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Breast-nonmalignant
Inflammatory / infectious
Acute mastitis / breast abscess
Author: Nat Pernick, M.D. (see Authors page)
Revised: 26 September 2012, last major update March 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Infection or inflammation, usually bacterial, of breast
Terminology
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● Zuska’s disease: periareolar abscess associated with squamous metaplasia of lactiferous ducts (J Am Coll Surg 1994;178:29)
Epidemiology
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● Mastitis occurs in 5-15% of post-partum primiparous women; 3% with mastitis have an abscess (BJOG 2004;111:1378)
Sites
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● Usually subareolar
Etiology
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● Associated with lactation and cracks in nipple
● Also associated with eczema, nipple dermatoses and post-reduction mammoplasty
● Bacteria often not isolated from culture
● Pregnancy related infections are usually due to Staphylococcus; usually unilateral, often MRSA (Arch Surg 2007;142:881, Asian J Surg 2009;32:55), also Staphylococcus epidermidis (BMC Microbiol 2009;9:82)
● Streptococcus usually causes diffuse infections leading to scarring, but is uncommon today
● Brucellosis is associated with ingestion of unpasteurized milk
● Tuberculosis may occur in endemic areas (Med Princ Pract 2009;18:245)
● Nonpregnancy related infections may be polymicrobial or associated with diabetes (Am J Med Sci 2009;338:123)
Clinical features
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● May cause fistulous tract between duct and surface of areola
● FNA useful if combined with culture (J Pak Med Assoc 2009;59:167)
● Rarely occurs in neonates (Pediatr Radiol 2009;39:955)
Prognostic factors
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●
Case reports
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● Brucellosis in 46 year old woman (Breast J 2006;12:375)
● Enterococcus faecalis (Indian J Pathol Microbiol 2005;48:507)
● Fusarium in 55 year old woman with diabetes (Indian J Med Microbiol 2005;23:198)
● Gordonia bronchialis in 43 year old woman (J Clin Microbiol 2005;43:3009)
● Lupus mastitis in 33 year old woman (J Obstet Gynaecol Res 2008;34:919)
● Mycobacterium abscessus in 54 year old woman (J Med Case Reports 2009;3:130)
● Prevotella in 40 year old woman (Int J Syst Evol Microbiol 2007;57:883)
● Salmonella typhi in 35 year old woman (Indian J Med Microbiol 2009;27:69)
● Streptococcus group B abscess in 22 year old woman (Archives 1987;111:74)
● Post-partum presentation with widespread symmetrical inflammatory polyarthropathy and marked synovitis in 20 year old woman with mastitis (Scand J Rheumatol 2000;29:133)
● With acute tubulo-interstitial nephritis and uveitis syndrome in 14 year old girl (Acta Paediatr 2004;93:135)
Treatment
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● Incision and drainage, but may recur (Gynecol Obstet Fertil 2007;35:645)
● Urokinase irrigation may be useful for large abscesses (J Ultrasound Med 2009;28:449)
● Also ultrasound guided drainage (Radiology 2004;232:904, J Am Coll Surg 2010;210:148)
● Antibiotics/nisin solution (J Hum Lact 2008;24:311), although the effectiveness of antibiotics has been questioned (Cochrane Database Syst Rev 2009 Jan 21;CD005458)
● Possibly kneading and dispersing manipulation for early stage disease (Zhong Xi Yi Jie He Xue Bao 2009;7:1130)
Clinical images
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Abscess (Fusarium)
Micro description (Histopathology)
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● Central cavity with neutrophils and secretory material surrounded by inflammatory cells and eventually fibrosis
Micro images
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AFIP Fig 32: Staph abscesses are sharply Breast abscess
demarcated; bacteria are in central cavity
9
Squamous metaplasia of lactiferous ducts #1: #2-squamocolumnar junction is displaced,
plug of keratin debris fills lactiferous duct, mild periductal lymphocytes are present
which has metaplastic squamous epithelium
Cytology description
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● Brucellosis: epithelioid granulomas with neutrophils (J Infect Dev Ctries 2009;3:255)
Differential Diagnosis
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● May clinically resemble inflammatory carcinoma
Additional references
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End of Breast-nonmalignant > Inflammatory / infectious > Acute mastitis / abscess
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