AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/cc.2021/002
1 Dept of Surgical Oncology, Vedant Cancer & Multispecialty Hospital, Mumbai, India.
2 Dept of Ophthalmology, Conwest & Jain Superspeciality Eye Hospital, Mumbai, India
*Corresponding Author: Sachin S Kadam, Dept. of Surgical Oncology, Vedant Cancer & Multispecialty Hospital, Mumbai, India
Citation: Sachin S Kadam, Tejaswini Kadam. (2021) A Rare Presentation of Aspergillosis of Breast Masquerading As Breast Carcinoma: A Case Report. Carcinogenesis and Chemotherapy, 1 (1); DOI:10.31579/cc.2021/002
Copyright: © 2021 Sachin S Kadam, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in Any medium, provided the original work is properly cited.
Received: 19 May 2021 | Accepted: 26 May 2021 | Published: 26 June 2021
Keywords: aspergillosis; breast; immunocompetent; carcinoma; surgical excision
Introduction: We are reporting a case of 39 year old lady who presented with large lump in the breast mimicking as breast carcinoma and after surgical excision diagnosed as breast aspergilloma. Aspergillus fungal infection of the breast is a very rarely encountered phenomenon. In the literature, only countable cases has been reported which were also encountered in immunosuppressed host. Breast aspergilloma in an immunocompetent patient is an extremely rare situation. The source of breast fungal infections are considered via contamination of implants during manufacture, airborne dissemination, hematogenous dissemination or nosocomial spread from the operating room environment. The most common presumed source in most of the patients is considered as airborne infection during a surgical procedure. A team of surgeon, pathologist and microbiologist are necessary for the diagnosis and management of patients with aspegillus infection of the breast. Breast aspergilloma patients should be addressed with early and aggressive surgical and medical treatment.
Aspergillus is a ubiquitous saprophytic fungus. Near about 200 species has been detected which may cause pulmonary aspergilloma, allergic bronchopulmonary aspergillosis, endocarditis, paranasal sinus infection and implant infections [1]. Aspergillus fungal infection is usually encountered in immunocompromised individuals with very are occurrence in immunocompetent host [2]. Species belonging to this group are A. fumigates, A.flavus, A. Niger, A. terreus [3]. Fungal infections of the breast have been reported in association with prosthetic breast implants [4].
The source of breast fungal infections are considered via contamination of implants during manufacture , airborne dissemination, hematogenous dissemination or nosocomial spread from the operating room environment or instruments during surgery [5]. The most common presumed source in most of the patients is considered as airborne infection during a surgical procedure [6]. We are reporting a case of 39 year old lady who presented with large lump in the breast mimicking as breast carcinoma and after surgical excision diagnosed as breast aspergilloma.
A 39 year old lady with Eastern Cooperative Oncology Group Performance Status 1 (ECOG PS – 1) with no comorbidity presented with a large right breast lump for the last 20 days. There was no positive surgical, family, past or medical history. Obstetric and menstrual history was normal. Patient had noticed right breast lump while bathing around 20 days back. She consulted a local physician who advised her to undergo mammogram and Fine Needle Aspiration Cytology (FNAC). Mammogram was suggestive of large lobulated lesion in the right breast measuring 10x 7.3cm suspicious of breast neoplastic lesion with BIRADS IV –C grading with one sub-centimetre right axillary lymph node of size 1.5x1cm with fatty hilum [Figuare.1].
FNAC was inconclusive. She was referred to our clinic with these reports. On clinical examination, a single, hard, well defined lump was palpable in the right breast in central quadrant with normal nipple-areola complex. A single, mobile lymph node of size 2x1cm was palpable in the right axilla. Left breast and axilla were normal. Rest of the systemic examination was unremarkable. Clinically, the impression of findings was in favor of breast carcinoma. Hence, we advised her to undergo core needle biopsy and it was suggestive of a purulent aspirate with no evidence of atypical or malignancy. Case was discussed in our institutional multidisciplinary tumor board. Our board decided to plan for wide excision of the breast lesion with frozen section control after metastatic work up. Thus, we advised her chest x ray and ultrasound of abdomen with pelvis. Metastatic work up was normal. As per board’s decision, patient underwent wide excision of the breast lesion with adequate margins and specimen was sent for frozen section control. Frozen reported it as pus containing cystic to firm lesion with no evidence of malignancy. Hence, we abandoned the further procedure. Patient was started on oral diet 6 hours post extubation and she was discharged in the evening on the same day. Final histopathology report described presence of multiple whitish, cystic to firm pus containing lesions with presence of dense inflammatory infiltrate with scanty granulomatous inflammation and multinucleate giant cells with no evidence of malignancy. Gene expert and culture was negative for mycobacterium tuberculosis and positive for aspergillus flavum [Figure 2, 3].
Wound dehiscence occurred on 6th postoperative day. It was managed conservatively with alternate day dressing and after 1 month of dressing wound healed by secondary intension. Palpable axillary lymph node was disappeared after one month. She was in periodic follow up with us according to our institutional follow up protocol and after one year of completion of her treatment, she is disease free.
Aspergillus is an opportunistic fungus. The growth and invasion depends on the biological features of the fungus and the immune status of the host [2]. They produce conidia which defines and characterizes its infectious life cycle [7]. These conidia are responsible for spread of infection onwards. They have a special characteristic of dispersion into the air when they come in contact with compassionate environment like lungs of an immunocompromised host where they germinate and become hyphae. The hyphae is the invasive form of Aspergillus fungus. The hyphal growth has the tendency to invade blood vessels which results in infarction, hemorrhagic necrosis and dissemination to other organ [8]. The most commonly affected organs are the lungs and paranasal sinuses followed by with less frequencies in the skin, heart, kidney, gastrointestinal tract and brain. They manifest with extra-pulmonary signs and symptoms [9]. However, in the index case, there was absence of such positive history.
Aspergillus fungal infection is found in over 90% patients who are immunosuppressed due to bone marrow transplantation, solid organ transplantation, cytotoxic chemotherapy, corticosteroid therapy and AIDS [10]. Aspegillus infection is diagnosed by biopsy with demonstration of septate, acute branching hyphae in the breast tissue [11]. Histopathology helps in detecting aspergillus fungal hyphae in necrotic material with distorted giant cells and final result will be possible after positive fungal culture [11]. The diagnosis is only possible with fungal culture. In immunocompetent patient, it’s difficult to detect aspergillus infection in the breast as radiology will be non-specific. In the index case, only after gene expert and fungal culture, we were able to diagnose aspergillus infection. It’s treating clinician and pathologist’s thinking and implementation which directs and helps in detecting fungal infection.
The treatment of breast aspergilloma needs a combination of surgical and medical treatment to avoid unnecessary complications. The surgical procedure is complete excision of the breast aspergilloma and recommended medical treatment for cutaneous aspergillosis is voriconazole, itraconazole, and amphotericin B. Voriconazole has been shown to be statistically superior to amphotericin B [12]. We did complete surgical excision and she had been given voriconazole in the postoperative period however, wound dehiscence occurred on 6th postoperative day which was managed conservatively with alternate day dressing. Apergillus fungal infection of the breast is one of the causative factor for non-healing breast wound [13].
Surgeon, pathologist, microbiologist should have an idea of organism specific diagnosis when there is aspergillus infection in the breast and especially surgeon should have a high index of suspicion [14]. The aim of presenting this case is to project the fungal infections as one of the rare cause of breast aspegilloma other than mycobacterium [15]. Until now, less than 10 case of breast aspergilloma has been reported in the literature.
Aspergillus fungal infection can involve breast even in immunocompetent host, hence slow growing and long standing breast lump should be investigated with high index of suspicion of aspergillus infection. Breast aspergilloma patients should receive early and aggressive medical and surgical treatment.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
