Inflammatory breast diseases

Inflammatory diseases of breast
Updated: 04/10/2023
© Jun Wang, MD, PhD

Acute mastitis/abscess
  • Infection or non-infection associated inflammation
  • Usually bacterial if infected
  • Associated with lactation and cracks in nipple
  • Pregnancy related infections: Staphylococcus, unilateral, often MRSA
  • Zuska’s disease
Periareolar abscess associated with squamous metaplasia of lactiferous ducts
May form fistula
  • Clinical features: Acute inflammation: fever, pain, erythematous changes, swelling
  • Pathological features: diffuse neutrophilic infiltrate
  • Treatment
Antibiotics
Incision and drainage, if abscess formed
Lymphocytic mastopathy
  • AKA diabetic mastopathy
  • More commonly associated with type I diabetes
  • May occur in type II diabetes or non-diabetes, or associated with autoimmune disorders
  • Clinical features: Palpable mass, usually subareolar
  • Pathological features: Dense polyclonal lymphocytic infiltrates, stromal fibrosis
  • Treatment: Usually NOT needed
  • Surgery for cosmetic concerns, or if malignancy cannot be ruled out

Idiopathic granulomatous mastitis
  • Diagnosis of exclusion
  • Young women
  • Clinical features: Firm mass, may have sinuses
  • Pathological findings: granulomatous inflammation (multinucleated giant cells), no evidence of fungi, acid fast bacilli, foreign bodies, etc.
  • May recur or be locally aggressive
  • Treatment: no consensus; observation, glucocorticoids, surgery

Fat necrosis
  • Associated with trauma (including surgery), ductectasia, fibrocystic change, etc
  • Simulates carcinoma clinically and mammographically
  • Clinical features: Painless ill-defined mass
  • Pathological features: Lipid laden macrophages, multinucleated giant cells, patially necrotic adipose tissue, NO significant atypia
  • Diagnosis: History, especially history of surgery, microscopic features
  • Treatment: Usually not necessary, surgery for cosmetic concerns



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Contents

Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders 4.  Benign blood cell disorders Anemia Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Adrenal gland Thyroid gland Parathyroid gland Endocrine pancreas M
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Anemia

Anemia Updated: 07/13/2024 © Jun Wang, MD, PhD   General features Decrease in red cell mass Hemoglobin: Levels of hemoglobin in a specific volume of whole blood Hematocrit: Fraction of whole blood composed of red blood cells Red cell count: Quantity of red cell in a specific volume of whole blood Three major groups based on RBC sizes Microcytic Normocytic Macrocytic Three major causes Blood loss: acute or chronic Increased red cell destruction: hemolysis Reduced production: marrow failure due to genetic abnormality or nutritional deficiency Etiology Genetic abnormality Hemoglobinopathies RBC cytoskeletal abomorlities Enzyme abnormalities Fanconi anemia Nutritional deficiencies: iron, VB12, folate, general malnutrition Physical etiologies: trauma, burns, frostbite, prosthetic valves, etc Chronic diseases: chronic infections, neoplasia, autoimmune disorders, kidney or liver diseases, etc Infectious diseases: hepatitis, sepsis , malaria, etc
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Lymphoid neoplasms

Lymphocytic neoplasms Updated: 05/17/2020 © Jun Wang, MD, PhD Terminology Lymphoma : Proliferations forming discrete tissue masses Leukemia : Widespread involvement of the bone marrow and usually the peripheral blood Any "lymphoma" can present with or evolve to a leukemic picture, and any "leukemia" can occasionally present with a mass lesion Other hematology terms Important risk factors Immunodeficiency (primary or secondary) Autoimmune disorders Viruses (HIV, KSHV/HHV8, HTLV-1) H. pylori infection Radiation Chemotherapy Diagnostic approaches Complete history, especially those with possible epidemic characters, such as Burkitt lymphoma CBC, Bone marrow Morphology/immunohistochemistry Immunofluorescence flow cytometry Cytogenetic studies Molecular studies Commonly used markers All lymphomas: CD45 B-cell neoplasms: CD5, CD10, CD19, CD20, CD79a, CD23, bcl2, bcl6, cyclin D1, light chai
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