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Breast-nonmalignant

Inflammatory / infectious

Hemorrhagic necrosis in breast

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 27 September 2012, last major update April 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Unusual complication of warfarin therapy (Ann Surg 1972;175:647)

Warfarin causes rapid onset of hemorrhagic necrosis of skin in 0.1 to 1.0% of patients (Br J Plast Surg 2000;53:624)

 

Terminology

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Epidemiology

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Sites

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Etiology

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Associated with protein S/C deficiency

● Warfarin induces paradoxical thrombosis in breast and other areas of excessive fat

● Warfarin reduces synthesis of both vitamin K dependent procoagulant factors and inhibitors of coagulation (including proteins S / C), but in patients with existing reductions of proteins S or C, the major clinical effect is towards thrombosis

 

Clinical features

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Prognostic factors

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Case reports

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● 38 year old woman with mass resembling inflammatory carcinoma (J Postgrad Med 2004;50:268)

 

Treatment

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● May require mastectomy

 

Clinical images

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Hemorrhagic necrosis of breast

 

Gross description (Macroscopy)

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Gross images

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Micro description (Histopathology)

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● Widespread necrosis with multiple small vessel thrombi

 

Micro images

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Venous thrombosis and                                                   Necrotizing arteritis

necrotizing arteritis

 

 

Intimal necrosis of artery

 

Virtual Slides

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Videos

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Cytology description

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Cytology images

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Positive stains

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Negative stains

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Electron microscopy descriptions

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Electron microscopy images

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Molecular / cytogenetics description

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Molecular / cytogenetics images

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Differential Diagnosis

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Additional references

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End of Breast-nonmalignant > Inflammatory / infectious > Hemorrhagic necrosis

 

 

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