CONGENITAL INFLAMMATORY
DISEASES OF BREAST
DR ZEENAT N.P.
PATHOLOGIST
COLLEGE OF MEDICINE
MAJMAAH
OBJECTIVES
• 1.Enlist common congenitalcdevelopmental
breast lesion.
• 2.Enumerate different types of inflammatory
breast lesions.
• 3. Discuss acute mastitis in terms of
etiopathogenesis,morphology,clinical features &
complications.
• 4.Discuss about breast inflammatory breast
lesions that mimic breast cancer(Duct
ectasia,Peri-ductal mastitis,&Fat necrosis)
Common congenital breast lesion
• Milkline Remnants.
• Supernumerary nipples or breasts result from
the persistence of epidermal thickenings along
the milk line, which extends from the axilla to
the perineum.
• The disorders that affect the normally situated
breast rarely arise in these heterotopic,
hormone-responsive foci, which most commonly
come to attention as a result of painful
premenstrual enlargements
• Accessory Axillary Breast Tissue.
• In some women the normal ductal system
extends into the subcutaneous tissue of the
chest wall or the axillary fossa (the “axillary tail
of Spence”). This epithelium can undergo
lactational changes (resulting in a palpable
mass) or give rise to carcinomas outside the
breast proper. Therefore, prophylactic
mastectomies markedly reduce, but do not
completely eliminate, the risk of breast cancer.
• Congenital Nipple Inversion.
• The failure of the nipple to evert during
development is common and may be unilateral.
Congenitally inverted nipples usually correct
spontaneously during pregnancy, or can
sometimes be everted by simple traction.
Acquired nipple retraction is of more concern,
since it may indicate the presence of an invasive
cancer or an inflammatory disorder (e.g.,
recurrent subareolar abscess or duct ectasia).
• Gynecomastia. Unilateral or bilateral
enlargement of the male breast occasionally
occurs, usually at puberty, the cause is probably
of some form of hormonal imbalance. In
conclusion these congenital anomalies of the
mammary glands occur rarely.
Read more: http://healthmad.com/health/eightcongenital-anomalies-of-the-mammaryglands/#ixzz3TJPoe8cv
BREAST LESIONS
INFLAMMATORY BREAST LESIONS
• Inflammatory diseases of the breast are
uncommon, accounting for less than 1% of
women with breast symptoms.
• Women usually present with an erythematous
swollen painful breast. “Inflammatory breast
cancer” mimics inflammation by obstructing
dermal vasculature with tumor emboli, resulting
in an enlarged erythematous breast, and should
always be suspected in a nonlactating woman
with the clinical appearance of mastitis.
CLINICAL FEATURES OF BREAST
LESIONS
• The most common symptoms reported by
women are pain, a palpable mass,
“lumpiness” (without a discrete mass), or
nipple discharge
• . Asymptomatic women with abnormal
findings on mammographic screening also
require further evaluation.
• Mammographic screening was introduced in the
1980s as a means to detect small, nonpalpable,
asymptomatic breast carcinomas
• . The sensitivity and specificity of mammography
increase with age, as a result of replacement of the
fibrous, radiodense tissue of youth with the fatty,
radiolucent tissue of the elderly
• . At age 40, the probability that a mammographic
lesion is cancer is only 10%, but this rises to greater
than 25% in women over 50
• . The principal mammographic signs of breast
carcinoma are densities and calcifications:
• In about 10% of cases, carcinomas are missed by
mammography. The principal causes of these failures
are the presence of surrounding radiodense tissue
(especially in younger women) that obscures the
tumor, the absence of calcifications, small size, a
diffuse infiltrative pattern with little or no
desmoplastic response, or a location close to the
chest wall or in the periphery of the breast.
• The inability to image a palpable mass does not
indicate that it is benign, and all palpable masses
require further investigation.
• Ultrasonography distinguishes between solid and cystic
lesions and can define more precisely the borders of solid
lesions. Most palpable masses that are not imaged by
mammography are detectable by ultrasound.
• Magnetic resonance imaging (MRI) detects cancers by the
rapid uptake of contrast agents due to increased tumor
vascularity and blood flow. It is useful in screening for
cancer in women with dense breasts or at very high risk
for cancer, in determining the extent of chest wall invasion
by locally advanced cancers, and in the evaluation of
breast implant rupture.
• A high rate of false-positive results limits its usefulness in
screening women outside of these groups.
ACUTE MASTITIS
• Almost all cases of 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.
MORPHOLOGY
• Staphylococcal infections usually produce a
localized area of acute inflammation that
may progress to the formation of single or
multiple abscesses. 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.
PERIDUCTAL MASTITIS( Squamous
metaplasia of lactiferous duct)
• Women, and sometimes men, present with a painful
erythematous subareolar mass that clinically appears to
be an infectious process. More than 90% of the afflicted
are smokers. This condition is not associated with
lactation, a specific reproductive history, or age. 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 inverted nipple, most likely as a secondary effect
of the underlying inflammation. The strong association
with cigarette smoking is intriguing. It has been suggested
that the vitamin A deficiency associated with smoking or
toxic substances in tobacco smoke alter the differentiation
of the ductal epithelium.[7]
• The key histologic feature is 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.
MAMMARY DUCT ECTASIA
• 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. 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.
Chronic inflammation and fibrosis surround an ectatic duct
filled with inspissated debris. The fibrotic response can produce
a firm irregular mass that mimics invasive carcinoma on
palpation or mammogram.
FAT NECROSIS
• Fat necrosis can present as a painless
palpable mass, skin thickening or retraction,
a mammographic density, or mammographic
calcifications. The majority of affected
women have a history of breast trauma or
prior surgery.
• Acute lesions may be hemorrhagic and contain central
areas of liquefactive fat necrosis. In subacute lesions the
areas of fat necrosis take on the appearance of ill-defined,
firm, 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 fibroblasts associated with
new vessels and chronic inflammatory cells surround the
injured area. 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.