Mastitis granulomatosa idiopática: Caso clínico y revisión literaria / Idiopathic granulomatose mastitis: Case report and literary review

Se describe el caso clínico de una paciente con diagnóstico histológico de mastitis granulomatosa idiopática, enfermedad poco frecuente en la que se utilizan inmunosupresores como tratamiento descripto y puede confundirse con otras entidades atendidas en la especialidad. Se describe el caso y se realiza una revisión de la literatura.

The clinical case of a patient with a histological diagnosis of idiopathic granulomatous mastitis is described, a rare disease in which immunosuppressants are used as the described treatment and can be confused with other entities treated in the specialty. The case is described and a literature review is carried out.

Corynebacterium kroppenstedtii y patología mamaria / Corynebacterium kroppenstedtii and breast pathology

Resumen Corynebacterium kroppenstedtii es un bacilo gram positivo corineforme lipofílico, poco frecuente en la clínica humana. Forma parte de la microbiota cutánea de los seres humanos y, por esta razón, su interpretación clínica es compleja. La mastitis granulomatosa es una enfermedad inflamatoria de origen incierto con baja incidencia. Se presentan dos casos clínicos en los que se describe la asociación de C. kroppenstedtii con mastitis granulomatosa. El tejido mamario es rico en lípidos. El carácter lipofílico de este microorganismo podría explicar su presencia en dicho tejido.

Abstract Corynebacterium kroppenstedtii is a rare lipophilic coryneform gram-positive bacillus. It is part of the human skin microbiota and, for this reason, its clinical interpretation is complex. Granulomatous mastitis is an inflammatory disease of uncertain origin with a low incidence. The association of C. kroppenstedtii with granulomatous mastitis was described in two clinical case reports. The lipophilic characteristics of this microorganism explains why it can be found in lipid-rich breast tissue.

Resumo Corynebacterium kroppenstedtii é um bacilo gram-positivo corineforme lipofílico poco frecuente. Faz parte da microbiota do seres humanos, por isso sua interpretação clínica é complexa. A mastite granulomatosa é uma doença inflamatória de origem incerta com baixa incidência. Foram apresentados dois casos clínicos nos quais é descrita a associação de C. kroppenstedtii com mastite granulomatosa. O tecido mamário é rico em lipídios. O caráter lipofílico desse microrganismo pode explicar sua presença em tal tecido.

Mastitis granulomatosa idiopática con respuesta al tratamiento inmunosupresor / Idiopathic Granulomatous Mastitis with Responses to Immunosuppressive Treatment: Two Case Report

La mastitis granulomatosa idiopática es una enfermedad inflamatoria crónica de causa desconocida y presentación infrecuente, que afecta a mujeres en edad reproductiva. Su presentación clínica similar al carcinoma de mama, sumada al desconocimiento de esta entidad, genera confusión, errores y retrasos en el diagnóstico en gran proporción de los casos, por lo que la histopatología es un requisito fundamental para el diagnóstico correcto de esta enfermedad. Presentamos dos casos de pacientes femeninas con cuadro clínico de mastitis crónica en quienes, tras descartar causas infecciosas y neoplásicas, se estableció el diagnóstico de mastitis granulomatosa idiopática. Se administró terapia inmunosupresora con prednisolona, metotrexate y ácido fólico. Las pacientes tuvieron una adecuada respuesta y se evidenció la resolución del cuadro clínico a las 3 semanas de tratamiento(AU)

Idiopathic granulomatous mastitis is a chronic inflammatory disease of unknown etiology and infrequent presentation. Confusion, delayed and mistaken in diagnosis has been atribuided to the similar clinical manifestation with breast carcinoma, added to the ignorance of this entity, that's why histopathology is a fundamental requirement for the correct diagnosis of this disease. We present two cases of female patients with clinical symptoms of chronic mastitis, in whom a diagnosis of idiopathic granulomatous mastitis was made after ruling out infectious and neoplastic causes(AU)

Mastitis granulomatosa idiopática recurrente tratada con dapsona: reporte de un caso / Recurrent idiopathic granulomatous mastitis treated with dapsone: a case report

La mastitis granulomatosa idiopática (IGM, por sus siglas en inglés) es una afección inflamatoria crónica infrecuente y benigna de los senos. Puede simular tres trastornos mamarios muy frecuentes: carcinoma de mama, mastitis y absceso mamario. La IGM se presenta típicamente como una masa mamaria unilateral y dolorosa. La etiología de la IGM no está bien definida, pero se ha propuesto que podría ser una reacción inmune localizada del tejido mamario.El diagnostico de IGM recurrente es complejo porque los hallazgos clínicos y radiológicos no son específicos, por lo que el estudio histopatológico es crucial. El cáncer de mama, la inflamación gra-nulomatosa infecciosa y no infecciosa deben des-cartarse. El tratamiento de la IGM es controver-tido, e incluye vigilancia estrecha, medicamentos inmunosupresores, antibióticos si hay evidencia de infección y escisión quirúrgica. Presentamos un caso de IGM recurrente tratada con dapsona, con buena respuesta a tratamiento, demostrando que este fármaco podría ser una buena alternativa terapéutica debido a su efecto inmunomodulador, antiinflamatorio y ahorrador de esteroides.

Idiopathic granulomatous mastitis (IGM) is an uncommon, non-malignant, chronic inflamma-tory breast condition. It can mimic three very fre-quent breast disorders: breast carcinoma, mastitis and breast abscess. IGM typically presents as a unilateral and painful breast mass. The etiology of IGM is not well defined, but it has been pro-posed that it could be localized immune reaction to breast tissue. The diagnosis of recurrent IGM is complex be-cause clinical and radiological findings are nons-pecific, therefore histopathologic evaluation is crucial. Breast cancer and infectious and nonin-fectious granulomatous inflammation should be discarded. Treatment of IGM is controversial, including close monitoring, immunosuppressive drugs, antibiotics if there is infection evidence and surgical excision. This is a case report of recurrent IGM treated with Dapsone, with good response to treatment, showing that this drug could be a good therapeutic alternative due to its immunomodulatory and anti-inflammatory and steroid sparing.

Lesões granulomatosas encontradas em bovinos abatidos para consumo / Granulomatous lesions found in cattle slaughtered for meat production

Com o objetivo auxiliar profissionais médico-veterinários no reconhecimento das lesões de bovinos encontradas na linha de inspeção de carnes em matadouros frigoríficos, três condições granulomatosas de bovinos foram pesquisadas e suas semelhanças e diferenças avaliadas. Essas três condições granulomatosas foram actinobacilose (causada por Actinobacillus lignieresii), actinomicose (causada por Actinomyces bovis) e mastite estafilocócica (causada por Staphylococcus aureus). Em 505 lesões encontradas em bovinos abatidos para consumo humano, 40 eram uma dessas três lesões granulomatosas: 24 eram actinobacilose, 10 eram actinomicose e seis eram mastite estafilocócica. De um modo geral, os aspectos macro e microscópicos dessas três lesões eram bastante semelhantes, mas suas localizações ajudavam a presumir sua etiologia. A. lignieresii afetou tecidos moles, principalmente língua e linfonodos da cabeça; A. bovis afetou o tecido ósseo, principalmente o da mandíbula; e S. aureus teve a glândula mamária como o tecido alvo. Histologicamente, os granulomas resultantes da infecção por qualquer um desses três agentes continham uma estrutura amorfa, eosinofílica, com clavas irradiadas, localizada centralmente; essa estrutura era rodeada por neutrófilos íntegros e degenerados, que, por sua vez, eram cercados por um manto de macrófagos epitelioides e ocasionais células gigantes multinucleadas. Esses mantos de macrófagos eram irregularmente infiltrados por linfócitos e plasmócitos que tendiam a se acumular na periferia da lesão, que era cercada por uma cápsula de tecido conjuntivo...

In order to help professionals of veterinary medicine in recognizing bovine lesions found during meat inspection at slaughterhouses, three granulomatous conditions of cattle were researched and their morphological similarities and differences were assessed. These three granulomatous conditions were actinobacillosis (caused by Actinobacillus lignieresii), actinomycosis (caused by Actinomyces bovis) and staphylococcal mastitis (caused by Staphylococcus aureus). Out of 505 lesions found in cattle slaughtered for human consumption, 40 were one of the three granulomatous conditions: 24 were actinobacillosis, 10 were actinomycosis and six were staphylococcal mastitis. Overall the gross and histological features of these three diseases are quite similar but their location helps give away the etiology. A. lignieresii affected soft tissues, mainly those of tongue and lymph nodes of the head region; A. bovis affected bone tissue mainly that of the mandible; and S. aureus main targeted tissue was the mammary gland. Histologically the granuloma resulting from the infection with either one of these three causal agents contained centrally located amorphous, eosinophilic, club like structures surrounded by viable and dead neutrophils. These were surrounded by a mantle of epithelioid macrophages and occasional multinucleated giant cells. These macrophage mantles were irregularly infiltrate by lymphocytes and plasma cells which tended to accumulate to the periphery of the lesion which, in turn, was fenced by a fibrous connective capsule. Given the employment of adequate techniques the causative the agent could be seen within or surrounding the clublike structures in each the three types of granulomatous lesions. In the case of staphylococcal mastitis, intralesional cocci were observed both in HE and Gram stained preparations, in the latter as gram-positive cocci...

Topical Steroids to Treat Granulomatous Mastitis: A Case Report

Idiopathic granulomatous mastitis (IGM) is a rare and chronic benign disease of the breast. Histologically, the disease presents as an intense inflammatory reaction with non-caseated granulomas that are the characteristic symptom of the disease. No consensus exists on the best treatment modality for this disease. In this report, we present a patient with granulomatous mastitis who was treated successfully with low-dose oral and topical steroids. Our aim here is to discuss various approaches for IGM in view of the literature and present treatment with topical steroids, which has not been reported.