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Resume Introduction La mastite granulomateuse idiopathique (MGI) est une inflammation du sein d’origine inconnue qui doit etre distinguee des tumeurs et des infections mammaires, y compris la tuberculose. La MGI est une cause rare d’erytheme noueux : nous presentons un cas de cette association, utile a connaitre pour le dermatologue. Observation Une femme de 32 ans, nullipare, consultait pour un erytheme noueux des membres inferieurs, des arthralgies inflammatoires et un syndrome febrile. L’examen trouvait un sein droit retracte, irregulierement bossele et indure sur une surface de 5 cm, douloureux a la palpation, associe a une adenomegalie sous-axillaire homolaterale. La lesion mammaire etait apparue progressivement 4 mois auparavant ; elle avait ete exploree par une cytoponction et deux biopsies qui n’avaient pas trouve de cellules tumorales suspectes mais un aspect d’inflammation subaigue a chronique granulomateuse. La recherche de mycobacteries sur les prelevements biopsiques etait negative a l’examen direct et en culture. Les autres explorations etiologiques de l’erytheme noueux etaient negatives. Le diagnostic retenu etait celui d’erytheme noueux associe a une MGI. Une corticotherapie generale etait debutee, permettant une regression de l’ensemble des manifestations, mais une rechute survenait sur le sein controlateral lors de la decroissance de la corticotherapie. Discussion La MGI est une inflammation subaigue aseptique du sein, d’origine inconnue. Son diagnostic repose sur l’examen anatomopathologique et l’exclusion des autres causes de granulomes. Les manifestations extra-mammaires sont rares et concernent l’erytheme noueux, des arthralgies et des episclerites. La prise en charge est mal codifiee.

Idiopathic granulomatous mastitis (IGM) is a benign, aseptic inflammatory disease of unknown origin, which must be distinguished from tumoral and infectious processes that affect the breast, including tuberculosis. IGM is a rare cause of erythema nodosum, but it is useful for dermatologists to be aware of this association.A 32-year-old nulliparous woman presented with erythema nodosum, arthralgia and fever. On examination, she had a firm and painful mass of 5cm in the right breast with retraction and axillary adenopathy. The breast lump developed gradually over the preceding 4 months. Although two biopsies showed no evidence of atypical cells, inflammatory areas and a granulomatous process were seen. Culture of breast tissue for mycobacteria was negative. A diagnostic of idiopathic granulomatous mastitis was made. Systemic corticosteroids led to a reduction in size of the mass, but relapse occurred in the contralateral breast on dose-reduction of the corticosteroids.IGM is a rare disease of unknown aetiology. Diagnosis is based on characteristic histological features and exclusion of other granulomatous diseases. Extra-mammary signs are rare and include erythema nodosum, arthralgia and episcleritis. Management is poorly codified.

After recalling the classical contra-indication of hormone replacement therapy (HRT) concerning patients with a personal history of breast cancer (BC), and arguments that may be opposed, the authors report the present results of a prospective study undertaken in the Center of Breast Diseases in Saint-Louis hospital in Paris since February 1992.By April 2001, 230 patients had been included. A free interval of 2 years at least since the treatment of the primary BC has been observed. The reasons for prescribing HRT were vasomotor troubles (flushes, nightly sweats) or a dyspareunia, which were severe and not controlled by non-hormonal treatments. There was also an indication of a major osteoporotic or cardiovascular danger. In fact, many of these patients had a premature, artificial, chemo-induced menopause. The HRT most often used was an estro-progestin association (estradiol + a progestin compound) given either continuously or with a 5-d interruption each month. The mean duration of treatment was 2.5 years.Results, concerning the improvement of menopause troubles, were remarkable in the great majority of troubles. HRT had to be stopped in 39 cases, reading as follows: 17 cases for relapses (seven local, six in the contro-lateral breast and four metastases (7%)). Also, 22 patients (9%) interrupted their HRT for serious side-effects. A case-control study did not show any significant difference between with and without HRT patients concerning the overall survival without relapse.Quality of life of patients was often substantially improved, and a deleterious effect on the cancer disease was not found. Our results are in agreement with the literature from other countries. However, one must be cautious. In such circumstances, HRT must be prescribed with the informed consent of the patients and delivered in appropriate hospital and university centers. It is wished that large randomised prospective studies may be undertaken.

Introduction La mastite granulomateuse idiopathique (MGI) est une inflammation du sein d’origine inconnue qui doit etre distinguee des tumeurs et des infections mammaires, y compris la tuberculose. La MGI est une cause rare d’erytheme noueux : nous presentons un cas de cette association, utile a connaitre pour le dermatologue. Observations Une femme de 32 ans, nullipare, consultait pour un erytheme noueux des membres inferieurs, des arthralgies inflammatoires et un syndrome febrile. L’examen trouvait un sein droit retracte, irregulierement bossele et indure sur une surface de 5 cm, douloureux a la palpation, associe a une adenomegalie sous-axillaire homolaterale. La lesion mammaire etait apparue progressivement 4 mois auparavant ; elle avait ete exploree par une cytoponction et deux biopsies qui n’avaient pas trouve de cellules tumorales suspectes mais un aspect d’inflammation subaigue a chronique granulomateuse. La recherche de mycobacteries sur les prelevements biopsiques etait negative a l’examen direct et en culture. Les autres explorations etiologiques de l’erytheme noueux etaient negatives. Le diagnostic retenu etait celui d’erytheme noueux associe a une MGI. Une corticotherapie generale etait debutee, permettant une regression de l’ensemble des manifestations, mais une rechute survenait sur le sein controlateral lors de la decroissance de la corticotherapie. Une ponction evacuatrice a visee symptomatique ainsi qu’une reascension de la corticotherapie generale etaient alors realisees. L’erytheme noueux disparaissait en quelques semaines. Discussion La MGI est une inflammation subaigue aseptique du sein, d’origine inconnue. Elle affecte la femme jeune, en periode d’activite genitale et mime souvent cliniquement et radiologiquement un abces ou un carcinome mammaire. Elle se presente sous la forme d’une masse ferme, inflammatoire et mal limitee, souvent douloureuse, pouvant secondairement s’abceder. Son diagnostic repose sur l’examen anatomopathologique et l’exclusion des autres causes de granulomes. La prise en charge therapeutique n’est pas codifiee mais fait classiquement appel a la corticotherapie generale. Les manifestations extra-mammaires sont rares et concernent l’erytheme noueux, des arthralgies, des episclerites et la maladie de Verneuil. Moins de 15 cas d’association a un erytheme noueux sont rapportes dans la litterature. D’autre part, l’association possible a une hidradenite suppuree pose la question d’une parente nosologique entre les deux affections. La prise en charge est mal codifiee. Conclusion Les similitudes cliniques avec l’hidradenite suppuree suggerent l’existence d’un lien possible entre ces deux entites et semblent interessantes sur le plan therapeutique. En effet, le role de l’infliximab n’a pas ete etudie dans le traitement de la MGI et pourrait constituer une alternative therapeutique interessante dans les formes severes corticoresistantes.

Plasma cell mastitis is a rare form of inflammatory, non-infectious, non-neoplastic, mastitis, not occurring during the post-partum and breastfeeding period. The pathogenesis of this lesion is not yet fully elucidated and an auto-immune origin is currently proposed. The common feature of this form of mastitis is the possibility of evolving towards recurrent aseptic abscesses. Treatment remains difficult and relapses are frequent with fistula formation to the skin, either spontaneously, or after surgery, even involving wide excision.

9044 Background: Due to the frequency of breast cancer, and to the high proportion of premenopausal women, contraception in survivors is a major concern. In contrast, literature data are dramatically nonexistent. Classical options included local methods, copper or hormonal (LNG) intrauterine devices (IUD). Little is known about the use of estroprogestins or progestative only contraception. The aim of this survey is to describe French current practice regarding contraception after breast cancer. Methods: A retrospective study was conducted between 1 June 2002 and 1 January 2003. Premenopausal patients with previous history of breast cancer, still menstruating, and consulting for contraception desire were included. 2,500 forms were sent to French gynecologist members of the GERM, FNCGM, and SFG, and 197 responses were obtained. Results: Median age was 38,6 years old. Tumor characteristics were invasive carcinoma (88%) versus in situ carcinoma (11.9%), N+ disease (18.9%) versus N-(48.6%), HR + (51.8%), HR- (...

The mammary cyst is part of the fibro-cystic disease. Only cysts with a diameter of more than 3 mm would have a pathological significance. Its clinical symptomatology is well known. The clearing puncture is the essential diagnostic and therapeutic act. Mammography, sustained by cystography, furnishes highly worthy information. Thermography and ultra-sonography may also be useful. Its pathogeny is still being very much discussed. Hormonal factors are incriminated: hyperestrogenemia, luteal deficiency, dysprolactinemia are inconstant. They are neither necessary nor sufficient to induce the cystic disease. The titration of TeBG may perhaps open an interesting path for research. The study of intracystic steroids (among which DHEAS) furnishes instructive results. Intracystic glycoproteins, proteins and electrolytes are also the objects of promising research. Recently, the interest lying in the study of EGF, its possible relation to DHEAS and the intracystic Na/K ratio were emphasized. It is also important to notice the presence of cysts with a flat wall or with a hyperplastic wall, of the apocrine type. The psychogenic factors seem to be determining in the cystic flare-ups. The relations with breast cancer remain the fundamental problem. Although the cyst itself only exceptionally degenerates into cancer (cyst-epithelioma), the very presence of a macrocytic disease multiplies by 3 or 4 the risk of cancer. The treatment is composed of psychotherapy, tranquillizers and a clearing puncture of the strained cysts. The administration of phlebotonics, anti-prostaglandins, colostrum extracts, can give substantial results. The author gives details about the part of hormonal treatment as a function of the titrations and the severity of the case. If it appears necessary to block the gonadotropic function, Danazol is a very effective agent. Surgery has but a small place. Indication of subcutaneous mastectomy will rest upon a very severe case-selection.

The Authors report their experience in a double-blind, crossover study (danazol versus placebo) in 38 patients suffering from severe benign mastopathy. The results were evaluated with regard to clinical data (mastodynia, breast nodularity) and data from comparative infrared thermography. Danazol was given in a dose of 400 mg/day for 3 months. Placebo, in identical packing, was also given for a three month period. In 32 cases out of 38, there was an improvement with Danazol treatment. For some patients, thermography was more precise than clinical part. Side effects consisted predominantly of menstrual disorders recorded in 30 cases and a generally moderate weight gain in 23 cases. In the light of these results it appears that danazol constitutes a powerful agent in the treatment of severe benign mastopathy of the breast. The best dosage and best duration of treatment remain to be specified. Finally, the original contribution of the thermographic document deserves to be underlined.