A: Mammogram of young women – dense white
(opaque)
 B: Young women’s breast – density due to fibrous
interlobular stroma & paucity of adipose tissue
 C: During pregnancy – undergo lactational changes
 D: Old women’s breast – small ducts & atrphic lobules
in adipose tissue
 E: Mammogram – more radiolucent in elder’s breast

 Enumerate
different types of inflammatory
breast lesions.
 Enumerate
the causes of inflammatory breast
lesions.
 Describe
clinical picture and management of
inflammatory breast lesion.
 Describe
the differentiation of the inflammatory
breast lesion from breast cancer.

Uncommon – less than 1% of women with breast symptoms-
1- Acute Mastitis
2- Periductal Mastitis.
3- Mammary Duct Ectasia
(plasma cell mastitis).
4- Traumatic fat necrosis.
Systemic Breast Disease
5- Lymphocytic Mastopathy
(autoimmune basis- scelrosing
lobulitis)
6- Granulomatous Mastitis \ 7- Radiation
 Cuases
- Infectious agents:
 1- Staph – localized area,single or multiple abscesses
 Acute inflammation, usually small-start at one duct
 Occasionally large abscess – heals by palpable scar.
 2- Strep – generally spread to entire breast
 Pain, marked diffuse, spread of infection, swelling and
tenderness
 Resolution rarely leaves areas of indurations.
Access of bacteria to the breast
 1-Through ducts- start at one duct, then spread.
 2- Fissures in nipple- lactation or nipple dermatitis.

 is
known as, subareolar abscess, squamous
metaplasia of lactiferous ducts, Zuska disease.
 1)Vitamin
A deficiency in associated with toxic
substances in tobacco smoke or smoking
 ↓↓
Altere the differentiation of ductal epithelial
 Note:-
Not association with lactation
Histologic feature is keratinizing squamous metaplasia of the nipple
ducts, chronic granulomatous response to keratin, +\- bacterial infections
occur in the 5th or 6th decade of life, in multiparous women
 Chronic mastitis (non-bacterial) - inspissation of secretions in

main excretory ducts
Morphology:
 Ductal dilatation (ectasia) with ductal rupture.
 Dilated ropelike ducts with thick cheesy secretions
 Reactive changes in the surrounding breast tissue+
calcification (nipple retraction and palpable mass).
 Ducts filled by granular debris, sometimes containing WBCs
mainly fat-laden macrophage (nipple discharge)
 The striking feature is prominent lymphocytic and plasma
cell infiltration with occasional granulomas


Mistaken for carcinoma by– retraction of overlying skin or nipple,
palpable mass (even on mammogram)- nipple discharge- calcificaftion
Define as foamy macrophages infiltrating partially necrotic
adipose tissue- involve adipose tissue, occ. parenchyma
 Traumatic fat necrosis: A) Post-traumatic fat necrosis, often
in pendulous large breast (1-2 WEEKS) B) Prior surgery


- Central necrotic fat
cells surrounded by
PMNs & mononuclear
infiltrates and fatladen macrophages.
- This is enclosed later
by fibrous tissue and
Replaced by scar
tissue or cyst +
Calcification.
- Skin retraction

Probably immune-mediated pathogenesis (Autoimmune
diseases- e.g.):- a) Type 1 (insulin-dependent)
diabetes mellitus. b) Autoimmune thyroid disease
Microscopy:
-Diffuse dense lymphocytic
infiltrates. (lobules& Small
blood vessels)
- Lobular atrophy.- Sclerosis: collagenized stroma surrounding
atrophic ducts and lobules.
- The epithelial basement
membrane is thickened.
 Immune-mediated
pathogenesis, can simulate
malignancy in presentation.= (granulomatous lobulitis)
 1- Systemic granulomatous diseases (e.g., Wegener
granulomatosis, SLE, amyloidosis or sarcoidosis).
 2-
Infections- (e.g. mycobacteria or fungi,
actinomycosis, Histoplasmosis)- common in
immunocompromised patients.
 3 4-
Foreign objects such as breast prostheses.
Hypersensitivity reaction to antigens expressed by
lobular epithelium during lactation (Granulomatous
lobular mastitis )- uncommon.
1- Mastitis –
development of cracks and fissures in the nipples,
erythematous and painful, and fever  single or multiple abscesses.
2- Periductal Mastitis- painful erythematous subareolar mass+ a
fistula tract of the smooth muscle of the nipple and opens onto the skin
3- Mammary Duct Ectasia
(plasma cell mastitis).
poorly defined palpable periareolar mass,+ a\w thick, white nipple
secretions and sometimes with skin retraction + No pain or erythematous
4- Traumatic fat necrosis-
painless palpable mass, skin
thickening or retraction, a mammographic density or calcifications.
5- Lymphocytic Mastopathy- LOBULAR
(autoimmune basis),
single or multiple hard palpable masses, may be bilateral, so hard lesion.
6- Granulomatous Mastitis-
immunocompromised patients or
adjacent to foreign objects + hypersensitivity reaction
 Diagnosis:
clinical examination, US, MG, FNAC, tissue biopsy
 Management: according to the type and etiology
Acute mastitis, Mammary duct ectasia and breast abscess
 A)- ;Frequent nursing and massaging of the breast(keep it empty)
 B) - Appropriate antibiotics. C) Incision and drainage.

Fat necrosis
 A) Using warm compresses B) Analgesics (ibuprofen,aspirin)
 C) FANC drainage of oil d) Lumpectomy if mass persist.
 LYMPHOCYTIC MASTOPATHY
 Surgery (often recur)
 Granulomatous mastitis systemic antibiotics, anti TB, steroids, immunosuppressive methotrexate, surgery

 Age,
sex, clinical presenting symptoms, signs& durations.
 Nipple
bloody discharge, Nipple pain.
 Examination
 Breast
findings:
mass (localized, involve X quadrants, size),
firm\hard, with irregular margins
 Skin:
irritation, dimpling, redness, pseduo-orange, ulcer.
 Nipple:retraction,
 Corresponding

depression, irritations, redness scaling.
axilla- enlarged lymph nodes, accessory.
Examination of other breast
Asymmetrical & distortion
Breast ca- skin changes
A: Mammogram of young women – dense white
(opaque)
 B: Young women’s breast – density due to fibrous
interlobular stroma & paucity of adipose tissue
 C: During pregnancy – undergo lactational changes
 D: Old women’s breast – small ducts & atrphic lobules
in adipose tissue
 E: Mammogram – more radiolucent in elder’s breast

 Supernumerary
nipples or breast: Mildline remnants –
extends from axilla to perineum
 Axillary
breast: Normal ductal system extends into chest wall
& axilla.
 Congenital
Nipple Inversion:
Failure to evert during
development, may be unilateral; may be confused with acquired
causes that may give rise to inversion sometimes – like in cases of
invasive breast cancer or inflammatory diseases of nipple
(recurrent subareolar abscess or duct ectasia).
 Macromastia: One cause is an unusual tissue response to
hormonal changes during puberty  massive rapid breast growth
(Juvenile hypertrophy)