Idiopathic Granulomatous Mastitis Diagnostic strategy and therapeutic implications in Omani patients

Objectives: Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. Methods: From 2009–2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. Results: The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months (11–33 months). All patients had complete remission with no further recurrence. Conclusion: This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGM’s excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat

Metastatic Invasive Lobular Carcinoma of the Breast Masquerading as a Primary Renal Malignancy

Breast cancer is known to metastasise to different organs in the body, but an initial presentation of breast cancer with loin pain secondary to a metastatic renal mass is extremely rare. We report a 58-year-old woman who presented with recurrent left loin pain due to a metastatic deposit of invasive lobular carcinoma of the breast. The detection of a renal mass on computed tomography led to the assumption of a renal pelvic malignancy. The diagnostic dilemma posed by the detection of a breast mass during staging and the usefulness of immunohistochemistry in the confirmation of diagnosis are discussed

Tc-99m Tetrofosmin Scintimammography for the Detection of Recurrent Breast Cancer in a Patient with Equivocal Mammography Study

This is a case report describing a patient at Sultan Qaboos University Hospital, Oman, with recurrent local breast cancer and axillary lymph node metastasis. The cancer was detected with 99Tc-m tetrofosmin scintimammography after an equivocal mammography study

Breast One Stop Clinic – Follow up Experience at Sultan Qaboos University Hospital in the Sultanate of Oman

Background: The role of the breast clinics is to diagnose breast cancer and reassure patients with benign disorders. One stop clinics - same day reporting - further reduce anxiety caused by the delay in the results. The first one stop clinic was introduced in SQUH–Oman in September 2011. Methods: This retrospective analysis of 395 consecutive cases presented to Breast One Stop Clinic at SQUH was done between September 2011 and December 2013. All patients underwent triple assessment conducted by consultants. Mammography was performed for patients above 35 years with no contraindications. Ultrasound was done for all patients with palpable lesions. The reports were assigned a score (BIRADS 0-6). Fine Needle Aspiration Cytology (FNAC) was done for all patients with palpable abnormality or nipple discharge. An immediate report was given using the standard reporting categories: acellular/inadequate, benign, atypical, suspicious, and malignant (C1-C5). Results: Out of 395 patients, 210 were found to have palpable lesions with a mean age of 36 years (12-84 years). All patients were female. The FNAC sensitivity and specificity was 95.7% and 92.2%, respectively. Out of 210 patients, 15.3% were diagnosed with breast cancer on FNAC who were subsequently staged and discussed in the Breast Multidisciplinary Team Meeting (MDT), and 84.7% were diagnosed to have benign breast disorders who were reassured and advised to be followed up after 6 months. Conclusions: Immediate relief and reassurance to the majority of patients with benign disease obviate the need for review appointments. A reliable diagnosis can be obtained with triple assessment which can be used to avoid unnecessary core biopsy of benign lesions, if correctly done

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population