Cystic neutrophilic granulomatous mastitisa review of 12 consecutive cases Aims: Cystic neutrophilic granulomatous mastitis (CNGM) is an uncommon but increasingly recognised cause of mastitis, often associated with Corynebacterium ssp. infection. We studied the histopathological and clinical features of CNGM in a Canadian setting, and the work-up required to identify pathogenic microorganisms. Methods and results: A retrospective search for breast specimens with abscess, acute, chronic and/or granulomatous inflammation from 1998 to 2018 was performed. Haematoxylin and eosin slides were reviewed for typical histological features of CNGM. Histochemically stained slides for microorganisms were also reviewed. Repeat Gram stains were performed if initially negative. Electronic medical records were abstracted for microbiology results and relevant clinical data. Twelve cases were identified. All were female, aged 25-57 years, mainly Caucasian, with one Venezuelan and two of Chinese ethnicity. Most were parous (10 of 12); five of 12 had an endocrinopathy. Bacteria were identified in one or more specimens from eight of 12 patients; additional Gram stains revealed organisms in four of 12 cases. Of four bacterial cultures, one grew Corynebacterium kroppenstedtii. 16S polymerase chain reaction for three samples was negative. Two patients had multiple breast biopsies, showing early palisaded granulomas followed by classic features of CNGM. The patients had various management approaches, including surgery and antimicrobials. Conclusions: CNGM may present as palisaded granulomatous inflammation, without the expected 'cystic' pattern, suggesting that there is an evolution of histomorphology with this infection. Most patients with CNGM are parous, and there may be an association with endocrinopathies. Application of multiple Gram stains increases the yield of microorganism identification. Recognition of CNGM in breast biopsies and collaborative communications are essential to direct appropriate therapy.

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INTRODUCTION: A review of current literature shows eosinophilic esophagitis and sloughing esophagitis as two distinct esophageal conditions that are diagnosed using clinical and pathological findings unique to each condition. Eosinophilic esophagitis is a known inflammatory condition associated with atopy, where high concentrations of eosinophils are found in the esophageal tissues resulting in esophageal dysfunction. Sloughing esophagitis however, is the necrosis and parakaratosis of longitudinal segments of surface esophageal squamous epithelium with intact underlying squamous epithelium underneath. This has been mainly associated with exposure to chemical esophageal irritants such as bisphosphonates and, on rare occasions, inflammatory conditions such as celiac disease. CASE DESCRIPTION/METHODS: We will describe a case of an otherwise healthy adult patient with eosinophilic esophagitis that presented to the emergency department repeatedly for food boluses. She was referred to gastroenterology and diagnosed with eosinophilic esophagitis. Unfortunately she was refractory to standard treatments to manage symptoms such as antiacid agents, inhaled corticosteriods, viscous budesonide, prednisone, and leukotriene receptor antagonists. She underwent a 6 food elimination diet to help identify a food trigger. Although improvement of her symptoms were seen with 6 food elimination, the reintroduction of wheat caused a return of her eosinophilic esophagitis symptoms, as well as findings on endoscopy consistent with sloughing esophagitis. DISCUSSION: An increasing incidence of both conditions presenting in the same patient may be suggestive of a similar underlying mechanism, and given the clinical context of this case, both conditions may be reflective of an immune-mediated response to a specific antigen trigger.