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Case Reports
. 2012 Jun;7(3):240-244.
doi: 10.1159/000339689. Epub 2012 Jun 22.

Recurrent Mastitis after Core Needle Biopsy: Case Report of an Unusual Complication after Core Needle Biopsy of a Phyllodes Tumor

Nikola Kasprowicz  1 , Gerd J Bauerschmitz, Alexandra Schönherr, Stephan E Baldus, Wolfgang Janni, Svjetlana Mohrmann
Affiliations
Case Reports

Recurrent Mastitis after Core Needle Biopsy: Case Report of an Unusual Complication after Core Needle Biopsy of a Phyllodes Tumor

Nikola Kasprowicz et al. Breast Care (Basel). 2012 Jun.

Abstract
in English, German

BACKGROUND: In the routine work-up of suspect breast lesions, ultrasound-controlled core needle biopsy (CNB) is the most common tool to acquire tissue for histopathologic analysis in a safe, quick and convenient way. Complications are generally rare. The most common complications are hematoma and infection, each with less than 1 in 1000 cases. CASE REPORT: Here, we present a case of a 48-year-old patient who underwent CNB for several lesions that were assessed as Breast Imaging Report and Data System (BI-RADS) IV in breast ultrasound and mammography. In the past, she had had 2 bilateral breast reduction surgeries and 1 open biopsy of a fibroadenoma. Histology revealed a phyllodes tumor. Following this, mastitis occurred which was resistant to common conservative measurements such as intravenous antibiotics over months. Finally, mastectomy was performed, followed by adequate wound healing. CONCLUSIONS: In the presented case, the prolonged course of breast infection after CNB was not as expected. If this occurs, conservative treatment with antibiotics can be initiated. Possible additional risk factors such as diabetes mellitus, steroid therapy, or immunosuppression should be identified. However, in case of missing recovery, wide surgical excision is recommended.

Hintergrund: Zur Abklärung von auffälligen sonographischen Befunden in der Brust gehört in der Hauptsache die Stanzbiopsie. Sie stellt eine bequeme, schnelle und komplikationsarme Methode zur Asservierung von Gewebe zur histopathologischen Diagnosesicherung dar. In sehr seltenen Fällen (weniger als 1/1000) treten Nebenwirkungen wie Hämatome oder Infektionen auf, die in aller Regel gut behandelbar sind.

Fallbericht: Wir möchten hier den Fall einer 48-jährigen Patientin schildern, die aufgrund eines Breast Imaging Report and Data System (BI-RADS) IV-begutach-teten mammasonographischen Befundes eine Stanzbiopsie erhalten hat. In der Vergangenheit wurden bei der Patientin bereits 2 Operationen zur Brustreduktion sowie 1 offene Probeexzision bei einem Fibroadenom durchgeführt. Nach der Biopsie entwickelte die Patientin eine therapierefraktäre Mastitis, die über Monate trotz intensiver konservativer Maßnahmen wie intravenöse Antibiose nicht beherrschbar war. In der Konsequenz wurde eine Mastektomie durchgeführt, an die sich eine adäquate Wundheilung anschloss.

Schlussfolgerungen: Auch wenn es eine täglich eingesetzte, komplikationsarme Methode ist, sollte bei der Anwendung einer Stanzbiopsie an Komplikationen wie Hämatom oder Infektion gedacht werden, gerade wenn Risikofaktoren wie Diabetes mellitus, Kortikoidtherapie oder Immunsuppression hinzukommen. Bei ausbleibender Besserung ist die operative Sanierung zu empfehlen.

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Figures

Fig. 1
Fig. 1
(Top) Mammography of the left breast, CC and OBL projection: confined lobular lesion of 3.5 × 2.5 cm with a well-defined margin in the upper outer quadrant and dystrophic macrocalcifications. (Bottom) Mammography of the right breast, CC and OBL projection: 2 masses (2.6 × 2.4 cm and 1.3 × 1.3 cm) showing progression in size in the upper outer quadrant.
Fig. 2
Fig. 2
(Left) US right breast: lesion suspicious of fibroadenoma. (Right) US left breast: 1 lesion suspicious of fibroadenoma; histology revealed a phyllodes tumor.
Fig. 3
Fig. 3
Histology of the CNB of the left breast at 2 o'clock: benign phyllodes tumor (100 ×).
Fig. 4
Fig. 4
MRI of the breast 9/2009: signs of infection and a lesion corresponding to the phyllodes tumor (left). Several lesions suspect of fibroadenoma and 1 with an assumed phyllodes tumor (right).
Fig. 5
Fig. 5
MRI of the breast 3/2010: constant signs of infection and central necrosis of the fatty tissue. 1 lymph node in the left axilla showed an increase in size.
Fig. 6
Fig. 6
Extension of the mastitis prior to surgery.
Fig. 7
Fig. 7
(Top) Phyllodes tumor of 3 cm in the left breast (100 ×). (Bottom) Signs of severe chronic infection (200 ×).
See this image and copyright information in PMC

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