title: Cystic Neutrophilic Granulomatous Mastitis: Further Characterization of a Distinctive Histopathologic Entity Not Always Demonstrably Attributable to Corynebacterium Infection.
abstract: Granulomatous lobular mastitis (GLM) is an uncommon condition that typically occurs in parous, reproductive-aged women and can simulate malignancy on the basis of clinical and imaging features. A distinctive histologic pattern termed cystic neutrophilic granulomatous mastitis (CNGM) is seen in some cases of GLM and has been associated with Corynebacterium infection. We sought to further characterize the clinical, imaging, and histopathologic features of CNGM by studying 12 cases and attempted to establish the relationship of this disease with Corynebacterium infection. Patients were women ranging in age from 25 to 49 years (median: 34 y), and all presented with a palpable mass that was painful in half of the cases. In 2 of 9 cases, imaging was highly suspicious for malignancy (BI-RADS 5). CNGM was characterized by lobulocentric granulomas with mixed inflammation and clear vacuoles lined by neutrophils within granulomas. Gram-positive bacilli were identified in 5/12 cases. In 4 patients, the disease process worsened after the diagnostic core biopsy, with the development of a draining sinus in 2 cases. No growth of bacteria was seen in any microbial cultures. No bacterial DNA was identified by 16S rDNA polymerase chain reaction for 1 case that showed gram-positive bacilli on histology. Patients were treated with variable combinations of surgery, antibiotics, and steroids. The time to significant resolution of symptoms ranged from 2 weeks to 6 months. Similar to other forms of GLM, CNGM can mimic malignancy clinically and on imaging. When encountered in a needle core biopsy sample, recognition of the characteristic histologic pattern and its possible association with Corynebacterium infection can help guide treatment.
authors.affiliation: Departments of *Pathology and Laboratory Medicine †Surgery ‡Radiology, Weill Cornell Medical College, New York, NY.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: D'Alfonso
authors.forename: Tracy-Ann
authors.initials: TA
authors.lastname: Moo
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Arleo
authors.forename: Esther
authors.initials: E
authors.lastname: Cheng
authors.forename: Lilian B
authors.initials: LB
authors.lastname: Antonio
authors.forename: Syed A
authors.initials: SA
authors.lastname: Hoda
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D003131:Combined Modality Therapy; D003354:Corynebacterium Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D005260:Female; D058890:Granulomatous Mastitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009504:Neutrophils / Q000382:microbiology / Q000473:pathology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids