Idiopathic granulomatous mastitis: a 5-year retrospective review of cases in a tertiary centre in Dublin, Ireland.

AIMS: Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast disorder of unknown aetiology usually affecting women of reproductive age. It classically presents as a unilateral painful breast mass. It is frequently mistaken for carcinoma or other inflammatory breast diseases. Diagnostic investigations include clinical examination, appropriate imaging and tissue sampling. A link between IGM and infection with the Corynebacterium species in particular Corynebacterium kroppenstedtii has been described. METHODS: A retrospective single-centre cohort study was conducted over a 5-year period (2017-2022); all cases of IGM were identified. RESULTS: Forty-one patients were diagnosed with IGM. Breast lump was the most common presenting complaint (n=29). The average age was 45 years. Eighteen patients had samples sent for culture and sensitivity, 11 of which had positive microbiology results indicative of Corynebacterium spp infection.An 82% resolution rate (27 of 33) was recorded in those who received either a short-antibiotic course or none at all. Eight patients reported persistent disease at 3 months, five of which had evidence of Corynebacterium spp. DISCUSSION: This 5-year review highlights the impact of IGM in a tertiary centre in Dublin, Ireland. Although no treatment guidelines exist, options include antibiotics, immunomodulators and surgery. Due to risk of fistulae and unfavourable cosmetic outcomes, surgery should be reserved for refractory IGM. We suspect that there may be a subset of patients where prolonged antibiotic therapy should be considered. Defining this subgroup requires further study, but likely includes those with cystic neutrophilic granulomatous mastitis, relapsing disease and in whom Corynebacterium spp is recovered.

Value of Long-term Follow-up in Surgically Excised Lesions of Uncertain Malignant Potential in the Breast - Is 5 Years Necessary?

INTRODUCTION: B3 lesions are a heterogeneous group of breast lesions of uncertain malignant potential which usually require excision. The aim was to assess the efficacy of 5 years routine radiological or clinical follow-up of patients who had "high-risk" B3 lesions surgically excised, by analyzing recurrence and subsequent development of invasive/in-situ cancer. PATIENTS AND METHODS: A 10-year retrospective review from 2010 to 2019 was performed of B3 lesions diagnosed on core needle biopsy, including patients who proceeded to surgical excision with a high-risk lesion on final histology. The database recorded 6 specific B3 lesion categories: 1. Atypical ductal hyperplasia (ADH), 2. Radial scars/complex sclerosing lesions (CSLs) with epithelial atypia 3. Classical Lobular neoplasia (ALH/LCIS), 4. Papillary lesions with epithelial atypia, 5. Mixed, 6. Flat epithelial atypia (FEA), including radiological and clinical follow-up data. RESULTS: Six hundred sixteen patients had a B3 lesion after core biopsy. 110 patients had "high risk" lesions. This included 17 (15.5%) Atypical Ductal Hyperplasia (ADH), 22 (20%) radial scars/CSLs with epithelial atypia, 47 (42.7%) classical lobular neoplasia (LCIS/ALH), 7 (6.4%) papillary lesions with epithelial atypia, 13 (11.8%) mixed lesions & 4 (3.6%) Flat Epithelial Atypia (FEA) lesions. 4 of 110 (3.6%) developed invasive/in-situ disease and 4 of 110 (3.6%) developed recurrence during follow-up. 33 of 616 (5.4%) upgraded to invasive/preinvasive disease after surgical excision. CONCLUSION: Five years of routine radiological surveillance may not be necessary in patients who undergo surgical excision of "high-risk" B3 lesions. Clinical surveillance appears to be of little benefit, especially in patients with radial scars, papillary lesions, and FEA. Subsequent development of invasive/in-situ disease in patients who undergo surgical excision of atypical B3 lesions remains low.

Process evaluation of health fairs promoting cancer screenings.

BACKGROUND: Low income and uninsured individuals often have lower adherence to cancer screening for breast, cervical and colorectal cancer. Health fairs are a common community outreach strategy used to provide cancer-related health education and services. METHODS: This study was a process evaluation of seven health fairs focused on cancer screening across the U.S. We conducted key-informant interviews with the fair coordinator and conducted baseline and follow-up surveys with fair participants to describe characteristics of participants as well as their experiences. We collected baseline data with participants at the health fairs and telephone follow-up surveys 6 months following the fair. RESULTS: Attendance across the seven health fairs ranged from 41 to 212 participants. Most fairs provided group or individual education, print materials and cancer screening during the event. Overall, participants rated health fairs as very good and participants reported that the staff was knowledgeable and that they liked the materials distributed. After the fairs, about 60% of participants, who were reached at follow-up, had read the materials provided and had conversations with others about cancer screening, and 41% talked to their doctors about screening. Based on findings from evaluation including participant data and coordinator interviews, we describe 6 areas in planning for health fairs that may increase their effectiveness. These include: 1) use of a theoretical framework for health promotion to guide educational content and activities provided, 2) considering the community characteristics, 3) choosing a relevant setting, 4) promotion of the event, 5) considerations of the types of services to deliver, and 6) evaluation of the health fair. CONCLUSIONS: The events reported varied in reach and the participants represented diverse races and lower income populations overall. Most health fairs offered education, print materials and onsite cancer screening. Participants reported general satisfaction with these events and were motivated through their participation to read educational materials or discuss screening with providers. Public health professionals can benefit from this process evaluation and recommendations for designing and evaluating health fairs.

Pancreatic Cancer Complicated by Pancreatitis Demonstrated on FDG PET/CT.

A 73-year-old man was referred for F-FDG PET/CT study for staging of biopsy-proven pancreatic adenocarcinoma. The scan demonstrated focal intense FDG uptake in the pancreatic head, localizing the primary tumor. Additional moderate diffuse uptake was seen throughout the pancreas, suggestive of acute pancreatitis. Concurrent diagnostic CT showed diffuse pancreatic hypoenhancement consistent with edema. Serum lipase level was elevated, confirming a diagnosis of acute pancreatitis.

Polyostotic Fibrous Dysplasia in McCune-Albright Syndrome Demonstrated on 68Ga-DOTATATE PET/CT.

A 33-year-old woman with McCune-Albright syndrome was referred for a Ga-DOTATATE PET/CT study for evaluation and staging of a biopsy-proven pancreatic tail neuroendocrine tumor. The scan demonstrated intense focal octreopeptide uptake corresponding to the known neuroendocrine tumor at the pancreatic tail/splenic hilum. There was no evidence of octreopeptide-avid metastases. Diffuse octreopeptide uptake was demonstrated in multiple bones involving the right side of the skeleton. The concurrent CT demonstrated corresponding expansile lucent changes consistent with the known fibrous dysplasia.