The Role of Establishing a Multidisciplinary Team for Idiopathic Granulomatous Mastitis in Improving Patient Outcomes and Spreading Awareness about Recent Disease Trends

Background. Iidiopathic granulomatous mastitis (IGM) is stereotypically described as a mysterious entity that mimics breast carcinoma imposing management challenges. In 2002, we established a multidisciplinary team to treat patients with IGM. This study aimed to evaluate the role of this team in improving patient outcomes. Also, a review of literature is provided to highlight recent disease trends. Patients and Methods. Pertinent data for 44 patients treated for IGM from 2002 to 2018 were analyzed and compared to data prior to 2002. Results. Mean age at diagnosis was 37.9 years ± 6.4. The diagnosis of IGM was confirmed by True-cut biopsy (TCB), Frozen section (FS), and surgical biopsy in 70.5%, 25%, and 4.5% of patients, respectively. FS was used to assess the resection margins in three patients. Suspicion for malignancy was raised in one out of 39 ultrasound reports, and one out of 20 mammography reports. Wide local excision was the main treatment modality (95.5%). 19 patients (43.2%) received corticosteroids. Prior to 2002, IGM was only recognized after surgical resection with a 71% initial false impression of carcinoma. After 2002, the initial false clinical impression of carcinoma dropped to 29.5%. Recurrence rate was 31.82%. Younger age at diagnosis was significantly associated with recurrence (χ2 = 5.598; p=0.018). Chi-square analysis showed no significant association between BMI and recurrence (χ2 = 0.776; p=0.678). Conclusion. The establishment of a multidisciplinary team for IGM was associated with a reduced erroneous impression of breast cancer, and a reduced false positive radiological diagnosis of breast carcinoma. FS was a useful confirmatory procedure. Our series included the first case of a diffuse papular rash as a systemic manifestation of IGM. Recent literature indicates that IGM is changing its face. IGM is being reported in all age groups, and even in males. The clinical manifestations have markedly expanded. Diagnosis by TCB has replaced blind surgical excision. More data regarding predictors of recurrence is accumulating

The association between interdigital pilonidal sinus and animal groomers is a historical narrative correlation and not a true occupational hazard

IntroductionPilonidal sinus (PNS) is a small hole or “tunnel” in the skin that frequently occurs in the sacrococcygeal region. Nevertheless, PNS has been reported to occur between the fingers (interdigital) in barbers, hairdressers, and animal groomers. The aim of this study was to estimate the prevalence of interdigital PNS among animal handlers in Bahrain and to treat any patients encountered.MethodsThis is a cross-sectional study with convenience sampling from November 2020 to October 2021. The study participants were animal handlers from stables, veterinary, and pet shops in Bahrain. There were 43 males and 7 females with direct animal contact. 86% of the study population were handling horses, and 15% were handling different types of animals.ResultsNo positive cases of interdigital PNS among participants were found, this might reflect the positive impact of good personal hygiene among our study population. Our study shows that groomers in Bahrain frequently wash their hands after handling animals, and 98% have a daily habit of bathing after work. It was also estimated that 60% of the participants use gloves to handle animals themselves or their waste.DiscussionThis could be the first study looking at the prevalence of interdigital PNS in animal groomers worldwide. The absence of any case report of interdigital PNS among animal groomers in the recent literature strengthens our assumption that the association between interdigital PNS and hair grooming could be a narrative coincidence rather than a true occupational hazard. The present work may help in better understanding of occupation-disease association, and highlights the importance of mass screening of animal handlers for occupation-dependent health problems