Breast Mass with Bloody Discharge: A Case of Idiopathic Granulomatous Mastitis

One of the rare identity of breast diseases is Idiopathic Granulomatous Mastitis (IGM), a chronic inflammatory breast condition that can mimic advanced breast cancer. The case came with nipple discharge and mass with skin changes, which was definitively diagnosed following core-cut biopsy of the mastitis group idiopathic granulomatous.

PATHOGENETIC MECHANISMS OF BENIGN BREAST DISEASE DEVELOPMENT IN WOMEN OF FERTILE AGE WITH ENDOMETRIAL HYPERPLASIA

Proliferative changes in the mammary glands very often associate with gynecological diseases. It is the state of receptors for sex steroids in the tissue but not the absolute concentration of hormones in the blood that influences the development of breast and endometrial diseases. It is still unclear how the structure and properties of estrogen (ER) and progesterone (PR) receptors, associated with ESR1 and PRG gene polymorphisms, change. Thus, a new line of scientific research was the examination of microRNA role in the pathogenesis of benign breast diseases in women of fertile age with endometrial hyperplasia. It is known, that microRNAs are involved in many cellular processes, as they influence target genes. The aim of the study was to determine the prognostic significance of epigenetic markers in benign mammary dysplasia pathogenesis in women of fertile age with endometrial hyperplasia. Materials and Methods. The authors examined 69 women aged 18–49, 27 women with endometrial hyperplasia (EН) without atypia and 42 women with benign mammary dysplasia (BMD) with endometrial hyperplasia without atypia. We studied the expression levels of estrogen and progesterone receptors, and their isoform ratio in the blood serum. We also isolated miR-125b, miR-155, miR-222, and miR-429 by real-time PCR. Results. The prevalence of CC allele of the PvuII C/T polymorphism and GG allele of the Xbal A/G polymorphism in ESR1 gene estrogen receptor causes the BMD in women of fertile age with EH, leading to a decrease in ER sensitivity. Epigenetic changes at the microRNA level indicate a decrease in cell adaptiveness, an increase in their proliferative activity, and an induction of angiogenesis. High expression of miR-155, miR-222, and miR-429 indicates poor prognosis for breast cancer patients. The study of correlation of miR-155, miR-222, and miR-429 with the ESR1 estrogen receptor gene polymorphism showed, that the highest Pvull C/T (TT, TC, and CC) and Xbal A/G (AA, AG, and GG) scores were found in women of fertile age with BMD associated with EH. Conclusion. The results of the molecular genetic studies demonstrate the possibility to predict the occurrence and development of breast proliferative diseases in women of fertile age with endometrial hyperplasia. Key words: benign mammary dysplasia, endometrial hyperplasia, estrogen receptors, progesterone receptors, microRNA. Пролиферативные изменения в молочных железах очень часто возникают на фоне гинекологических заболеваний. Решающее значение в возникновении заболеваний молочных желез и эндометрия имеет не абсолютная концентрация гормонов в крови, а состояние рецепторов к половым стероидам в ткани. Остается открытым вопрос об изменении структуры и свойств эстрогеновых (ER) и прогестероновых (PR) рецепторов, связанных с наличием полиморфизмов кодирующих их генов (ESR1 и PRG). Новым направлением научного поиска стало изучение роли микроРНК в патогенезе доброкачественных заболеваний молочных желез при гиперплазии эндометрия в репродуктивном возрасте. Известно, что микроРНК участвуют во многих клеточных процессах, действуя на специфические гены-мишени. Цель исследования. Определить прогностическую значимость эпигенетических маркеров в патогенезе доброкачественной дисплазии молочных желез при гиперплазии эндометрия в репродуктивном возрасте. Материалы и методы. Было обследовано 69 женщин в возрасте 18–49 лет, из них 27 – с гиперплазией эндометрия (ГЭ) без атипии и 42 – с доброкачественной дисплазией молочных желез (ДДМЖ) при гиперплазии эндометрия без атипии. Исследовали уровни экспрессии эстрогеновых и прогестероновых рецепторов, соотношение их изоформ в сыворотке крови. Произвели выделение miR-125b, -155, - 222, -429 методом ПЦР в режиме real time. Результаты. В основе патогенеза развития ДДМЖ при ГЭ в репродуктивном возрасте лежит преобладание аллеля CC полиморфизма PvuII C/T и аллеля GG полиморфизма Xbal A/G гена ESR1 эстрогенового рецептора, что приводит к снижению чувствительности ER. Эпигенетические изменения на уровне микроРНК свидетельствуют о снижении адаптивных свойств клеток, увеличении их пролиферативной активности, индукции ангиогенеза. Высокая экспрессия miR-155, miR-222 и miR-429 является фактором плохого прогноза для больных раком молочной железы. При изучении взаимосвязи miR-155, -222 и -429 с полиморфизмом гена ESR1 эстрогенового рецептора, самые высокие показатели Pvull C/T (ТТ, ТС и СС) и Xbal A/G (АА, АG и GG) выявлены у женщин с ДДМЖ при ГЭ в репродуктивном возрасте. Выводы. На основании полученных результатов молекулярно-генетических исследований дано научное обоснование возможности прогнозирования возникновения и развития пролиферативных заболеваний молочных желез при гиперплазии эндометрия в репродуктивном возрасте. Ключевые слова: доброкачественная дисплазия молочных желез, гиперплазия эндометрия, эстрогеновые рецепторы, прогестероновые рецепторы, микроРНК.

Clinical case: pregnancy-associated breast cancer

This article presents a clinical case of pregnancy-associated breast cancer. We have analyzed the features of the diagnostic algorithm, considered the radiological manifestations and presented the main literature sources about this pathology.Pregnancy-associated breast cancer is breast cancer that occurs during pregnancy or within the first year after a baby birth. It is most often diagnosed only after first clinical symptoms, the most characteristic of which is a feeling of compaction in the breast, less often bloody discharge from the nipple, pain, breast deformation and baby's refusal to breastfeed.Radiological signs of pregnancy-associated breast cancer are not pathognomonic and may mimic benign changes associated with pregnancy and lactation at early stage: lactation adenoma, mastitis, abscess, galactocele, fibroadenoma. Uncertainty of physicians about the harm of radiological methods of examination for pregnant women and the fetus and, consequently, incorrect diagnostic algorithms can delay the early detection of pathology, establish an accurate diagnosis and worsen the prognosis for the patient.Compliance with a sequential diagnostic algorithm using sonographic diagnostics, X-ray mammography with digital breast tomosynthesis, magnetic resonance imaging in accordance with the diagnostic categories of the BI-RADS scale allows you to verify breast tumors. Diagnosis should be consistent with American College Radiology guidelines.In case of detection of suspicious breast pathology in a pregnant woman or woman in labor, a doctor of any specialty should refer the patient to specialized specialists in the diagnosis and treatment of breast diseases. Adherence to the correct algorithms for the appointment, conduct and interpretation of radiological studies, taking into account changes in the breast structure, will allow timely diagnosis, proper treatment and save the lives and health of childbearing aged women.

Accuracy of ultrasound in distinguishing pathology of malignant thyroid diseases: A protocol for systematic review and meta-analysis

Review question / Objective: This meta-analysis aimed to determine the accuracy of ultrasound in distinguishing pathology of malignant thyroid diseases. Eligibility criteria: Type of study. This study will only include high quality clinical cohort or case control studies. Type of patients. The patients should be those who had undergone breast diseases. Intervention and comparison. This study compares AI with pathology for diagnosing breast diseases. Type of outcomes. The primary outcomes include sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and the area under the curve of the summary receiver operating characteristic.

Patients with benign breast disease and breast cancer need more COVID-19 vaccines

Albeit the efficacy of COVID-19 vaccines in immunocompromised patients is undermined, it is still found beneficial. Patients with cancer have a much lower COVID- 19 vaccination rate globally, and the vaccination coverage in breast cancer patients in China remains elusive. A total of 23029 patients with benign breast diseases and breast cancers were included in the study, and the vaccination rates of patients with benign breast tumors and other benign breast diseases, nonmetastatic and metastatic breast cancer were 44.0%, 54.7%, 19.2% and 9.6%, respectively. Breast cancer in situ patients had a similar vaccination rate with patients with benign breast tumors (45.9% vs 44.0%) while those with invasive breast cancer had much lower vaccination rates. The overall vaccination rate remains meager in breast cancer patients, and gap was found in patients with lower clinical stage. Hence vaccination should be further promoted among patients with benign breast diseases and breast cancer.

Histopathological study of benign breast lesions

Benign breast lesions are common in young females and are painless. Fibroadenoma is the commonest lesion among all the breast lesions and occurs in any age.1:To study the age and sex wise distribution of benign breast lesions; 2: To study the clinicopathological changes of benign breast diseases; 3: To study different types of benign breast lesions; 4. To study the histomorphological changes of benign breast lesions with clinical correlation.A prospective study of two years was done to evaluate the different types, patterns of benign breast lesions in females in relation to age, clinical and radiological features.A total of 140 benign breast diseases were studied. Fibroadenoma (76; 54.2%) was the most common lesion noted in younger females (18-24yrs) followed by fibrocystic disease (25; 17.8%) & benign phyllodes (14; 10%).FNAC followed by histopathological examination were the diagnostic criteria used for confirmation of the lesions.Benign breast lesions were common in young females, presented with painless, mobile breast lumps. Mastalgia and nipple discharge were other symptoms.

Urinary estrogen metabolites and breast cancer risk in Chinese population

Background: In China, the association between estrogen metabolism and breast cancer risk and the differences in metabolic pattern between breast cancer patients and controls are poorly understood. Methods: A total of 84 patients with invasive breast cancer and 47 controls with benign breast diseases were included in this study. Estrogen metabolites from their morning urine were determined by HPLC-MS/MS and evaluated in both groups, and the predictive value of each estrogen metabolite in the malignant group according to their menstrual status was analyzed. Results: Urinary concentration of estrogen metabolites 2-OHE1, 2-OHE2, 4-OHE2, 4-MeOE1, and 16ɑ-OHE1 were lower in postmenopausal patients with breast cancer, compared with benign controls, In logistic regression model, breast cancer risk increased with the decline in the levels of 4-OHE2 and 4-MeOE1. In premenopausal patients,, a difference in the level of 2-OHE2 was observed between both groups, and 2-OHE2 was found to have predictive value for breast cancer. Additionally, urinary 2-OHE2 level in premenopausal HR+ patients was considerably higher compared with HR- patients. Conclusions: We found that lower urinary levels of 4-OHE2 and 4-MeOE1had predictive value for breast cancer, and higher 2-OHE1 were associated with HR+ breast cancer in premenopausal women.