Evaluation of significantly changed chemokine factors of idiopathic granulomatous mastitis in non-puerperal patients.

Idiopathic granulomatous mastitis (IGM), a recurrent inflammation disease of the non-lactating breast, has had an increasing clinical morbidity rate in recent years, and its complicated symptoms and unclear etiology make it challenging to treat. This rare benign inflammatory breast disease, centered on the lobules, represents the most challenging type of non-puerperal mastitis (NPM), also known as non-lactating mastitis. In this study, patients diagnosed with IGM (M, n = 23) were recruited as cases, and patients with benign control breast disease (C, n = 17) were enrolled as controls. Cytokine microarray detection measured and analyzed the differentially expressed cytokine factors between IGM and control patients. Then, we verified the mRNA and protein expression levels of the significantly changed cytokine factors using Q-RT-PCR, ELISA, western blot, and IHC experiments. The cytokine factor expression levels significantly changed compared to the control group. We observed a significant increase between IGM and control patients in cytokine factors expression, such as interleukin-1ß (IL-1ß), monokine induced by gamma interferon (MIG), macrophage inflammatory protein (MIP)-1α, MIP-1ß, tumor necrosis factor receptor 2 (TNF RII). Then, we verified the expression of these top five dysregulated factors in both mRNA and protein levels. Our results demonstrated the cytokine map in IGM and indicated that several cytokines, especially chemokines, were associated with and significantly dysregulated in IGM tissues compared to the control group. The chemokine factors involved might be essential in developing and treating IGM. These findings would be helpful for a better understanding of IGM and offer valuable insights for devising novel diagnostic and therapeutic strategies.

MAC mediates mammary duct epithelial cell injury in plasma cell mastitis and granulomatous mastitis.

Plasma cell mastitis (PCM) and granulomatous mastitis (GM) are common inflammatory nonbacterial mastitis (NBM). However, the pathogenesis of NBM is still unclear. METHODS: In this study, we statistically analyzed the pathological features of PCM and GM using pathological HE staining and tissue transmission electron microscopy. The levels of MAC (C5b-9n), P-selectin, E-selectin, and ICAM-1 were detected through IHC, WB, ELISA, and qPCR. The expression level and location of MAC were observed by tissue immunological electron microscopy. In addition, exosomes were isolated from tissues, identified using transmission electron microscopy, and the densities were detected by Nano-FCM. Finally, the expression intensity of MAC in exosomes was detected by flow cytometry and immunoelectron microscopy. RESULTS: The damage and apoptosis of mammary duct epithelial cells are the common pathological features of PCM and GM. MAC is primarily located in the cell membrane of mammary ductal epithelial cells and is significantly expressed in PCM and GM. The density of exosomes in PCM and GM tissues was elevated, and MAC was highly expressed in exosomes. In addition, the expression of P-selectin, E-selectin, and ICAM-1 in PCM and GM was significantly higher than in the normal group. CONCLUSION: We found severe damage of the mammary duct epithelial cells in PCM and GM tissues, which was verified by relevant pathological methods. Earlier studies demonstrated that MAC is highly expressed in PCM and GM tissues and exosomes seem to play a very important role in the understanding of MAC. Furthermore, MAC is involved in inflammatory infiltration and lesion of mammary duct epithelial cells upregulated by P-selectin, E-selectin, and ICAM-1. These findings provide new insights into PCM and GM molecular mechanisms.

Mastitis granulomatosa / Granulomatous mastitis

La mastitis granulomatosa es una rara enfermedad de la mama de tipo inflamatorio, de causa desconocida, que se encuentra en pacientes premenopáusicas. Las características clínicas y radiológicas son similares a la de la tuberculosis y al carcinoma de mama, por lo que el clínico debe tenerla presente sobre todo al obtener cultivos persistentemente negativos y/o biopsias no concluyentes, y siempre descartando otras patologías antes de iniciar un tratamiento. El hallazgo clínico más frecuente es el de un bulto en la mama, que suele ser unilateral y de características inflamatorias. Se debe ser cuidadoso al hacer el diagnóstico para evitar que estas pacientes sean sometidas a mastectomía por error. La biopsia excisional para una evaluación histopatológica esta recomendada en todos los casos. El diagnóstico histológico está caracterizado por una lobulitis necrosante granulomatosa crónica con microabscesos. Entre de los tratamientos que han sido utilizados, se encuentran la escisión quirúrgica, corticoterapia, antibioticoterapia y metotrexato (MTX), con eficacia variable. La modalidad de tratamiento inicial preferida es antibioticoterapia previa a los corticoides. Sin embargo, el método más apropiado aún parece poco claro. Se recomienda un seguimiento a largo plazo por el alto índice de recurrencias que presenta esta enfermedad. Presentamos el caso de una mastitis granulomatosa en la que se han usado corticoides inicialmente y posteriormente se reforzó con MTX, con remisión completa de la misma

Granulomatous mastitis is a rare inflammatory disease of the breast with no known cause that occurs in premenopausal women. The clinical and radiological features are similar to those of tuberculosis and breast carcinoma and consequently clinicians should consider this diagnosis in patients with persistently negative cultures and/or inconclusive biopsies. Other diseases should always be excluded before treatment is begun. The most frequent clinical finding is a lump in the breast. These lumps are usually unilateral and inflammatory. Correct diagnosis is essential to ensure that these patients do not undergo an unnecessary mastectomy. Excisional biopsy for histopathological analysis is recommended in all patients. Histological diagnosis is characterized by chronic necrotizing granulomatous lobulitis with microabscesses. Treatments include surgical excision, corticosteroids, antibiotics, and methotrexate, with variable efficacy. The preferred initial treatment is antibiotic therapy prior to steroids but the most appropriate method remains unclear. Long-term monitoring is recommended due to the high recurrence rate of the disease. We present a case a granulomatous mastitis that was initially treated with corticosteroids and subsequently by methotrexate, with complete remission of the disease

Inflammatory diseases of the non-lactating female breasts.

UNLABELLED: Chronic inflammatory diseases of the non-lactating breasts cause considerable difficulty in diagnosis and treatment. There is a spectrum of aetiological factors ranging from infection to autoimmune disorders. The disease causes considerable morbidity and psychological distress in relatively young females. The study aimed to analyse the spectrum of chronic disease and to formulate a treatment protocol. METHOD: Female patients with histological confirmation of inflammatory disease of the breast in the non-lactational phase were included in the study. The patients were categorized based on histological findings supplemented with immunohistochemical staining with CD3 and CD20 antibodies. RESULT: Out of 50 patients included in the study, 38 patients (76%) were diagnosed as idiopathic granulomatous mastitis (IGM) and 12 (24%) patients as periductal mastitis (PD). The possible aetiology of IGM was localized autoimmunity as evidenced by the infiltration of CD3 positive T lymphocyte. Systemic prednisolone was given for 6 months and 95.6% patients were disease-free after 24months. Out of 15 patients who did not receive prednisolone, only 2 patients were disease-free after 24 months (p = .003). CONCLUSION: Idiopathic granulomatous mastitis is an uncommon inflammatory disease of the non-lactating breast. The combination of limited surgical treatment and systemic prednisolone given for 6 months effectively controls the disease as well as prevents recurrence.