Breast Tuberculosis in Iran: A Comprehensive Review.

ABSTRACT: 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.

Screening for those at risk for anxiety and depression warranting further clinical evaluation among patients presenting to breast services: a single-centre, cross-sectional study.

OBJECTIVES: Studies show that anxiety and depression are widespread across patients presenting to outpatient services for medical illnesses. We expect similar or even higher prevalence in patients with breast complaints owing to the relevance of breasts in terms of sexuality, identity and confidence. Thus, this study was proposed to estimate the prevalence and identify risk factors for being at risk for anxiety and depression in patients seeking breast services. DESIGN: Descriptive, cross-sectional study. SETTING: Tertiary care teaching hospital in Mumbai, Western India. PARTICIPANTS: Patients seeking breast services for either benign or malignant conditions. OUTCOME MEASURES: Proportion of those at risk for clinical depression (defined as a score of ≥10 on Patient Health Questionnaire-9) and proportion of those at risk for clinical anxiety warranting further clinical evaluation (defined as a score of ≥10 on Generalized Anxiety Disorder-7) and their predictors. RESULTS: A total of 208 patients were screened, and 192 consenting patients were enrolled. The prevalence of those at risk for anxiety requiring further clinical evaluation was 46.4% (95% CI 39.2% to 53.7%) and for those at risk for major depression that warrants further clinical evaluation by a mental health provider was 29.7% (95% CI 23.3% to 36.7%). The predictors of anxiety were age (adjusted odds ratio (aOR) 1.053; 95% CI 1.024 to 1.083; p<0.001) and postmenopausal status (aOR 2.475; 95% CI 1.200 to 5.103; p=0.014). The predictors of depression were age (aOR 0.954; 95% CI 1.927 to 0.981; p=0.001) and rural place of residence (aOR 2.362; 95% CI 1.023 to 5.433; p=0.044). CONCLUSIONS: There is a high prevalence of being at risk for anxiety and depression among patients who seek breast services warranting further clinical evaluation. The predictors of being at risk for anxiety were higher age and postmenopausal status, and for those at risk for depression were young age and residing in rural areas.

Non-sclerosing (T-cell) and sclerosing (B-cell) lymphocytic lobulitis in diagnostic breast biopsies: Clinical, imaging, and pathologic features.

Lymphocytic lobulitis (LL) is characterized by prominent lymphocytic infiltrates centered on lobules. Sclerosing lymphocytic lobulitis (SCLL) associated with diabetes mellitus (DM) or autoimmune disease (AI) was the first type to be described. Subsequently, non-sclerosing LL (NSCLL) was reported as an incidental finding in prophylactic mastectomies due to high risk germline mutations or a family history of breast cancer. The two types of LL were distinguished by stromal features and a predominant population of B-cells in the former and T-cells in the latter. In this study, 8 cases of NSCLL detected clinically or by screening were compared to 44 cases of SCLL. One case of NSCLL presented as a palpable mass, 2 as masses on screening, and 5 as MRI enhancement. In contrast, 80% of SCLL cases presented as palpable masses. Half the cases of NSCLL were associated with a BRCA1 or 2 mutation compared to 1 case of SCLL (2%). Three additional cases of NSCLL were associated with a strong family and/or personal history of breast cancer. Almost half (52%) of SCLL cases were associated with DM or AI, but only 25% of NSCLL. Immunoperoxidase studies confirmed a predominance of T-cells in NSCLL and B-cells in SCLL associated with DM or AI. It is important for pathologists to be aware of this new observation that NSCLL can be detected as a palpable mass or an imaging finding in diagnostic biopsies, as its presence can be indicative of a significant risk for breast cancer.

Mastitis granulomatosa no caseificante: revisión retrospectiva de 61 casos / Non-caseating granulomatous mastitis: Restrospective review of 61 cases

Objetivo: determinar las características clínicas, de diagnóstico y opciones de tratamiento de la mastitis granulomatosa no caseificante. Métodos: el presente estudio es de tipo descriptivo, transversal, retrospectivo y no experimental de 61 pacientes atendidos en el Hospital Belén de Trujillo, desde enero de 2018 hasta diciembre de 2022. Fue criterio de inclusión que tengan diagnóstico histopatológico de mastitis granulomatosa no caseificante BAAR negativo. Resultados: el 93,4% afectó a mujeres en edad reproductiva (edad promedio 33 ± 7 años). La paridad, el haber dejado de dar de lactar y el uso de anticonceptivos se asociaron en forma estadísticamente significativa con la mastitis (p ≤ 0,05). En su mayoría afectó la mama izquierda. La tumoración varió entre 3 y 11 cm con un tamaño promedio de 5,0 ± 2 cm. En el 49,2% la tumoración se acompañó de una o más fistulas. El 38,5% hizo uso de anticonceptivos hormonales. El cultivo de 25 tejidos mamarios biopsiados fue negativo. El estudio ecográfico fue categorizado en el 91,8% como BIRADS 2 y 3. El 67,2% mejoró con tratamiento antituberculoso, aun cuando no había evidencia de BAAR positivo. El 32,8% mejoró con tratamiento diverso con antibióticos y sin antibióticos. Conclusiones: este tipo de mastitis se presenta en la etapa reproductiva de la mujer, pero después del periodo de lactancia. Los anticonceptivos hormonales podrían predisponer a esta afección. Su manejo es variable, puede hacerse con antituberculosos, antibióticos comunes y en casos extremos resección quirúrgica.(AU)

Objective: To determine the clinical characteristics, diagnosis and treatment options of non-caseating granulomatous mastitis. Methods: The present study is descriptive, cross-sectional, retrospective and non-experimental of 61 patients treated at the Hospital Belen of Trujillo, from January 2018 to December 2022. The inclusion criterion was that they have a histopathological diagnosis of granulomatous mastitis without caseification Acid-Fast Bacilli negative. Results: 93.4% affected women of reproductive age (age average 33 ± 7 years). Parity, having finishing breastfeeding and the use of contraceptives were associated in a statistically significant way with matitis (p ≤ 0.05). It mostly affected the left breast. The tumor varied between 3 and 11 cm with an average size of 5 ± 2 cm. In 49.2%, the tumor was accompanied by one or more fistulas. 38.5% used hormonal contraceptives. The culture of 25 biopsied breast tissues was negative. The ultrasound study was categorized in 91.8% as BIRADS 2 and 3. 67.2% improved with anti-tuberculosis treatment even though there was no evidence of positive AFB. 32.8% improved with diverse treatment, with antibiotics and without antibiotics. Conclusions: This type of mastitis occurs in the reproductive stage of the woman, but after the lactation period. Hormonal contraceptives could predispose to this condition. Its management is variable, it can be done with anti-tuberculosis drugs, common antibiotics and in extreme cases surgical resection.(AU)

Absceso mamario neonatal / Neonatal breast abscess: a case report

Presentamos el caso de una niña de 27 días de vida, sin antecedentes de interés, que acude a su pediatra por edema y hematoma en la mama derecha. La paciente acude al día siguiente a las urgencias hospitalarias por evolución del cuadro hacia un absceso mamario, teniendo que ser ingresada e iniciando tratamiento antibiótico intravenoso. Dada la mala evolución, y a pesar del tratamiento antibiótico, se decide intervención quirúrgica mediante drenaje y lavado de la cavidad. Finalmente, se resuelve el cuadro sin secuelas posteriores. (AU)

We present a 27-day-old girl with no significant medical history who attended pediatric consultation presenting with edema and hematoma in her right breast. The patient was admitted the next day following examination in ER due to the worsening of a starting breast abscess and was treated with intravenous antibiotic therapy. Due to the worsening of the condition and despite the intravenous antibiotic therapy, a surgical treatment was performed consisting in draining the abscess and washing the cavity. Finally, the problem was solved without any consequences. (AU)

Patient Notification About Breast Arterial Calcification on Mammography: Empowering Women With Information About Cardiovascular Risk.

OBJECTIVE: To assess the impact of informing women about the presence of breast arterial calcification (BAC) on mammography by determining whether those notified about the presence of BAC would seek cardiovascular evaluation. METHODS: This IRB-approved prospective study included 494 patients who underwent screening mammography between June 8, 2021, and April 22, 2022. Mammograms were reviewed by a radiologist, and patients were notified via e-mail about the presence or absence of BAC. Patients with BAC were advised to discuss the results with their physicians and were surveyed 3 months later. Frequencies and proportions were calculated for study participation, presence of BAC, survey participation, health actions, and perceptions. Confidence intervals were calculated for proportions of health actions and perceptions. RESULTS: Of 494 study participants, 68/494 (13.8%; 95% CI: 10.9%-17.1%) had BAC detected on mammography and 42/68 (61.8%; 95% CI: 61.1%-62.1%) with BAC completed the follow-up survey at 3 months. Of these 42 survey respondents, 24/42 (57.1%; 95% CI: 41.1%-72.3%) reported discussing results with their primary care physician (PCP) or a cardiologist. In addition, 34/42 (81.0%; 95% CI: 65.9%-91.4%) reported finding it helpful to receive information about BAC and 32/42 (76.2%; 95% CI: 60.6%-88.0%) believed all women should be informed about BAC after mammography. CONCLUSION: After notification about the presence of BAC on screening mammography, the majority (57.1%) of survey respondents reported discussing the results with a PCP or cardiologist. These results suggest that providing mammography patients with information about BAC may promote preventive cardiovascular health.

Breast development and disorders in children and adolescents.

Breast masses are infrequently encountered in pediatric and adolescent populations. Most breast masses in children are benign entities arising from embryological defects which can be managed once breast development is complete. Diagnostic and management dilemmas arise when fibroepithelial lesions of the breast are seen in clinical practice. Differentiation between a fibroadenoma and a phyllodes tumor is important to guide management. Breast cancer in children under 18 years of age is extremely rare and invasive diagnostic testing and aggressive management is only recommended when clinical suspicion of malignancy is very high. Patient and caregiver counseling plays an important role in the management of these diseases. While adult-onset breast diseases have been studied very closely, there is a dearth of literature on pediatric breast anomalies. This review aims to provide a scoping overview of the available literature on benign, fibroepithelial, and malignant lesions of the breast in pediatric and adolescent populations to help guide physicians and surgeons with decision-making regarding the diagnosis and management of pediatric breast diseases.

Serum miR-181a and miR-25 in patients with malignant and benign breast diseases.

Breast tumor diseases include a wide range of pathologies that require different approaches to their treatment. MicroRNA (miR) levels, reflecting regulation of the gene expression involved in tumorigenesis, can be diagnostic and prognostic markers of breast diseases. The levels of circulating miR-181a and miR-25 were measured in patients with benign breast diseases (BBD), patients with invasive carcinoma of a nonspecific type (ICNT) and also in conditionally healthy women. Expression of both miRs was higher in patients of both groups as compared to controls; at the same time, the content of serum miR-181a and miR-25 was higher in BBD patients than in ICNT patients. The detected changes may be of interest in the context of precancerous changes in BBD. It seems possible to use them in the future as markers of the pathological process as a part of a large diagnostic panel.

Differences in Diagnosis and Treatment of Nipple Conditions of Reproductive-Age Women at a Tertiary Health System.

Background: Nipple-areolar complex (NAC) conditions affect reproductive-age women, yet it is not known how care of NAC complaints is distributed among medical specialties. There is a need to characterize all NAC conditions, including their treatment and the care team involved in their clinical management, of nonlactating and lactating patients to determine care gaps. Materials and Methods: This was a retrospective cohort study of reproductive-age females who presented to a large tertiary health system with an NAC complaint between 2015 and 2020. Data about the symptoms, diagnosis, specialty providing care, diagnostic considerations, and treatments were collected. Results: Nipple pain, dermatitis, and thrush were the most common diagnoses among 407 encounters (215 patients). Lactating patients represented half (204, 50%) of the study sample. Benign breast conditions like obstructed ductal openings, accessory nipples, nipple growth, inverted nipples, and chronic and bacterial infections represented a third of all encounters. Primary care physicians (167, 41%) and obstetricians (105, 26%) provided most of the care and referred a third and quarter of patients, respectively, to another provider. Conclusion: The care of patients with NAC complaints is not limited to obstetricians. Internal medicine, family medicine, emergency medicine, and obstetrician-gynecology, dermatology, and surgery resident physicians should receive training in benign breast conditions and clinical lactation.

Cholesterol Granuloma of the Breast Mimicking Cancer: A Case Report and Review of the Literature.

Cholesterol granuloma of the breast is an infrequent benign lesion with clinical and radiological findings suggestive of cancer. Herein, we present the case of a 52-year-old woman with no significant past medical history, who presented to the outpatient department for her routine breast screening. Physical examination revealed a painless palpable nodule in the upper external quadrant of the left breast, measuring 0.7 cm. On imaging, the mass met the criteria for Breast Imaging Reporting and Data System (BI-RADS) category 4B. Subsequently, a core needle biopsy of the mass was performed. Despite the alarming radiologic features, microscopic findings were consistent with breast cholesterol granuloma.

Clinicohistopathological study of benign breast lesions in surgically excised specimens in a tertiary care hospital.

Background: Distinguishing benign breast diseases (BBDs) from malignant breast diseases is a worrisome entity and should also have knowledge of the pattern of occurrence of the disorders in their geographical location. This research aimed to study the clinical and histopathological pattern of BBD in Indian patients. Materials and Methods: The study was conducted on 153 specimens from lumpectomy, core needle biopsy, and mastectomy. Data regarding patients' age, sex, presenting complaints, duration of the complaints, and history of menstrual cycles and lactation were collected from the biopsy requisition forms and case papers. The tissue bits were processed and stained with hematoxylin and eosin, and a histopathological examination was performed. Results: Most of the patients in the present study were females (n = 151, 98.7%). The mean age of the patients was 30.45 years. Most of the BBD cases (n = 118, 77.14%) were benign, of which fibroadenoma (101 cases) accounted for 66%. Majority of the lesions were in the upper outer quadrant (39.22%). Of the 153 cases, 94 cases of fibroadenoma, one case of breast abscess, nine cases of fibrocystic change, four cases of phyllodes, three cases of lipoma, and one case of gynecomastia diagnosed clinically correlated well with histopathology (n = 112, 73%). Conclusion: BBDs are mostly seen in female patients in the age group of 21-30 years. Fibroadenoma is the most common BBD. Clinical assessment followed by histopathological examination provided an accurate diagnosis. The clinical diagnosis correlated well with histopathology.

Pseudoangiomatous stromal hyperplasia of the breast: Clinical evaluation.

BACKGROUND: Pseudoangiomatous stromal hyperplasia is a rare benign breast stromal proliferative lesion of the breast. Clinical presentation ranges from rapidly growing mass to incidental identification in routine screening. This difference in manifestation and its rarity makes it difficult to be a standard treatment protocol. Therefore, we aimed to share our clinical experience in Pseudoangiomatous stromal hyperplasia. METHODS: The files of patients who underwent core biopsy or surgical excision due to a breast mass and resulted in pseudoangiomatous stromal hyperplasia between January 2013 and December 2021 were included in the study. RESULTS: 17 patients with a median age of 37 (22-68) were found Pseudoangiomatous stromal hyperplasia confirmed by surgical excision or core biopsy. Chosen treatment option was observation in 8 patients (47.1%), while surgical excision was used in 9 (52.9%) patients. The mean follow-up period was 55.24 ± 26.72 (13-102) months. None of the patients observed the Malignant transformation during the follow-up period. CONCLUSION: For Pseudoangiomatous Stromal Hyperplasia of the breast, surgical excision with clean margins or close follow-up after diagnosis confirmation by tissue biopsy is sufficient. Pseudoangiomatous Stromal Hyperplasia is not a risk factor for developing breast cancer.

Diagnóstico de precisão das lesões mamárias / Accurate diagnosis of breast lesions

PONTOS-CHAVE As lesões mamárias compreendem uma ampla variedade de diagnósticos que apresentam comportamentos diversos. As lesões mamárias podem ser classificadas como lesões benignas, de potencial de malignidade indeterminado (B3), carcinoma in situ e carcinoma invasor. Na era da medicina personalizada, individualizar e obter um diagnóstico preciso faz grande diferença no desfecho final da paciente, principalmente no caso do câncer de mama. Exames de imagem direcionados e de qualidade, métodos de biópsia adequadamente selecionados e análises de anatomopatologia convencional, imuno-histoquímica e até molecular são determinantes no diagnóstico e no manejo das pacientes.

Exploration of utility of combined optical photothermal infrared and Raman imaging for investigating the chemical composition of microcalcifications in breast cancer.

Microcalcifications play an important role in cancer detection. They are evaluated by their radiological and histological characteristics but it is challenging to find a link between their morphology, their composition and the nature of a specific type of breast lesion. Whilst there are some mammographic features that are either typically benign or typically malignant often the appearances are indeterminate. Here, we explore a large range of vibrational spectroscopic and multiphoton imaging techniques in order to gain more information about the composition of the microcalcifications. For the first time, we validated the presence of carbonate ions in the microcalcifications by O-PTIR and Raman spectroscopy at the same time, the same location and the same high resolution (0.5 µm). Furthermore, the use of multiphoton imaging allowed us to create stimulated Raman histology (SRH) images which mimic histological images with all chemical information. In conclusion, we established a protocol for efficiently analysing the microcalcifications by iteratively refining the area of interest.