Breast- Inflammatory D/O

Question 1

Inflammatory Disorders

Answer 1

1. Acute Mastitis
2. Periductual Mastitis
3. Mammary Duct Ectasia
4. Fat Necrosis
5. Lymphocytic Mastopathy (sclerosing Lymphocytic Lobulitis
6. Granulomatous Mastitis

Question 2

________________ of the breast are uncommon, accounting for less than 1% of women with
breast symptoms.

Answer 2

Inflammatory diseases

Question 3

What is the usual presentation of breast inflammation? _______________

Answer 3

erythematous swollen painful breast.

Question 4

• *“Inflammatory breast cancer” mimics inflammation** by __________________ and should always be suspected in a
• *nonlactating woman** with the clinical appearance of mastitis.

Answer 4

obstructing dermal vasculature with tumor emboli,

resulting in an enlarged erythematous breast,

Question 5

ACUTE MASTITIS
Almost all cases of acute mastitis occur during the ______________

Answer 5

first month of breastfeeding.

Question 6

What is the reason behind why Acute Mastitis occur during the first month of breastfeeding?

Answer 6

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 outsetonly one duct system or sector of the breast is involved.

If not treated the infection may spread to the entire breast.

Question 7

What is the morphology of Acute Mastitis caused by Staphylococcal infection?

Answer 7

Morphology.

Staphylococcal infections usually produce a localized area of acute
inflammationthatmay progress to the formation of single or multiple abscesses.

Question 8

What is the morphological difference of Acute Mastitis caused by Streptococcal infection?

Answer 8

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.

Question 9

Most cases of lactational mastitis are easily treated with _______________________________________

Answer 9

• appropriate antibiotics
• and continued expression of milk from the breast.

Rarely, surgical drainage is required.

Question 10

PERIDUCTAL MASTITIS
This condition is known by a variety of names, including recurrent _________________

Answer 10

• subareolar abscess,
• squamous metaplasia of lactiferous ducts,
• and Zuska disease.

Question 11

What is the presentation of men and women periductal mastitis?

Answer 11

Women, and sometimes men,
present with a painful erythematous subareolar mass that clinically appears to be an infectious
process.

Question 12

In periductal mastitis, more than 90% of the afflicted are ____________

Answer 12

smokers

Question 13

Periductal Mastitis is a condition is not associated with
_______________

Answer 13

• lactation,
• a specific reproductive history,
• or age

Question 14

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
underlying inflammation.

Answer 14

inverted nipple,

Question 15

​in Periductal Mastitis ,the strong association with cigarette smoking is intriguing. It has been suggested that the _______________alter the differentiation of the ductal epithelium

Answer 15

vitamin A deficiency associated with smoking or toxic substances in tobacco smoke

Question 16

What is the key histologic feature of Periductal Mastitis?

Answer 16

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
the areola.

Question 17

What is the treatment of Periductal Mastitis?

Answer 17

In most cases en bloc surgical removal of the involved duct and contiguous fistula tract is
curative. [7

] 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.

Question 18

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.

Answer 18

MAMMARY DUCT ECTASIA

Question 19

What is the presentation of mammary duct ectasia?

Answer 19

Patients present with a
poorly defined palpable periareolar mass that is often associated with thick, white nipple
secretionsand sometimes withskin retraction.

Pain and erythema are uncommon.

Question 20

What is the morpholigical characteristic of Mammary Duct Ectasia?

Answer 20

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 ).

Question 21

What is filled in the dilated ductal ectasia?

Answer 21

The dilated ducts are filled by:

granular debris that contains numerous_ lipid-laden macrophages.**** _

Question 22

What is contained in the periductal and interductal tissue

of Mammary Ductal Ectasia?

Answer 22

contains dense infiltrates of
lymphocytes and macrophages, and variable numbers of plasma cells

Question 23

VOCABULARY :

Ectasia means?

Answer 23

Ectasia (meaning “dilation” or “distention of a tubular structure”)[1] occurs as part of a pathophysiologicalprocess.

Question 24

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

Answer 24

Fibrosis

Question 25

Mammary duct ectasia.

Chronic inflammation and fibrosis surround an
ectatic duct filled with inspissated debris.

The______________-that mimics invasive carcinoma on palpation or mammogram.

Answer 25

fibrotic response can produce a firm irregular
mass

Question 26

The principal significance of Mammary Duct Ectasia is that it ___________________

Answer 26

produces an irregular palpable mass that
mimics the mammographic appearance of carcinoma.

Question 27

Fat necrosis can present as a ______________

Answer 27

• painless palpable mass,
• skin thickening or retraction,
• a mammographic density,
• or mammographic calcifications

Question 28

In Fat Necrosis, the majority of affected women have a
history of_________________-

Answer 28

breast trauma or prior surgery.

Question 29

What is the morphology iof Fat Necrosis Acute lesions may be ______________

Answer 29

• hemorrhagic
• and contain central areas of liquefactive fat necrosis.

Question 30

What is the morphology iof Fat Necrosis subacute lesions__________________

Answer 30

the areas of fat necrosis take on the appearance of

• illdefined,
• firm,
• gray-white nodules containing small chalky-white foci or dark hemorrhagic debris.

Question 31

​ The central region of necrotic fat cells is initially associated ______________________

Answer 31

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
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.

Question 32

As with other inflammatory breast disorders, the major clinical significance of Fat Necrosis is its
______________________

Answer 32

possible confusion with breast cancer

Question 33

LYMPHOCYTIC MASTOPATHY (SCLEROSING LYMPHOCYTIC LOBULITIS)
This condition presents with \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 33

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.

Question 34

What is the appearance of Lymphocytic Mastopathy in microscopy?

Answer 34

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.

Question 35

This
condition is most common in women with type 1 (insulin-dependent) diabetes or autoimmune
thyroid disease

. 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.

Answer 35

LYMPHOCYTIC MASTOPATHY (SCLEROSING LYMPHOCYTIC LOBULITIS)

Question 36

GRANULOMATOUS MASTITIS
Granulomatous inflammation is present in less than 1% of all breast biopsy specimens.

The
causes include:

Answer 36

• systemic granulomatous diseases (e.g., Wegener granulomatosis or sarcoidosis) that occasionally involve the breast
• and granulomatous infections caused by mycobacteria or fungi.

Question 37

Infections of this type are most common in immunocompromised patients
or adjacent to foreign objects such as breast prostheses or nipple piercings.

Answer 37

GRANULOMATOUS MASTITIS

Question 38

_____________ is an uncommon breast-limited disease that only occurs in parous women.

Answer 38

Granulomatous
lobular mastitis

Question 39

In Granulomatous Mastitis the
granulomatous inflammation is confined to the lobules, suggesting that it is caused by a
______________________

Answer 39

hypersensitivity reaction to antigens expressed by lobular epithelium during lactation