Mastitis Quística Granulomatosa Neutrofílica, Reporte De Caso / Granulomatous Neutrophilic Cystic Mastitis, Case Report

La mastitis granulomatosa neutrofílica quística (MGNQ) es una entidad recientemente caracterizada, con detalles histopatológicos específicos que la diferencian de otros tipos de mastitis crónicas idiopáticas. La presencia de bacilos grampositivos dentro de espacios de apariencia quística rodeados de neutrófilos, en un contexto de inflamación granulomatosa supurativa, definen esta entidad. La importancia de su reconocimiento en el reporte diagnóstico recae en su asociación a la infección por especies de corinebacterias, de esa manera se puede direccionar el tratamiento con antibióticos, más allá del tratamiento antiinflamatorio que suele administrarse en mastitis idiopáticas. Se describe el caso de una paciente de sexo femenino, de 35 años de edad, sin antecedentes relacionados, con dolor mamario intermitente, asociado a la presencia de múltiples nodulaciones palpables, duras, en ambas mamas, con resultados de múltiples biopsias particulares previas que describieron mastitis crónica granulomatosa con reacción de tipo tuberculoso, por lo cual recibió tratamiento antituberculoso. Pese a ello, las tumoraciones cedieron sólo parcialmente. Se revisó las láminas histológicas en la institución y se estableció el diagnóstico de MGNQ. Se consideró importante la presentación de este caso debido a su escaso reconocimiento entre patólogos, pese a presentar características ya definidas en estudios previos.

Cystic neutrophilic granulomatous mastitis (CNGM) is a recently characterized entity, with specific histopathological details that differentiate it from other types of chronic idiopathic mastitis. The presence of gram-positive bacilli within cystic-like spaces surrounded by neutrophils, in a context of suppurative granulomatous inflammation, define this entity. The importance of its recognition in the diagnostic report lies in its association with infection by corynebacterial species, so that treatment with antibiotics can be targeted, beyond the anti-inflammatory treatment that is usually administered to idiopathic mastitis. We describe the case of a 35-year-old female patient with no related history, with intermittent breast pain, associated with the presence of multiple hard, palpable nodules in both breasts, with results from multiple previous private biopsies that described chronic granulomatous mastitis with a tubercular reaction, for which she received treatment for tuberculosis. Despite this, the clinical response was partial. Histological slides were reviewed at the institution and the diagnosis of CNGM was then established. The presentation of this case was considered important due to its low recognition among pathologists, despite presenting characteristics already defined by previous studies.

Mastitis quística granulomatosa neutrofílica asociada a corinebacterias: Reporte de caso

La mastitis granulomatosa neutrofílica quística (MGNQ) es una entidad recientemente caracterizada, con detalles histopatológicos específicos que la diferencian de otros tipos de mastitis crónicas idiopáticas. La presencia de bacilos grampositivos dentro de espacios de apariencia quística rodeados de neutrófilos, en un contexto de inflamación granulomatosa supurativa, definen esta entidad. La importancia de su reconocimiento en el reporte diagnóstico recae en su asociación a la infección por especies de corinebacterias, de esa manera se puede direccionar el tratamiento con antibióticos, más allá del tratamiento antiinflamatorio que suele administrarse en mastitis idiopáticas. Se describe el caso de una paciente de sexo femenino, de 35 años de edad, sin antecedentes relacionados, con dolor mamario intermitente, asociado a la presencia de múltiples nodulaciones palpables, duras, en ambas mamas, con resultados de múltiples biopsias particulares previas que describieron mastitis crónica granulomatosa con reacción de tipo tuberculoso, por lo cual recibió tratamiento antituberculoso. Pese a ello, las tumoraciones cedieron sólo parcialmente. Se revisó las láminas histológicas en la institución y se estableció el diagnóstico de MGNQ. Se consideró importante la presentación de este caso debido a su escaso reconocimiento entre patólogos, pese a presentar características ya definidas en estudios previos.

Cystic neutrophilic granulomatous mastitis (CNGM) is a recently characterized entity, with specific histopathological details that differentiate it from other types of chronic idiopathic mastitis. The presence of gram-positive bacilli within cystic-like spaces surrounded by neutrophils, in a context of suppurative granulomatous inflammation, define this entity. The importance of its recognition in the diagnostic report lies in its association with infection by corynebacterial species, so that treatment with antibiotics can be targeted, beyond the anti-inflammatory treatment that is usually administered to idiopathic mastitis. We describe the case of a 35-year-old female patient with no related history, with intermittent breast pain, associated with the presence of multiple hard, palpable nodules in both breasts, with results from multiple previous private biopsies that described chronic granulomatous mastitis with a tubercular reaction, for which she received treatment for tuberculosis. Despite this, the clinical response was partial. Histological slides were reviewed at the institution and the diagnosis of CNGM was then established. The presentation of this case was considered important due to its low recognition among pathologists, despite presenting characteristics already defined by previous studies.

Pathogen effects on milk yield and composition in chronic subclinical mastitis in dairy cows.

This study aimed to evaluate the effects of chronic subclinical mastitis (CSM) on milk production and component yields in dairy cows. A total of six herds located in the Midwest area of São Paulo State, Brazil were selected. Herds were visited once every 2 weeks to measure milk yield and to collect milk samples from lactating Holstein cows. Milk samples were collected at two stages (1 and 2), and each stage comprised three milk samplings. In stage 1, a total of 117 of 647 cows were diagnosed with CSM based on at least two of three repeated somatic cell counts (SCC) > 2000,000 cells/mL and positive bacterial milk culture results (BC). Cows with CSM were selected for the second stage. In stage 2, selected cows had quarter sampling aseptically collected for BC analyses prior to milking, and quarter milk yield was measured. Milk components (total protein, fat, lactose, and total solids) were measured using mid-infrared spectroscopy. Mammary quarters were considered healthy if all three repeated SCC results were ≤ 200,000 cells/mL and no bacterial growth was detected on BC. All quarters with positive bacterial growth were classified as having (non-chronic) subclinical mastitis when only one of three SCC results were > 200,000 cells/mL, and CSM when at least two of three SCC results were > 200,000 cells/mL. The effects of CSM by type of pathogen on milk and components yield were assessed using a linear mixed model. Mammary quarters with CSM caused by major pathogens had milk loss of 1.1 kg/quarter milking in comparison to healthy quarters. Milk losses were 0.8 and 1.3 kg/quarter milking when CSM was caused by Staphylococcus aureus or environmental streptococci, respectively. In addition, healthy quarters produced more milk components than quarters with CSM caused by major pathogens. Minor pathogens causing CSM (non-aureus staphylococci and Corynebacterium spp.) had no effect on milk yield. Quarters with CSM had lower milk and component yields when compared with healthy quarters. Milk losses varied according to the type of pathogen and were higher when associated with major pathogens such as S. aureus and environmental streptococci compared with healthy quarters.

Tuberculosis de mama: reporte de un caso / Breast tuberculosis: a case report

RESUMEN Presentamos caso de mastitis en mujer de 45 años sin antecedentes de infección en otras regiones corporales. Presentó cuadro clínico, estudios de imágenes y baciloscopia inespecíficos, sin embargo, mediante muestras histológicas obtenidas por punción aspirativa se encontró células epiteliodes gigantes, necrosis y formaciones granulomatosas, lo cual justificó el pensamiento clínico en tuberculosis. En ausencia de evidencias confirmatorias de lesión en otros tejidos, la existencia de mastitis de evolución tórpida es un indicativo clínico para sospechar tuberculosis mamaria, pues usualmente las características del proceso suelen plantear diagnósticos erróneos con otras entidades tumorales de la mama como cáncer. La tuberculosis en mama, representa una rara enfermedad cuyo diagnóstico es difícil por las bajas evidencias clínicas, microbiológicas y la inespecificidad de los resultados imagenológicos, por lo que la sospecha de su real posibilidad diagnóstica es una condición primordial para su determinación, aun cuando no se confirme el agente causal.

ABSTRACT We present a case of mastitis in a 45-year-old woman with no history of infection in other areas of the body, with unspecific clinical picture, imaging studies, and bacilloscopy. However, histological samples obtained by aspiration showed giant epithelial cells, necrosis, and granulomatous formations, which justified a clinical inclination toward tuberculosis. In the absence of confirmatory evidence of any lesions in other tissues, the existence of mastitis of torpid evolution is a clinical indication to suspect mammary tuberculosis, since the characteristics of the process usually lead to erroneous diagnoses with other breast tumors such as cancer. Tuberculosis in the breast is a rare disease with a difficult diagnosis due to the low clinical and microbiological evidence and the lack of specificity of the imaging results, so the suspicion of its real diagnostic possibility is a fundamental condition for its determination, even when the causal agent is not confirmed.

Carcinoma metastático mamário em uma vaca / Metastatic mammary carcinoma in a cow

Mammary gland neoplasms in cattle are rarely observed in the field veterinary diagnostics routine. Therefore, the objective of this study is to report a metastatic mammary carcinoma in a fourteen-year-old Holstein cow in the state of Santa Catarina, Brazil. The animal was diagnosed by the field veterinarian with clinical mastitis that was unresponsive to treatment, and was euthanized due to the poor prognosis. At the necropsy, multiple yellow, firm, and sometimes friable nodules, ranging from 0.1 to 20cm were observed in all mammary glands, lymph nodes, kidneys, spleen, liver, pancreas, mediastinal lymph nodes, heart, and lungs. The final diagnosis of mammary carcinoma was established through the association of clinical, necropsy, histopathological, and immunohistochemical findings. Differential diagnoses included diseases such as bovine tuberculosis and chronic fungal or bacterial mastitis.(AU)

Carcinomas de glândula mamária em bovinos raramente são vistos na rotina de diagnóstico no campo. Portanto, o objetivo do trabalho é relatar a ocorrência de um carcinoma de mama metastático em uma fêmea bovina de 14 anos, holandesa, no estado de Santa Catarina, Brasil. O animal foi diagnosticado pelo veterinário com mastite irresponsiva a tratamento clínico, e foi eutanasiada devido ao prognóstico desfavorável. Na necropsia foram observados múltiplos nódulos amarelados, firmes, e por vezes friáveis, variando entre 0.1 e 20cm, disseminados em todas as glândulas mamárias, linfonodos, rins, baço, fígado, pâncreas, coração e pulmão. O diagnóstico de carcinoma de glândula mamária foi baseado em achados clínicos, macroscópicos, histopatológicos e de imuno-histoquímica. Os diagnósticos diferenciais incluíram doenças como tuberculose bovina, mastites crônicas de origem bacteriana ou fúngica.(AU)

Carcinoma metastático mamário em uma vaca / Metastatic mammary carcinoma in a cow

Mammary gland neoplasms in cattle are rarely observed in the field veterinary diagnostics routine. Therefore, the objective of this study is to report a metastatic mammary carcinoma in a fourteen-year-old Holstein cow in the state of Santa Catarina, Brazil. The animal was diagnosed by the field veterinarian with clinical mastitis that was unresponsive to treatment, and was euthanized due to the poor prognosis. At the necropsy, multiple yellow, firm, and sometimes friable nodules, ranging from 0.1 to 20cm were observed in all mammary glands, lymph nodes, kidneys, spleen, liver, pancreas, mediastinal lymph nodes, heart, and lungs. The final diagnosis of mammary carcinoma was established through the association of clinical, necropsy, histopathological, and immunohistochemical findings. Differential diagnoses included diseases such as bovine tuberculosis and chronic fungal or bacterial mastitis.

Carcinomas de glândula mamária em bovinos raramente são vistos na rotina de diagnóstico no campo. Portanto, o objetivo do trabalho é relatar a ocorrência de um carcinoma de mama metastático em uma fêmea bovina de 14 anos, holandesa, no estado de Santa Catarina, Brasil. O animal foi diagnosticado pelo veterinário com mastite irresponsiva a tratamento clínico, e foi eutanasiada devido ao prognóstico desfavorável. Na necropsia foram observados múltiplos nódulos amarelados, firmes, e por vezes friáveis, variando entre 0.1 e 20cm, disseminados em todas as glândulas mamárias, linfonodos, rins, baço, fígado, pâncreas, coração e pulmão. O diagnóstico de carcinoma de glândula mamária foi baseado em achados clínicos, macroscópicos, histopatológicos e de imuno-histoquímica. Os diagnósticos diferenciais incluíram doenças como tuberculose bovina, mastites crônicas de origem bacteriana ou fúngica.

Metastatic mammary carcinoma in a cow / Carcinoma metastático mamário em uma vaca

ABSTRACT: Mammary gland neoplasms in cattle are rarely observed in the field veterinary diagnostics routine. Therefore, the objective of this study is to report a metastatic mammary carcinoma in a fourteen-year-old Holstein cow in the state of Santa Catarina, Brazil. The animal was diagnosed by the field veterinarian with clinical mastitis that was unresponsive to treatment, and was euthanized due to the poor prognosis. At the necropsy, multiple yellow, firm, and sometimes friable nodules, ranging from 0.1 to 20cm were observed in all mammary glands, lymph nodes, kidneys, spleen, liver, pancreas, mediastinal lymph nodes, heart, and lungs. The final diagnosis of mammary carcinoma was established through the association of clinical, necropsy, histopathological, and immunohistochemical findings. Differential diagnoses included diseases such as bovine tuberculosis and chronic fungal or bacterial mastitis.

RESUMO: Carcinomas de glândula mamária em bovinos raramente são vistos na rotina de diagnóstico no campo. Portanto, o objetivo do trabalho é relatar a ocorrência de um carcinoma de mama metastático em uma fêmea bovina de 14 anos, holandesa, no estado de Santa Catarina, Brasil. O animal foi diagnosticado pelo veterinário com mastite irresponsiva a tratamento clínico, e foi eutanasiada devido ao prognóstico desfavorável. Na necropsia foram observados múltiplos nódulos amarelados, firmes, e por vezes friáveis, variando entre 0.1 e 20cm, disseminados em todas as glândulas mamárias, linfonodos, rins, baço, fígado, pâncreas, coração e pulmão. O diagnóstico de carcinoma de glândula mamária foi baseado em achados clínicos, macroscópicos, histopatológicos e de imuno-histoquímica. Os diagnósticos diferenciais incluíram doenças como tuberculose bovina, mastites crônicas de origem bacteriana ou fúngica.

Características clínicas de la tuberculosis mamaria en pacientes atendidas en un servicio de ginecoobstetricia, 2002- 2011

Objetivos: Determinar las características clínicas de la tuberculosis mamaria en pacientes atendidas en un Servicio de Gineco-Obstetricia. Diseño: Estudio observacional, descriptivo, retrospectivo. Institución: Servicio de Gineco-Obstetricia, Hospital Nacional Docente Madre Niño San Bartolomé, Lima, Perú. Participantes: Pacientes con tuberculosis mamaria. Intervenciones: Se revisó 40 historias clínicas de pacientes que tuvieron el diagnostico clínico de tuberculosis mamaria, durante el periodo 2002 a 2011. Principales medidas de resultados: Características clínicas de mujeres con tuberculosis mamaria. Resultados: Se encontró 29 casos de tuberculosis mamaria, correspondiendo a 2,9% de incidencia anual. La mayoría procedía del Rímac, San Martin de Porres y Cercado de Lima. La edad promedio fue 32,8 ± 8,2 años de edad y con promedio de 2,3 ± 1,2 gestaciones; 51,7% tenía sobrepeso y 13,8% obesidad. El tiempo de enfermedad fue dos a cuatro meses en 70%. El 72,4% presentó tumor mamario, 31% nodularidad dolorosa y 13,8% linfoadenopatía axilar. Un 10,7% se encontraba gestando o dando de lactar al momento del diagnóstico; 10,3% de los casos estaba asociado a tuberculosis pulmonar, 7,1% a tuberculosis extrapulmonar y 14,3% tuvo contacto con pacientes tuberculosos. El 68% recibió tratamiento antituberculoso. Solo 31% de las pacientes fue sometida a intervención quirúrgica. La respuesta al tratamiento en 96,6% de los casos fue buena. Conclusiones: De las pacientes con tuberculosis mamaria atendidas, una de cada seis estuvo asociada a tuberculosis pulmonar y extrapulmonar. Los procedimientos más utilizados para el diagnóstico fueron la biopsia, mamografía, ecografía mamaria y radiografía de tórax. Se requiere tener en cuenta la posibilidad de tuberculosis mamaria en gestantes y madres lactantes.

Objectives: To determine clinical characteristics of breast tuberculosis in patients treated at an Obstetrics and Gynecology Service. Design: Observational, descriptive, retrospective study. Setting: Obstetrics and Gynecology Service, Hospital Nacional Docente Madre Niño San Bartolome, Lima, Peru. Participants: Patients with mammary tuberculosis. Interventions: Medical records of 40 patients who had clinical diagnosis of breast tuberculosis were reviewed. Main outcome measures: Breast tuberculosis clinical characteristics. Results: Twenty-nine cases of mammary tuberculosis were found, with 2.9% annual incidence. Most lived in Rimac, San Martin de Porres and Cercado de Lima. Average age was 32.8 ± 8.2 year-old with 2.3 ± 1.2 pregnancies average; 51.7% were overweight and 13.8% obese. Time of disease was two to four months in 70%; 72.4% presented breast tumor, 31% painful nodularity and 13.8% axillary lymphadenopathy; 10.7% were pregnant or lactating at diagnosis; 10.3% were associated to pulmonary tuberculosis, 7.1% to extrapulmonary tuberculosis, and 14.3% had contact with patients with tuberculosis; 68% received treatment for tuberculosis, and only 31% of patients underwent surgical intervention. Treatment response was good in 96.6% of cases. Conclusions: One of six patients attended for breast tuberculosis had associated pulmonary or extra-pulmonary tuberculosis. Procedures mostly used for diagnosis were biopsy, mammography, breast ultrasound, and chest radiography. It is important to consider the possibility of mammary tuberculosis in pregnant and lactating women.