and clinicians should keep it in their list of differential diagnosis of breast lumps so appropriate handling of breast specimens including microbiological studies can be pursued. Utility of fine needle aspiration biopsy as a diagnostic tool is to be considered

Mastitis granulomatosa. Informe de 16 casos / Granulomatous mastitis. Report of sixteen cases

Se informan 16 casos de mastitis granulomatosa, visto en la clínica de mama del Hospital Regional de Río Blanco, Veracruz entre 1985-1996. La edad promedio fue de 41.7 años (rango 22-62 años), el promedio de gestaciones fue de cinco. El 50 por ciento tenía antecedentes de lactancia en los seis meses anteriores al inicio de la enfermedad, pero no hubo casos de mastitis puerperal. El 75 por ciento de los casos tenía la presencia de tumor mamario con tamaño promedio de 6 cm (2-10 cm de rango), que fue sospechoso de cáncer en 62.5 por ciento. En dos casos (12.5 por ciento) se encontró carcinoma mamario asociados y en un caso se demostró etiología por tuberculosis. El tratamiento fue quirúrgico en 100 por ciento con excisción local amplia en todos los casos excepto dos casos que requirieron de mastectomía. Se dio tratamiento antifímico en un caso, en ningún caso se usaron esteroides. Sólo hubo dos recurrencias en un tiempo promedio de seguimiento de 20 meses. Es necesario que todo cirujano dedicado a tratar problemas mamarios esté familiarizado con esta patología, también es importante su reconocimiento para los patólogos ya que el diagnóstico es hecho microscópicamente, generalmente a partir de una muestra amplia de tejido