Periductal Mastitis Research Articles

Recurrent Polymorphic Ventricular Tachycardia: The Real Thing or a Soapy Explanation?

A 51-YEAR-OLD, 144.4-lb, 168-cm man was admitted to the authors' hospital for the treatment of bilateral breast periductal mastitis with fistulas and a right breast abscess. The patient had been homeless until very recently and did not receive routine medical care as a result. He chronically abused tobacco and alcohol, but he denied any major medical sequelae from these activities. He reported a family history of coronary artery disease, but his cardiovascular review of systems was unremarkable. The cardiac and pulmonary physical examinations were noncontributory. A laboratory analysis, including a serum potassium concentration, was normal. A preoperative electrocardiogram showed sinus bradycardia (heart rate of 58 beats/min) with a sinus arrhythmia, but no other abnormalities were present. The patient was transported to the operating room for the excision of bilateral breast subareolar ducts and fistula tracts and drainage of the right breast abscess. Anesthesia was induced using propofol (2 mg/kg), fentanyl (2 μg/kg), and rocuronium (0.6 mg/kg) and maintained using sevoflurane (end-tidal concentrations of 1.5%-2.0%) in an air-oxygen mixture. The patient remained hemodynamically stable in sinus rhythm before and after anesthetic induction. A few minutes after endotracheal intubation, an arrhythmia was observed (Fig 1). Sinus rhythm briefly returned spontaneously without medical intervention, but the arrhythmia subsequently recurred, prompting the rapid arrival of several other anesthesiologists and certified registered nurse anesthetists who had been watching the electrocardiographic (ECG) events on a remote monitor in the anesthesia service office. What is the diagnosis?

264. Core Needle Biopsy (CNB) to Differentiate Plasma Cell Mastitis From Breast Cancer

Background: Plasma cell mastitis is a rare breast disease which has been described under different terms such as comedomastitis, mastitis obliterans, pseudotubercolosis, periductal mastitis and recently mammary duct ectasia. ItÕs not uncommon to be misdiagnosed as cancers like comedocarcinoma in pathologic examination. Plasma cell mastitis usually presents with pain, tenderness, nipple discharge and usually an indurated peri-areolar breast lump when the acute phase subsides. ItÕs very common for this condition to be confused with malignant lesions specially when the overlying skin is involved, inflammatory changes are dominant, nipple retraction is present or large and multiple axillary lymph nodes exist.

Aesthetic outcome as a goal using pectoral muscle-strip in recurrent subareolar abscess of the breast and for double subdermal flap in modelling of the inverted nipple

Aesthetic outcome as a goal using pectoral muscle-strip in recurrent subareolar abscess of the breast and for double subdermal flap in modelling of the inverted nipple

Subareolar abscess in a male breast: cytological characterisation and distinction from other benign and malignant squamous cell aspirate

Subareolar abscess in a male breast: cytological characterisation and distinction from other benign and malignant squamous cell aspirate

Treatment of Inverted Nipple with Subareolar Abscess: Usefulness of High-Resolution MRI for Preoperative Evaluation

Background. Inverted nipples with subareolar abscesses can recur due to insufficient resection. It is important to provide reliable curative treatment after determination of the extent of resection by preoperative imaging evaluation. Methods. Ten patients were treated for inverted nipples with subareolar abscess. Sonography and high-resolution MRI were used as preoperative imaging modalities. The endpoints of preoperative imaging evaluation were defined as the identification of the abscess site, isolated fistula site, and extent of inflammation. Results. In all patients, sonography confirmed the presence of abscesses but their locations could not be identified. Sonography could not confirm the presence of isolated fistula or inflammation. In contrast, high-resolution MRI not only confirmed the presence of abscesses but also revealed their positional relationships with the nipples. In addition, high-resolution MRI confirmed the presence of isolated fistulas and inflammation as well as revealed their positional relationships with the nipples. In all patients, no recurrence was observed, and satisfactory surgical results were obtained. Conclusion. High-resolution MRI is useful in determination of the extent of resection of subareolar abscess associated with inverted nipple.

Imaging Approaches to Diagnosis and Management of Common Ductal Abnormalities

Ductal disease is an important, often overlooked, and poorly understood issue in breast imaging that results in delays in diagnosis and patient care. The differential diagnosis for an intraductal mass is broad and includes inspissated secretions, infection, hemorrhage, solitary or multiple papillomas, and malignancy. Each breast is composed of eight or more ductal systems, with most disease arising in the terminal ductal-lobular unit. Imaging evaluation of the ductal system usually entails a combination of mammography, galactography, ultrasonography (US), and in some cases magnetic resonance (MR) imaging. The most common finding with all modalities is ductal dilatation with a focal or diffuse abnormality. Benign diseases of the ducts include duct ectasia, blocked ducts, inflammatory infiltrates, periductal mastitis, apocrine metaplasia, intraductal papillomas, and papillomatosis. Malignant diseases of the ducts include ductal carcinoma in situ, invasive ductal carcinoma, and Paget disease. Most commonly performed with US or MR imaging guidance, percutaneous biopsy methods are helpful in diagnosis and management of ductal findings. Because most findings are smaller than 1 cm, located within a duct, and thus sometimes not visible after a single pass, vacuum-assisted devices help improve the accuracy of sampling.

Clinicopathologic Profile of Benign Breast Conditions in Indian Women: Prospective Study Based on Aberrations of Normal Development and Involution Classification

Benign conditions of the breast are common, but a great deal of confusion exists in their nomenclature, classification, and, treatment protocols. The Aberration of Normal Development and Involution (ANDI) classification provides a comprehensive framework within which to correlate clinical presentation with pathogenesis. Most clinical studies have not used this classification system. We studied the spectrum of benign breast conditions in Indian patients with reference to the ANDI system and performed a clinicopathologic correlation. This prospective study was carried out on 262 consecutive patients attending the surgery department on an outpatient basis for benign breast conditions. A total of 199 (76 %) patients had a diagnosis of benign breast disorder, and 44 (17 %) had benign breast disease. There were 19 (7 %) women with non-ANDI and other conditions. The spectrum of benign breast disorders included fibroadenoma 77, mastalgia with nodularity 98, galactocele 7, cysts 4, and nipple discharge (ND) 13. Benign breast diseases included giant/multiple fibroadenomas 18, incapacitating mastalgia and nodularity 13, subareolar abscess with mammary fistula 7, periductal mastitis with suppuration 4, and ND 2. Cytopathologic correlation performed in 115 patients showed nonproliferative disease in 82, proliferative disease without atypia in 19, proliferative disease with atypia in 3, and miscellaneous 11. The ANDI classification is a comprehensive system that delineates the borderline between normal and abnormal, achieves correlation of clinical signs and symptoms with histologic changes, and provides risk stratification and pragmatic definition of management protocols.

Mammary fistula could be included in the follicular occlusion tetrad

ejd.2011.1629 Auteur(s) : Juan D. Berna-serna jdberna@gmail.com, Juan D Berna-Mestre Department of Radiology, Virgen de la Arrixaca University Hospital, 30120-El Palmar (Murcia) Spain Mammary fistula (MF), or Zuska's disease, is a recurrent condition characterised by draining periareolar abscesses in non-lactating women [1]. The aetiology of MF remains unclear. The most accepted cause is obstruction of a distal lactiferous duct by squamous metaplasia with keratinisation or epidermisation of the duct [...]

A Case of Erythema Nodosum Associated with Subareolar Abscess

While erythema nodosum is a nodular, erythematous eruption predominantly affecting the extensor aspects of the legs, breast abscesses are the result of relatively common bacterial infections, and only 2 studies have reported an association between erythema nodosum and breast abscesses. Here, we report the case of a patient with repeated erythema nodosum associated with subareolar abscesses. The patient was a 34-year-old woman with painful erythematous nodules on her right shin, accompanied by an indurated lesion on her right breast 4 days before the onset of the nodules. Therefore, the patient underwent circumareolar incision, and consequently the painful erythematous nodules disappeared. However, after 39 days, the patient developed another tender, painful lesion in her right breast and painful erythematous nodules on her right shin. After another circumareolar incision, the painful erythematous nodules disappeared again. Therefore, we suggested a significant association between erythema nodosum and breast abscess in this patient. The most common underlying causative organism in breast abscess is Staphylococcus aureus; however, erythema nodosum has rarely been proven to be associated with staphylococcal infections. Therefore, the relationship between S. aureus and erythema nodosum is rather controversial. However, the resistance to the usual treatment methods and prolonged clinical course in our case suggest that the pathogenesis of erythema nodosum associated with breast abscesses might be different from that of the common form of erythema nodosum.

Enfermedad de zuska. Diagnóstico en atención primaria

A fistula is an abnormal pathological communication which links two organs together or with the exterior. They are fibrous paths internally coated with granulation tissue, extending from an internal o primary opening to one or more openings located outside or on the skin. The recurrent mastitis that some patients suffer is due to a fistula between a lactiferous duct and the limit of the areola, and this condition is called a recurrent periareolar fistula.To incorporate this clinical condition into the proposed terminology, Zuska disease, is essential to believe in its existence, in order to to treat it from the source. The knowledge of this disease, a proper diagnosis and treatment will prevent the constant recurrence of mastitis as presented by these patients, avoiding their pilgrimage to various specialists. In this article we review this disease, methods of diagnosis and treatment.

Periductal mastitis in a male breast masquerading as lobular carcinoma on fine needle aspiration cytology

Fine needle aspiration cytology (FNAC) is quite successful in identifying specific benign and malignant breast lesions, but its role in the categorization of proliferative breast lesions has not been well defined. Mastitis/ breast abscess can lead to intense inflammatory response; however, its association with epithelial hyperplasia is rarely reported. At times, it may be difficult to differentiate dense lymphoplasmacytic infiltrate from non-Hodgkin's lymphoma. We present a case of periductal mastitis associated with epithelial hyperplasia, presenting as a subaerolar swelling in a male breast, which was misinterpreted as lobular carcinoma on FNAC.

Surgical treatment of recurring subareolar abscess using oncoplastic techniques

To evaluate the clinical and cosmetic results of our treatment of recurrent periareolar abscess. Our technique was applied to 27 patients with recurrent periareolar abscess who had been previously surgically treated three or more times between January 2001 and December 2008. Our treatment combined resection of the fistula, the terminal milk ducts, and mammary gland involved in the inflammatory process. This was associated with glandular remodeling and a lift of the periareolar skin. Long-term clinical results and evaluation of cosmetic result are analyzed. The median age of patients was 36 years and the median course of disease was 5 years (2-11 years). The duration of follow-up was 37 months. Before being treated in our service, patients had a median of four prior surgeries for this condition (3-12). The average hospital stay was 3.2±0.6 days after surgery. One recurrence occurred among the 24 patients reviewed. She was treated by excision of the nipple and areola. Six patients (25%) rated their outcome excellent and 13 patients (54%) considered their results good. Five patients assessed their overall result as fair (21%), and no patients judged their results as poor. Our technique is simple and feasible and the results are encouraging. It can be used regardless of the location of the fistula around the periphery of the nipple-areola complex and it is perfectly suited to the management of chronic fistulous abscess.

Incidence of Breast Cancer in Patients Undergoing Diagnostic Duct Excision for Pathological Nipple Discharge.

Abstract BackgroundWomen with pathological nipple discharge (PND), defined as single duct, blood stained or serous discharge, usually undergo diagnostic surgery to exclude breast cancer. The purpose of this study was to ascertain the incidence of breast cancer in women undergoing such surgery in our unit and examine the use of nipple discharge cytology.MethodsPatients who underwent either total duct excision (Hadfield's procedure) or microdochectomy at City Hospital, Birmingham between January 2005 & April 2009 were identified from hospital computer records. In total 139 women were identified but 37 were excluded as they did not have PND and underwent surgery for indications such as recurrent episodes of sepsis due to peri-ductal mastitis, for symptomatic relief of nipple discharge and for correction of nipple inversion.Overall, 102 patients with PND and no other clinical signs of malignancy underwent diagnostic duct surgery. Data collected included patient age, laterality of surgery, radiological imaging undertaken, nipple discharge cytology results and final pathology from the resection specimen.ResultsThe majority of patients (99%) were female. Patient age ranged from 21 – 81 years, with a median of 50 years. Fifty nine patients (57.8%) had surgery for left breast symptoms, 41 (40.2%) for the right side and 2 patients (2%) had bilateral surgery. Most patients had imaging – 50 patients (49.0%) had mammography, 41 (40.2%) had mammography plus ultrasound whilst 7 (6.9%) had ultrasound alone. Only 4 patients (3.9%) had no imaging and all these patients were < 35 years. Imaging did not show any features of breast cancer in any of the patients.Nipple discharge cytology showed benign changes (C1/C2) in 65 patients (63.7%), atypical cells (C3) in 21 patients (20.6%) and suspicious or malignant cells (C4/C5) in 4 patients (3.9%) whilst 12 patients (11.8%) did not have cytology performed. Hadfield's was the most common operation (61.8%) and was performed in an older age group (median age 55yrs) compared to microdochectomy (median age 43 yrs) (p=0.02 Mann-Whitney test).The most frequent primary pathological findings were intraduct papilloma (39.2%) and duct ectasia (38.2%). Other benign changes including fibrocystic disease accounted for 8.9% whilst 14 patients (13.7%) had either invasive or in-situ breast cancer. All patients with suspicious or malignant cytology were found to have an underlying breast cancer, but of note, 13.8% of patients with benign cytology were found to have breast cancer. One male patient who did not have nipple cytology performed was found to have DCIS. Of the 14 patients diagnosed with breast cancer, 8 (57%) had pure ductal carcinoma in situ whilst 6 (43%) had foci of invasive disease in additional to the DCIS.Result of Nipple Discharge Cytology & Final PathologyCytology Resultn=No. Patients with breast cancerNo cytology121 (8.3%)Benign (C1/C2)659 (13.8%)Atypical (C3)210 (0%)Suspicious / Malignant (C4/C5)44 (100%) ConclusionsNipple discharge cytology is unreliable in diagnosing the cause of pathological nipple discharge and its routine use should be reconsidered. All patients with pathological nipple discharge require diagnostic surgery. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6014.

Characterization of High-grade Ductal Carcinoma In Situ With and Without Regressive Changes

Regressive changes (RC) have been described in malignant melanoma, carcinomas of the prostate and cervix. The presence of RC in these neoplasms may signify some degree of host response to tumor and seems to be a sign of poor prognosis for some neoplasms. RC in breast cancer is vaguely defined in the older literature. We have observed periodically similar RC in a subset of high-grade ductal carcinoma in situ (HGDCIS) in breast specimens. The aim of our study is to demonstrate how to recognize RC in the diagnostic setting and an attempt to understand the biologic behavior in this subset of HGDCIS cases. Fifty-nine cases of HG-DCIS (35 cases with RC and 24 cases without RC) were included. We defined RC in our study as demonstrating thick periductal fibrosis, dense lymphocytic infiltrate, and a thin rim of intact neoplastic cells. A short panel of immunomarkers to study this entity included myoepithelial markers. Reduced expression of myoepithelial markers (p63 and smooth muscle heavy chain myosin) were seen more frequently in the HGDCIS group with RC than without RC cases. Invasion as well as metastatic disease was seen in association with HGDCIS with RC nearly 4 times as often. It is also critically important to recognize HGDCIS-RC for diagnostic purposes, as the differential diagnosis of RC includes, benign associations such as papilloma, fibrocystic changes and periductal mastitis. HGDCIS-RC may also be a sign of an aggressive phenotype than other HGDCIS subtypes. Further outcome studies are necessary to determine if it has a clinical impact akin to other tumors with RC.

Classification of Inflammatory Breast Disorders and Step by Step Diagnosis

In this study, the authors proposed a classification of inflammatory breast disorders based on which a practical systematic scheme in diagnosis was applied aiming to differentiate simple forms of mastitis from more complicated and malignant forms. The study population included 197 female patients who were clinically or pathologically diagnosed as having mastitis. All patients underwent Ultrasound examination. Mammography was performed for 133/197 cases. Cases of simple mastitis and periductal mastitis were followed up to ensure complete resolution. Abscess cavities and postoperative collections were drained. Other cases were biopsied to confirm diagnosis and were managed accordingly by their treating physicians. Statistical analysis was performed by the Statistical Package for Social Science. Nominal Data were expressed as frequency and relative frequencies (percentage). Ultrasound and Mammography categorical results were compared using the Pearson Chi Square and Fisher's exact test. Patients were classified into three groups; infectious, noninfectious and malignant mastitis. Simple and malignant forms of mastitis showed many signs in common. The presence of ill defined collections and abscess cavities on ultrasound favored simple over malignant forms of mastitis while extensive skin thickening and infiltrated malignant nodes favored malignant forms. Interstitial edema, edematous fat lobules, abscess cavities, skin thickening seen on ultrasound examination were significantly lower in noninfectious than simple and malignant mastitis. Mammography signs were less discriminating. Diffuse skin thickening and increased density favored malignant mastitis while dilated retro areolar ducts and characteristic calcification patterns favored noninfectious forms. Simple mastitis showed nonspecific signs. Ultrasound examination in mastitis cases shows more specific signs in differentiating between the three forms of mastitis and is useful in monitoring treatment, excluding complications and guide for interventional procedures. Mammography should be performed whenever complicated, malignant and uncommon forms of mastitis are suspected.

Pectoralis major interposition flap: A new technique for treatment of severe peri-ductal mastitis

Background Peri-ductal mastitis is an uncommon benign disorder of the major lactiferous ductal system of the female breast. It can be a very difficult problem to treat and may cause significant patient morbidity. We describe a new technique, involving use of the pectoralis major muscle flap, for treating recurrent sub-areolar abscess refractory to standard surgical treatment. Method Three patients who underwent this new technique for severe refractory peri-ductal mastitis at Calvary Hospital, Canberra are presented. Results These patients who had recurrent peri-ductal mastitis with abscess and fistula formation on a monthly basis despite numerous courses of antibiotics and surgical procedures experienced no further recurrences following pectoralis major interposition flap surgery at 42, 32 and 22 months follow-up respectively. Conclusion This new technique may provide an opportunity to control these otherwise difficult to treat cases of severe recurrent peri-ductal mastitis where standard surgical methods have failed.

Nipple-Areolar Complex: Normal Anatomy and Benign and Malignant Processes

The nipple-areolar complex may be affected by many normal variations in embryologic development and breast maturation as well as by abnormal processes of a benign or malignant nature. Benign processes that may affect the nipple-areolar complex include eczema, duct ectasia, periductal mastitis, adenomas, papillomas, leiomyomas, and abscesses; malignant processes include Paget disease, lymphoma, and invasive and noninvasive breast cancers. Radiologists should be aware of the best methods for evaluating each of these entities: Many disorders of the nipple-areolar complex are unique or differ in important ways from those that occur elsewhere in the breast, and they require a diagnostically specific imaging evaluation. Patients may present with benign developmental variations; inversion, retraction, or enlargement of the nipple, which may have either a benign or a malignant cause; a palpable mass; nipple discharge; skin changes in and around the nipple; infection with resultant nipple changes or a subareolar mass; or abnormal findings at routine mammographic screening. Further diagnostic imaging may include repeat mammography, breast ultrasonography, galactography, and magnetic resonance imaging. When skin changes are present, a clinical evaluation by the patient's primary care physician, dermatologist, or surgeon should be part of the diagnostic work-up.

Subareolar abscess in the male breast

Subareolar abscess in the male breast

High-Resolution MRI in Detecting Subareolar Breast Abscess

High-Resolution MRI in Detecting Subareolar Breast Abscess

Idiopathic Granulomatous Mastitis: A 25-Year Experience

Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast that can mimic inflammatory breast cancer and periductal mastitis (PDM). Eighteen patients with a histopathologic diagnosis of IGM, seen over a period of 25 years, were retrospectively reviewed and compared with 133 patients with PDM and 100 normal patients. The unit's pathology database and clinic letters for this time period were used to identify patients who had presented with IGM. A retrospective review of the notes was used to extract reproductive factors, cigarette smoking habits, and ethnicities that were recorded at presentation. These were compared with data from a similar group of patients with PDM and a control group. All IGM patients were women. Median age was 36 years (range 18 to 67 years) compared with 52 years (range 20 to 77 years) for PDM patients (p < 0.001). Seventeen percent of IGM patients were smokers at the time of presentation, as compared with 60% of PDM patients (p < 0.001). Although parity was similar for all groups, 10 IGM patients (56%) had given birth in the last 5 years, compared with 6 (5%) PDM patients (p < 0.001) and 20 (20%) in the control group (p=0.0194). Two IGM patients had recurrences after pregnancy. The course of IGM varied from 11 to 105 weeks and was not affected by any treatment modalities. IGM patients are younger, have given birth more recently, and are less likely to be Caucasian as compared with PDM patients. IGM is not related to smoking and can recur. Treatment should be supportive.