2. Inflammatory disorders

Question 1

Types of inflammatory disorders of the breast

Answer 1

1. Acute mastitis
2. Periductal mastitis
3. Mammay duct ectasia
4. Fat necrosis
5. Lymphocytic mastopathy
6. Granulomatous diseases
7. Breast implants/injections

Question 2

Definition of acute mastitis

Answer 2

Acute inflammation of the breast, typically found in post-partum or pre-menopausal women

Question 3

Microbial causes of acute mastitis

Answer 3

1. Staphylococcus aureus
   - Usually manifests as a localized abscess
2. Streptococcus spp.
   - Usually causes diffuse infection of the whole breast

Question 4

Pathogenesis of acute mastitis

Answer 4

1. Cracked of inflamed nipple permits entry of microbe
2. Proliferation of microbe occurs in stagnant milk
3. Acute inflammation ensues, resulting in abscess formation

Question 5

Clinical features of acute mastitis

Answer 5

1. Breast appears erythematous, painful

2. Fever

Question 6

Definition of periductal mastitis

Answer 6

Also known as recurrent subareolar abscess, squamous metaplasia of lactiferous ducts or Zuska disease

Question 7

Etiologies and associations of periductal mastitis

Answer 7

Strongly associated with smoking

Question 8

Pathogenesis of periductal mastitis

Answer 8

1. Keratinizing squamous metaplasia of the lactiferous ducts
2. Keratin sheds & plugs ducts, causing dilation & eventual rupture of ducts
3. Intense chronic inflammation occurs in periductal tissue
4. Fistula tract may form to open onto skin at areolar edge

Question 9

Etiologies and associations of mammary duct ectasia

Answer 9

Multiparous women, 50-60 years old

Question 10

Morphology of mammary duct ectasia

Answer 10

1. Dilated ducts containing inspissated secretions
2. Marked periductal & interstitial chronic granulomatous inflammation
3. No squamous metaplasia of ducts

Question 11

Clinical features of mammary duct ectasia

Answer 11

1. Poorly-defined palpable periareolar mass
2. Thick white nipple secretions
3. Skin & nipple retraction due to underlying fibrosis
4. Pain & erythema uncommon
5. Main significance: mimics breast carcinoma

Question 12

Etiologies & Associations of fat necrosis of the breast

Answer 12

History of breast trauma or surgery

Question 13

Clinical features of fat necrosis of the breast

Answer 13

1. Painless palpable mass
2. Skin retraction
3. Mammographic density
4. Main significance: mimics breast carcinoma

Question 14

Etiologies and associations of lymphocytic mastopathy

Answer 14

Postulated autoimmune mechanism (commonly seen in

type I diabetes mellitus & autoimmune thyroid diseases)

Question 15

Morphology of lymphocytic mastopathy

Answer 15

Lymphocytic infiltrate & collagenized stroma surrounding atrophic ducts

Question 16

Clinical features of lymphocytic mastopathy

Answer 16

1. Single/multiple, unilateral/bilateral masses

2. Main significance: mimics breast carcinoma

Question 17

Classification of granulomatous disease of the breast

Answer 17

1. Idiopathic granulomatous mastitis

2. Non-idiopathic granulomatous diseases

Question 18

Idiopathic granulomatous mastitis

Answer 18

1. Autoimmune disease of unknown etiology targeting secretory products of breast
2. Lobulocentric granulomatous inflammation (mainly involves breast lobules, spares stroma)
3. Treatment: steroids, immunosuppressives, surgery

Question 19

Non-idiopathic granulomatous mastitis

Answer 19

1. Granulomatous diseases (Wegener’s, sarcoidosis)

2. Granulomatous infections (Mycobacterial, fungal)

Question 20

Types of breast implants / injections

Answer 20

Paraffin injections, implants, autologous tissue

Question 21

Pathological effects of breast implants / injections

Answer 21

1. Fibrosis around implant

2. Foreign body inflammatory reaction to leakages

Question 22

Morphology of breast implants / injections

Answer 22

1. Empty spaces in histological section representing areas of paraffin
2. Surrounded by foreign body giant cells & histiocytes