- Acute Mastitis
- Periductual Mastitis
- Mammary Duct Ectasia
- Fat Necrosis
- Lymphocytic Mastopathy (sclerosing Lymphocytic Lobulitis
- Granulomatous Mastitis
________________ of the breast are uncommon, accounting for less than 1% of women with
What is the usual presentation of breast inflammation? _______________
erythematous swollen painful breast.
“Inflammatory breast cancer” mimics inflammation by __________________ and should always be suspected in a
nonlactating woman with the clinical appearance of mastitis.
obstructing dermal vasculature with tumor emboli,
resulting in an enlarged erythematous breast,
Almost all cases of acute mastitis occur during the ______________
first month of breastfeeding.
What is the reason behind why Acute Mastitis occur during the first month of breastfeeding?
During this time the breast is vulnerable to bacterial infection because of the development of cracks and
fissures in the nipples.
From this portal of entry, Staphylococcus aureus or, less commonly, streptococci invade the breast tissue.
The breast is erythematous and painful, and fever is
often present. At the outset only one duct system or sector of the breast is involved.
If not treated the infection may spread to the entire breast.
What is the morphology of Acute Mastitis caused by Staphylococcal infection?
Staphylococcal infections usually produce a localized area of acute
inflammation that may progress to the formation of single or multiple abscesses.
What is the morphological difference of Acute Mastitis caused by Streptococcal infection?
Streptococcal infections tend to cause (as elsewhere) a diffuse spreading infection that eventually involves the entire breast. The involved breast tissue is infiltrated by neutrophils
and may be necrotic.
Most cases of lactational mastitis are easily treated with _______________________________________
- appropriate antibiotics
- and continued expression of milk from the breast.
Rarely, surgical drainage is required.
This condition is known by a variety of names, including recurrent _________________
- subareolar abscess,
squamous metaplasia of lactiferous ducts,
- and Zuska disease.
What is the presentation of men and women periductal mastitis?
Women, and sometimes men,
present with a painful erythematous subareolar mass that clinically appears to be an infectious
In periductal mastitis, more than 90% of the afflicted are ____________
Periductal Mastitis is a condition is not associated with
- a specific reproductive history,
- or age
In Periductal Mastitis in recurrent cases, a fistula tract often tunnels under the smooth muscle of the nipple and opens onto the skin at the edge of the areola.
Many women with this condition have an____________ most likely as a secondary effect of the
in Periductal Mastitis ,the strong association with cigarette smoking is intriguing. It has been suggested that the _______________alter the differentiation of the ductal epithelium
vitamin A deficiency associated with smoking or toxic substances in tobacco smoke
What is the key histologic feature of Periductal Mastitis?
keratinizing squamous metaplasia of the nipple
ducts ( Fig. 23-5 ).
Keratin shed from these cells plugs the ductal system, causing dilation and eventually rupture of the duct.
An intense chronic and granulomatous inflammatory response
develops once keratin spills into the surrounding periductal tissue. Sometimes a secondary bacterial infection supervenes and causes acute inflammation.
Recurrent subareolar abscess.
When squamous metaplasia extends deep
into a nipple duct, keratin becomes trapped and accumulates. If the duct ruptures, the
ensuing intense inflammatory response to keratin results in an erythematous painful mass.
A fistula tract may burrow beneath the smooth muscle of the nipple to open at the edge of
What is the treatment of Periductal Mastitis?
In most cases en bloc surgical removal of the involved duct and contiguous fistula tract is
] Simple incision drains the abscess cavity, but the offending keratinizing epithelium
remains and recurrences are common.
When bacterial infection is present, antibiotics also have
a therapeutic role.
This disorder tends to occur in the fifth or sixth decade of life, usually in multiparous women.
Unlike periductal mastitis, it is not associated with cigarette smoking.
MAMMARY DUCT ECTASIA
What is the presentation of mammary duct ectasia?
Patients present with a
poorly defined palpable periareolar mass that is often associated with thick, white nipple
secretions and sometimes with skin retraction.
Pain and erythema are uncommon.
What is the morpholigical characteristic of Mammary Duct Ectasia?
This lesion is characterized
- chiefly by dilation of ducts,
- inspissation of breast secretions,
- and a marked periductal and interstitial chronic granulomatous inflammatory reaction ( Fig. 23-6 ).
What is filled in the dilated ductal ectasia?
The dilated ducts are filled by:
granular debris that contains numerous lipid-laden macrophages.
What is contained in the periductal and interductal tissue
of Mammary Ductal Ectasia?
contains dense infiltrates of
lymphocytes and macrophages, and variable numbers of plasma cells
Ectasia (meaning "dilation" or "distention of a tubular structure") occurs as part of a pathophysiologicalprocess.
In Mammary Ductal Ectasia on occasion,
granulomatous inflammation forms around cholesterol deposits. _______ may eventually produce skin and nipple retraction.
Squamous metaplasia of nipple ducts is absent
Mammary duct ectasia.
Chronic inflammation and fibrosis surround an
ectatic duct filled with inspissated debris.
The______________-that mimics invasive carcinoma on palpation or mammogram.
fibrotic response can produce a firm irregular
The principal significance of Mammary Duct Ectasia is that it ___________________
produces an irregular palpable mass that
mimics the mammographic appearance of carcinoma.
Fat necrosis can present as a ______________
- painless palpable mass,
- skin thickening or retraction,
- a mammographic density,
- or mammographic calcifications
In Fat Necrosis, the majority of affected women have a
breast trauma or prior surgery.
What is the morphology iof Fat Necrosis Acute lesions may be ______________
- and contain central areas of liquefactive fat necrosis.
What is the morphology iof Fat Necrosis subacute lesions__________________
the areas of fat necrosis take on the appearance of
- gray-white nodules containing small chalky-white foci or dark hemorrhagic debris.
The central region of necrotic fat cells is initially associated ______________________
with an intense neutrophilic infiltrate mixed with macrophages.
Over the next few days proliferating ibroblasts associated with new vessels and chronic inflammatory cells surround the injured
Subsequently, giant cells, calcifications, and hemosiderin make their appearance, and eventually the focus is replaced by scar tissue or is encircled and walled off by fibrous tissue.
As with other inflammatory breast disorders, the major clinical significance of Fat Necrosis is its
possible confusion with breast cancer
LYMPHOCYTIC MASTOPATHY (SCLEROSING LYMPHOCYTIC LOBULITIS)
This condition presents with ______________
single or multiple hard palpable masses.
- The masses may be bilateral
- and may be detected as mammographic densities.
The lesions are so hard that it can be difficult to obtain tissue with a needle biopsy.
What is the appearance of Lymphocytic Mastopathy in microscopy?
Microscopically, they show :
- collagenized stroma
- surrounding atrophic ducts and lobules.
- The epithelial basement membrane is often thickened.
- A prominent lymphocytic infiltrate surrounds the epithelium and small blood vessels.
condition is most common in women with type 1 (insulin-dependent) diabetes or autoimmune
. Based on this association, it is hypothesized to have an autoimmune basis.
Its only clinical significance is that it must be distinguished from breast cancer.
LYMPHOCYTIC MASTOPATHY (SCLEROSING LYMPHOCYTIC LOBULITIS)
Granulomatous inflammation is present in less than 1% of all breast biopsy specimens.
- systemic granulomatous diseases (e.g., Wegener granulomatosis or sarcoidosis) that occasionally involve the breast
- and granulomatous infections caused by mycobacteria or fungi.
Infections of this type are most common in immunocompromised patients
or adjacent to foreign objects such as breast prostheses or nipple piercings.
_____________ is an uncommon breast-limited disease that only occurs in parous women.
In Granulomatous Mastitis the
granulomatous inflammation is confined to the lobules, suggesting that it is caused by a
hypersensitivity reaction to antigens expressed by lobular epithelium during lactation