The morphological characteristics of this neoplasm are different from phyllodes tumor and stromal sarcoma. It appears to be responsible for 12% of all symptomatic breast conditions. A case of periductal mastitis and mammary duct ectasia is presented in a 50 year old male, with presenting symptoms similar to those of females, namely subareolar breast lump and mastalgia. The inflammation results in breast pain, swelling, warmth and redness. Necrotizing granulomas are the histopathological hallmark of tb infection. Diabetic mastopathy lymphocytic mastitis stanford university. Periductal mastitis is sometimes seen as a complication of duct ectasia. Idiopathic granulomatous mastitis is a chronic inflammatory disease of the breast, which is often difficult to differentiate both clinically and radiologically from infectious aetiologies such as tuberculosis, fungal infections, and also from malignancy, thus posing a diagnostic dilemma. Periductal mastitis in a male breast masquerading as. Periductal mastitis is a distinct benign breast condition of. Periductal mastitis article about periductal mastitis by. A periductal chronic inflammatory cell infiltrate composed of. Lupus mastitis is an uncommon presentation of lupus erythematosus profundus or lupus panniculitis, a rare variant of lupus erythematosus characterized by inflammation of the subcutaneous fat. Associated complications include noncyclical central breast pain, nipple retraction, nipple discharge and mammary fistula.
The breast breasts are made up of lobules milkproducing glands and ducts tubes that carry milk to the nipple. Periductal fibrosis pdf along the bile duct wall occurs in chronic inflammation of bile ducts from ov infection in an animal model 18, 27, 28. Periductal definition of periductal by medical dictionary. The disease causes considerable morbidity and psychological distress in relatively young females. Mammary duct ectasia has been reported under many names, including varicocele tumor, comedomastitis, periductal mastitis, plasma cell mastitis, stale milk mastitis, chemical mastitis, granulomatous mastitis, and mastitis obliterans. Granulomatous mastitis an overview sciencedirect topics. In the present case control study, 87 pdm and 87 healthy controls were enrolled and the results were evaluated to identify the significant risk factors for pdm. Periductal mastitis usually affects women who are in the age of 2030. Histopathological studies and culture of the ductal tissue taken intraoperatively were carried out. These microbes can also cause spontaneous mammary disease. It is a frequently aseptic inflammation and has been associated with squamous metaplasia of lactiferous ducts. However, its still important to be breast aware and go back to your gp if you notice any further changes in your breasts regardless how soon these occur after having periductal mastitis. Periductal mastitis occurs when the ducts tubes under the nipple become inflamed and infected. Mastitis most commonly occurs in nursing mothers between the first and third weeks after childbirth, usually of the first child explanation of periductal mastitis.
This term is sometimes used interchangeably with mammary duct ectasia. Fine needle aspiration cytology showed noncaseating granulomatous inflammatory reaction c2. To the best of our knowledge, only 12 male cases of periductal mastitis mammary duct ec. Background the management of granulomatous mastitis depends on the causative factor, and accurate diagnosis in distinguishing between idiopathic granulomatous mastitis igm and tuberculous mastitis tbm is indispensable.
Lymphocytic mastitis usually presents as a palpable mass with radiological findings highly suggestive of breast carcinoma. To investigate the roles of bacterial infection and critical cytokines expression, 16s rrna gene sequencing and bacterial. Ultrasound scan showed the lesion to be hypoechoic without any characteristic benign features. Periductal mastitis in a male breast masquerading as lobular. In geographical areas where tuberculosis is common, a picture of granulomatous inflammatory change is indicative of tuberculosis. Mastitis occurs in 5 15% of postpartum primiparous women. Although much emphasis has been placed on the primary presentations of breast cancer, little focus has been placed on how systemic illnesses may affect the breast. Having periductal mastitis does not increase your risk of breast cancer. Mastitis, inflammation of the breast in women or of the udder in sheep, swine, and cattle. Epithelioid stromal cells in lymphocytic mastitisa source of confusion with invasive carcinoma.
In this low power view, one can see a distorted lobule surrounded by fibrous tissue. Pss is a distinct, lowgrade breast sarcoma with no clinical or radiological specificity. In this article, we discuss systemic illnesses that can manifest in the breast. Periductal mastitis happens more often in those who smoke. Periductal mastitisduct ectasia affects major breast ducts and is poorly understood. Today there is insufficient awareness among the physicians about the benign breast conditions such as mammary duct ectasia and periductal mastitis, both causing nipple discharge.
Periductal mastitis is a benign not cancer breast condition and does not increase your risk of developing breast cancer. Periductal mastitis pdm is histopathologically defined as a chronic inflammation of the breast, with dilation of the mammary duct, plasma cell infiltration, and. Management of periductal mastitis and mammary fistula. A number of antibiotics are used to treat mastitis, including cephalexin, amoxicillin, azithromycin, dicloxacillin, and clindamycin. Mammary duct ectasia surgical pathology criteria stanford. Periductal stromal sarcoma pss, spindle and epithelioid types, is a rare subtype of malignant fibroepithelial tumor. Mastitis refers to inflammation of the breast tissue that may or may not be accompanied by infection. This is more commonly seen in women who have a habit of smoking, than those who are nonsmokers. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Duct ectasia is a result of shortening and widening of the milk ducts below the nipple or areola. Lupus mastitis can present as single or multiple subcutaneous or deep breast masses, often clinically mimicking. The excised specimen consisted of a piece of fibrofatty tissue measuring 4. Also called zuskas disease only nonpuerperal case, subareolar abscess is a subcutaneous abscess of the breast tissue beneath the areola of the nipple.
Duct ectasia and periductal mastitis in indian women ncbi nih. Not only those two entities can ring a false alarm of malignancy. Duct ectasia periductal mastitis or dilated ducts associated with. Breast biopsy showing lymphocytic mastitis consistent w. Ill defined lesion of dense intralobular, perilobular and perivascular lymphocytes. Recurrence p value yes no inverted nipple yes 15 08. Nonpuerperal mastitis and subareolar abscess of the breast. Dilated large ducts with fibrous thickening of wall, elastic fibers in wall and foamy macrophages in lumen. We summarize the clinical features, imaging, histopathology, and treatment recommendations for endocrine, vascular, systemic inflammatory. There is a spectrum of aetiological factors ranging from infection to autoimmune disorders. Mammogram and ultrasound frequently demonstrate findings suspicious of malignancy. The clinical findings of granulomatous mastitis often mimic malignancy, a feature demonstrated in a number of case series and reports 2,3,4,5,6,7,8, 10,11. Periductal mastitis pdm is histopathologically defined as a chronic inflammation of the breast, with dilation of the mammary duct, plasma cell infiltration, and abscess formation.
May contain foreign body giant cells granulomatous periductal mastitis plasma cells when prominent have lead to the designation of the lesion as plasma cell mastitis may form abscess or fistula. Nonpuerperal subareolar mastitis and abscess is a benign breast entity often associated with prolonged morbidity. Periductal mastitisduct ectasia affects major breast ducts and is poorly. However, the gold standard method to diagnose parenchymal change of the liver is the histology of the liver obtained by biopsy, which is invasive and painful, and has risks of complication. Inflammatory diseases of the nonlactating female breasts. Pdf from axilla to groin, accessory breast tissue can present anywhere along the milk line. Thank you for your interest in spreading the word about the bmj. Histo pathology reported tuberculous mastitis in four 7. A variety of different terms, including mammary ductal ectasia and plasma cell mastitis, have been used for this condition 1, 2. The infection also can occur because of duct estasia the shortening and widening of milk ducts behind the nipple. It usually comes to the attention of breast cancer physicians as a differential diagnosis following the discovery of mass behind the nipple, nipple discharge, or nipple retraction. Recently, magnetic resonance imaging mri was shown to be effective for evaluating.
The longterm outcomes among patients with subareolar abscess have not been fully examined. Although the clinical manifestations of periductal mastitis are now well recognized, the role of cigarette smoking in disease aetiology, and its effect on outcome, are unclear. This is a brief video on neoplastic and nonneoplastic diseases of the breast in females excluding gynecomastia i created this presentation with. A chronic abscess associated with periductal mastitis may cause retraction by a combination of shortening of the ducts and areola oedema. Clinical characteristics, classification and surgical treatment of. We present two cases of lymphocytic mastitis, emphasizing mammogram and ultrasound findings, and correlation with.
Epithelium usually atrophic may show squamous metaplasia. Periductal mastitis is a condition where lactiferous ducts in the breast are distended and filled with amorphous eosinophilic material and foam cells, with concomitant presence of severe. Histological confirmation of periductal fibrosis from. Chronic inflammatory diseases of the nonlactating breasts cause considerable difficulty in diagnosis and treatment. Breastfeeding usually should be continued, because the rate of abscess formation an abscess is a persistent pocket of pus in the infected breast goes up steeply among women who stop breastfeeding during a bout with mastitis.
It presents with recurrent episodes of periareolar sepsis and clinical thickening. Duct ectasia and periductal mastitis in indian women. A large cyst or fibroadenoma arising centrally among the major ducts can cause relative shortening by displacement and. Pathology outlines lymphocytic mastitis mastopathy. Jul 19, 2018 mastitis, which mainly affects breastfeeding women, causes redness, swelling and pain in one or both breasts. Feb 27, 2019 today there is insufficient awareness among the physicians about the benign breast conditions such as mammary duct ectasia and periductal mastitis, both causing nipple discharge. Lymphocytic mastitis mimicking breast carcinoma, radiology. Histopathology is essential to establish diagnosis. C the pathology of chronic cystic mastitis of the female breast with. May 06, 2019 periductal mastitis periductal mastitis is beginning to be considered a unique subclass of duct ectasia. However, a growing body of evidence suggests that it is a separate entity. Histopathology is mandatory to establish the diagnosis and decide management. Periductal mastitis inflammation around the areola. Mastitis is broadly defined as the inflammation of the mammary gland.
Mastitis does not necessarily occur during lactation, is not always accompanied by microbial infection, and may not resolve with antibiotics. Diabetic mastopathy lymphocytic mastitis definition a fibrous breast mass witha prominent lymphocytic infiltrate most often occurring in patients with longstanding diabetes. The acute inflammatory changes seeninyoungerwomenare probablyduetoperiductal inflammation periductal mastitis without duct dilatation whereasthe chronic symptomsseenin older. Mastitis is an inflammation of breast tissue that sometimes involves an infection. Duct ectasia of the breast, mammary duct ectasia or plasma cell mastitis is a condition in which occurs when a milk duct beneath the nipple widens, the duct walls thicken and the duct fills with fluid. Use the link below to share a fulltext version of this article with your friends and colleagues. Periductal mastitis and duct ectasia are well recognised,2 presenting either with acute inflammation of the breast or with chronic breast symptoms such as nipple discharge. Periductal mastitis an overview sciencedirect topics. The term granulomatous mastitis was introduced by veyssiere et al. Epidemiology it is typically seen in older women e. Oct 04, 2009 this feature is not available right now. The finding that increasing age rather than smoking was related to duct dilatation seems to confirm clinicians view that periductal mastitis and duct ectasia are two separate diseases. Mastitis means inflammation injury from infection or irritation of the breast tissue.
Periductal mastitis pd was the common type of nonlactational abscess and constituted 12% of symptomatic breast diseases. Periductal mastitis is a condition seen in young women usually women in their early 30s and is strongly associated with cigarette smoking. Through better understanding of the underlying disease process the imaging, physical, and clinical findings of this rare process can be more readily recognized and treatment options expedited, improving patient care. Plasma cell mastitis is a benign breast condition which represents calcification of inspissated secretions in or immediately adjacent to ectatic benign ducts. We present a case of periductal mastitis associated with epithelial hyperplasia, presenting as a subaerolar swelling in a male breast, which was misinterpreted as lobular carcinoma on fnac. Bloodgood described duct dilatation and periductal inflammation as the pathological features in 1921 and recognized the disease as a distinct clinical entity 2 years later. Forms of nonlactational mastitis include periductal mastitis and idiopathic granulomatous mastitis. It begins almost exclusively during the first three. Feb 27, 2019 periductal mastitis is a condition where lactiferous ducts in the breast are distended and filled with amorphous eosinophilic material and foam cells, with concomitant presence of severe.
Periductal mastitis pdm is a prolonged inflammatory disease, but the cause of pdm is poorly understood. Mammary duct ectasia and periductal mastitis patient. This is particularly problematic in the cases of granulomatous mastitis in which the microbiological studies are negative. Clinical characteristics, classification and surgical. Periductal mastitis definition of periductal mastitis by. The etiology of granulomatous lobular mastitis is unknown, though some. Acute mastitis in women is a sudden infectious inflammation caused usually by the bacterium staphylococcus aureus, or sometimes by streptococcus organisms. Jul 30, 2012 lymphocytic mastitis, or diabetic mastopathy, is an unusual finding in earlyonset and longstanding diabetes.
Bundred nj, dixon jm, lumsden ab, radford d, hood j, miles rs, chetty u, forrest ap. Lymphocytic mastitis, or diabetic mastopathy, is an unusual finding in patients with earlyonset or longstanding diabetes mellitus. A number of rather large series of cases of granulomatous mastitis have been reported from the developing world, particularly within the last 8 years 3, 4, 6, 8, 10. It can presents as a nontender or tender palpable breast mass. Periductal mastitis pdm, first recognized as a morbid condition of lactiferous ducts by birkett in 1850, is an inflammatory condition of the subareolar ducts. Granulomatous mastitis in the cow occurs when drugs for the treatment or prevention of mastitis are introduced through the teat and are contaminated with nocardia asteroides, cryptococcus neoformans, atypical mycobacterium sp. When lactation mastitis is due to an infection, it is usually caused by bacteria, although fungal yeast infections can also be the cause. May contain foreign body giant cells granulomatous periductal mastitis. Very little is known to this day about its aetiology and pathogenicity. Mastitis is a painful inflammatory condition of the breast which may or may not be accompanied by infection. As for mastitis in breastfeeding females, it can result when milk ducts experience a buildup of milk milk stasis.
Mastitis may occur in up to a third of women who are lactating forming breast milk after giving birth and is then called lactation mastitis. Also lobular atrophy and sclerosis keloidal fibrosis, b cell lymphoepithelial lesions, lymphoid follicles with germinal centers. Teaching points idiopathic granulomatous mastitis often poses a diagnostic dilemma for the radiologist by mimicking malignancy. Mastitis is inflammation of one or several lobes of the mammary gland, with or without infection. A variety of different terms have been used for this condition and these probably reflect different stages in one disease process. Periductal mastitis periductal mastitis is beginning to be considered a unique subclass of duct ectasia. Periductal mastitis develops when a breast duct beneath the nipple becomes infected or inflamed. In this study, in a large cohort, the histological. A subareolar periductal chronic inflammatory process that in early stages is characterized by dilated ducts but eventually produces ductal obliteration. From the viewpoint of clinical features, histology and progression, it was truly established as an individual entity by kessler and wolloch in 1972. As far as can be ascertained only 4 cases of mammary duct ectasia and periductal mastitis in males have been reported previously.
The terms duct ectasia and periductal mastitis cover the second major group of benign breast disorders. A pathological diagnosis of granulomatous mastitis was given. Periductal mastitis and mammary duct ectasia in a male. At times, it may be difficult to differentiate dense lymphoplasmacytic infiltrate from non. It occurs in a younger age group than mammary duct ectasia and presents with pain, a periareolar mass and pus discharge from the nipple. Can periductal mastitis increase my risk of breast cancer. In one study, breast cancer screening of 277 patients with nonpuerperal mastitis within a year of the mastitis diagnosis showed that five women had noninflammatory breast cancer, all but one located at a site different from the location of mastitis. This is the most common cause of greenish discharge.