The most frequent inflammatory condition of the breast is mastitis related to lactation or weaning. It may be caused by stasis/milk engorgement, trauma or other injury or infection.
Inflammations and infections of the breast unrelated to pregnancy form a heterogeneous group of diseases. The term nonpuerperal mastitis is sometimes used as a summary term for this conditions. Acute mastitis, duct ectasia, Zuska's disease, subareolar abscess, retroareolar abscess, periductal mastitis, plasma cell mastitis, comedo mastitis, granulomatous mastitis and secretory disease are names used for nonpuerperal mastitis or special cases of it.[1] The terminology is not entirely consistent and subject to regional variation.
Mild hyperprolactinemia and thyroid problems are frequent aetiological factors.[2] Other causes are secretory stasis, hormonal stimulation, infections and autoimmune reactions.
Classification edit
Periductal mastitis edit
Duct ectasia edit
Duct ectasia - literally (lactiferous) duct widening is a very common and thus rather unspecific finding, increasing with age. It may be associated with cyclical breast pain or breast inflammation.
Duct ectasia syndrome is characterised by subareolar dilation of lactiferous ducts filled by debris, non-cyclical breast pain and sometimes inflammation, nipple discharge, nipple retraction, a subareolar breast mass or abscess and fistula.
It is more common in women over 50. It is frequently assumed to be a late complication of periductal mastits[3] Hyperprolactinemia seems to be an important etiological factor.[4][5]
Mastitis obliterans edit
Mastitis obliterans is a rare late stage manifestation of duct ectasia syndrome. Significant share of cases occurred in diabetic patients. Characteristic is obliteration of the large and medium sized ducts by an infiltrate of lymphocytes and histiocytes.[6]
Subareolar abscess edit
Subareolar abscesses occur mostly as a complication of duct ectasia syndrome, due to squamous metaplasia of lactiferous ducts - also called Zuska's disease. Cases caused by nipple piercing are reported with increasing frequency.[7] It is a frequently aseptic, often with fistula formation.
Granulomatous mastitis edit
Characteristic for granulomatous mastitis are multinucleated giant cells and epithelioid histiocytes around lobules. Often minor ductal and periductal inflammation is present. The lesion is in some cases very difficult to distinguish from breast cancer.
Infectious nonpuerperal mastitis edit
- tuberculosis of the breast. << TBM was more likely to occur in younger patients, with a larger clinical mass at presentation. Histologically, TBM tends to show more eosinophils and necrosis, and IGM is associated with more plasma cells. The characteristics of the granulomas and giant cells were not distinguishing features. >> [8]
- syphilis of the breast
- retromammary abscess
- actinomycosis of the breast
Comedo mastitis edit
Comedo mastitis is a very rare form similar to granulomatous mastitis but with tissue necrosis. Because it is so rare it may be sometimes confused with comedo carcinoma of the breast although the conditions appear to be completely unrelated.
Chronic cystic mastitis edit
Chronic cystic mastitis is not usually described as an inflammatory condition but a serious inflammation may develop in rare cases.
Mastitis in children edit
Mastitis in truly prepubertal children is very rare and appears to have a diverse spectrum causes. Hormonal and non hormonal causes as well as premature adrenarche have been suspected.
So called pre-pubertal mastitis (the name is apparently used only in the UK) can occur shortly before or during the first stages of puberty of both boys and girls with very mild symptoms and resolves without intervention.
Mastitis in newborns may be due to a combination of infection and the same hormonal factors that cause witch milk. It has been observed mostly in infants 1-7 weeks old, symptoms are mostly local, the sex ratio 1:1 in the first weeks is later shifting towards a 2:1 female to male ratio.[9]
References edit
- ^ Hughes, L. E. (1991). "Non-lactational inflammation and duct ectasia". British medical bulletin. 47 (2): 272–283. PMID 1933213.
- ^ Peters, F.; Schuth, W. (1989). "Hyperprolactinemia and nonpuerperal mastitis (duct ectasia)". JAMA: the Journal of the American Medical Association. 261 (11): 1618–1620. doi:10.1001/jama.1989.03420110094030. PMID 2918655.
- ^ Dixon, J. M. (1989). "Periductal mastitis/duct ectasia". World journal of surgery. 13 (6): 715–720. doi:10.1007/BF01658420. PMID 2696225.
- ^ Radojković, D.; Antić, S.; Pesić, M.; Radojković, M.; Basić, D.; Radjenović-Petković, T.; Radenković, S.; Ilić, I. (2010). "Significance of hyperprolactinemia for cytomorphologic features of breast secretions". Vojnosanitetski pregled. Military-medical and pharmaceutical review. 67 (1): 42–47. doi:10.2298/VSP1001042R. PMID 20225634.
- ^ Peters, F.; Schuth, W. (1989). "Hyperprolactinemia and nonpuerperal mastitis (duct ectasia)". JAMA: the Journal of the American Medical Association. 261 (11): 1618–1620. doi:10.1001/jama.1989.03420110094030. PMID 2918655.
- ^ Blay, J.; Medina, R.; Rausell, N.; Fonfria, C.; Atares, M.; Requeni, L.; Vilar, J. (2012). "Unilateral mastitis obliterans presented as a palpable breast mass in a patient with long-standing diabetes mellitus". Breast disease. doi:10.3233/BD-2012-000341. PMID 23151592.
- ^ Gollapalli, V.; Liao, J.; Dudakovic, A.; Sugg, S. L.; Scott-Conner, C. E. H.; Weigel, R. J. (2010). "Risk Factors for Development and Recurrence of Primary Breast Abscesses". Journal of the American College of Surgeons. 211 (1): 41–48. doi:10.1016/j.jamcollsurg.2010.04.007. PMID 20610247.
- ^ Lacambra, M.; Thai, T. A.; Lam, C. C. F.; Yu, A. M. C.; Pham, H. T.; Tran, P. V. T.; Law, B. K. B.; Van Nguyen, T.; Pham, D. X.; Tse, G. M. (2011). "Granulomatous mastitis: The histological differentials". Journal of Clinical Pathology. 64 (5): 405–411. doi:10.1136/jcp.2011.089565. PMID 21385894.
- ^ Rudoy, R. C.; Nelson, J. D. (1975). "Breast abscess during the neonatal period. A review". American journal of diseases of children (1960). 129 (9): 1031–1034. PMID 1103616.