Nonpuerperal mastitis

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The term nonpuerperal mastitis describes inflammatory lesions of the breast (mastitis) that occur unrelated to pregnancy and breastfeeding.

Contents

It is sometimes equated with duct ectasia, but other forms can be described. [1]

Types

Duct ectasia—periductal mastitis complex

Duct ectasia in the literal sense (literally: duct widening) is a very common and thus rather unspecific finding, increasing with age. However, in the way in which the term is mostly used, duct ectasia is an inflammatory condition of the larger-order lactiferous ducts. [2] It is considered likely that the condition is associated with aseptic (chemical) inflammation related to the rupture of ducts or cysts. It is controversial whether duct dilation occurs first and leads to secretory stasis and subsequent periductal inflammation or whether inflammation occurs first and leads to an inflammatory weakening of the duct walls and then stasis. [2] When the inflammation is complicated by necrosis and secondary bacterial infection, breast abscesses may form. [2] Subareolar abscess, also called Zuska's disease (only nonpuerperal case), is a frequently aseptic inflammation and has been associated with squamous metaplasia of the lactiferous ducts.

The duct ectasia—periductal mastitis complex affects two groups of women: young women (in their late teens and early 20s) and perimenopausal women. [3] Women in the younger group mostly have inverted nipples due to squamous metaplasia that lines the ducts more extensively compared to other women and produces keratin plugs which in turn lead to duct obstruction and then duct dilation, secretory stasis, inflammation, infection and abscess. This is not typically the case for women in the older group; in this group, there is likely a multifactorial etiology involving the balance in estrogen, progesterone and prolactin. [3]

Treatment of mastitis and/or abscess in nonlactating women is largely the same as that of lactational mastitis, generally involving antibiotics treatment, possibly surgical intervention by means of fine-needle aspiration and/or incision and drainage and/or interventions on the lactiferous ducts (for details, see also the articles on treatment of mastitis, of breast abscess and of subareolar abscess). Additionally, an investigation for possible malignancy is needed, normally by means of mammography, and a pathological investigation such as a biopsy may be necessary to exclude malignant mastitis. [4] Although no causal relation with breast cancer has been established, there appears to be an increased statistical risk of breast cancer, warranting a long-term surveillance of patients diagnosed with non-puerperal mastitis. [5]

Nonpuerperal breast abscesses have a higher rate of recurrence compared to puerperal breast abscesses. [6] There is a high statistical correlation of nonpuerperal breast abscess with diabetes mellitus (DM). On this basis, it has recently been suggested that diabetes screening should be performed on patients with such abscesses. [7] [8]

Granulomatous mastitis

Characteristic for granulomatous mastitis are multinucleated giant cells and epithelioid histiocytes around lobules. Often minor ductal and periductal inflammation is present. The lesion is in some cases very difficult to distinguish from breast cancer.

Comedo mastitis

Comedo mastitis is a very rare form similar to granulomatous mastitis but with tissue necrosis. Because it is so rare it may be sometimes confused with comedo carcinoma of the breast although the conditions appear to be completely unrelated.

Related Research Articles

<span class="mw-page-title-main">Mammary gland</span> Exocrine gland in humans and other mammals

A mammary gland is an exocrine gland in humans and other mammals that produces milk to feed young offspring. Mammals get their name from the Latin word mamma, "breast". The mammary glands are arranged in organs such as the breasts in primates, the udder in ruminants, and the dugs of other animals. Lactorrhea, the occasional production of milk by the glands, can occur in any mammal, but in most mammals, lactation, the production of enough milk for nursing, occurs only in phenotypic females who have gestated in recent months or years. It is directed by hormonal guidance from sex steroids. In a few mammalian species, male lactation can occur. With humans, male lactation can occur only under specific circumstances.

<span class="mw-page-title-main">Mastitis</span> Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

<span class="mw-page-title-main">Apocrine</span>

Apocrine is a term used to classify the mode of secretion of exocrine glands. In apocrine secretion, secretory cells accumulate material at their apical ends, and this material then buds off from the cells, forming extracellular vesicles. The secretory cells therefore lose part of their cytoplasm in the process of secretion.

Inflammatory breast cancer (IBC) is one of the most aggressive types of breast cancer. It can occur in women of any age. It is referred to as "inflammatory" due to its frequent presentation with symptoms resembling a skin inflammation, such as erysipelas.

<span class="mw-page-title-main">Nipple discharge</span> Medical condition

Nipple discharge is fluid from the nipple, with or without squeezing the breast. The discharge can be milky, clear, green, purulent, bloody, or faintly yellow. The consistency can be thick, thin, sticky, or watery.

<span class="mw-page-title-main">Squamous metaplasia</span>

Squamous metaplasia is a benign non-cancerous change (metaplasia) of surfacing lining cells (epithelium) to a squamous morphology.

Breast pain is the symptom of discomfort in either one or both breasts. Pain in both breasts is often described as breast tenderness, is usually associated with the menstrual period and is not serious. Pain that involves only one part of a breast is more concerning, particularly if a hard mass or nipple discharge is also present.

<span class="mw-page-title-main">Inverted nipple</span> Medical condition

An inverted nipple is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.

<span class="mw-page-title-main">Lactiferous duct</span>

Lactiferous ducts are ducts that converge and form a branched system connecting the nipple to the lobules of the mammary gland. When lactogenesis occurs, under the influence of hormones, the milk is moved to the nipple by the action of smooth muscle contractions along the ductal system to the tip of the nipple. They are also referred to as galactophores, galactophorous ducts, mammary ducts, mamillary ducts or milk ducts.

A galactocele is a retention cyst containing milk or a milky substance that is usually located in the mammary glands. They can occur in women during or shortly after lactation.

Breast diseases make up a number of conditions. The most common symptoms are a breast mass, breast pain, and nipple discharge.

Breast surgery is a form of surgery performed on the breast.

Comedocarcinoma is a kind of breast cancer that demonstrates comedonecrosis, which is the central necrosis of cancer cells within involved ducts. Comedocarcinomas are usually non-infiltrating and intraductal tumors, characterized as a comedo-type, high-grade ductal carcinoma in situ (DCIS). However, there have been accounts of comedocarcinoma which has then diversified into other cell types and developed into infiltrating (invasive) ductal carcinoma. Recurrence and survival rates differ for invasive breast cancer which has originated as comedocarcinoma compared with other types of cancer cells.

<span class="mw-page-title-main">Duct ectasia of breast</span> Medical condition

Duct ectasia of the breast, mammary duct ectasia or plasma cell mastitis is a condition that occurs when a milk duct beneath the nipple widens, the duct walls thicken, and the duct fills with fluid. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.

Also called Zuska's disease, subareolar abscess is a subcutaneous abscess of the breast tissue beneath the areola of the nipple. It is a frequently aseptic inflammation and has been associated with squamous metaplasia of lactiferous ducts.

Granulomatous mastitis can be divided into idiopathic granulomatous mastitis and granulomatous mastitis occurring as a rare secondary complication of a great variety of other conditions such as tuberculosis and other infections, sarcoidosis and granulomatosis with polyangiitis. Special forms of granulomatous mastitis occur as complication of diabetes. Some cases are due to silicone injection or other foreign body reactions.

<span class="mw-page-title-main">Breast ultrasound</span> Type of medical imaging

Breast ultrasound is a medical imaging technique that uses medical ultrasonography to perform imaging of the breast. It can be performed for either diagnostic or screening purposes and can be used with or without a mammogram. In particular, breast ultrasound may be useful for younger women who have denser fibrous breast tissue that may make mammograms more challenging to interpret.

<span class="mw-page-title-main">Nipple adenoma</span> Medical condition

A nipple adenoma is a rare benign tumour of the breast.

Microdochectomy is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct is called microdochotomy.

A urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers (fascia) that surround it.

References

  1. ↑ Peters F, Schuth W (March 1989). "Hyperprolactinemia and nonpuerperal mastitis (duct ectasia)". JAMA. 261 (11): 1618–20. doi:10.1001/jama.1989.03420110094030. PMID   2918655.
  2. 1 2 3 A. Thomas Stavros (2004). Breast Ultrasound. Lippincott Williams & Wilkins. p. 372. ISBN   978-0-397-51624-7.
  3. 1 2 A. Thomas Stavros (2004). Breast Ultrasound. Lippincott Williams & Wilkins. p. 373. ISBN   978-0-397-51624-7.
  4. ↑ Liong, Yee; Hong, Ga; Teo, Jennifer Gek; Lim, Geok (2013). "Breast ductal carcinoma in situ presenting as recurrent non-puerperal mastitis: case report and literature review". World Journal of Surgical Oncology (review). 11 (1): 179. doi: 10.1186/1477-7819-11-179 . ISSN   1477-7819. PMC   3765146 . PMID   23924035.
  5. ↑ Peters, Friedolf; Kießlich, Anja; Pahnke, Volker (October 2002). "Coincidence of nonpuerperal mastitis and noninflammatory breast cancer". European Journal of Obstetrics & Gynecology and Reproductive Biology. 105 (1): 59–63. doi:10.1016/S0301-2115(02)00109-4. ISSN   0301-2115. PMID   12270566.
  6. ↑ Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L (October 2011). "Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up". Radiographics (review). 31 (6): 1683–99. doi:10.1148/rg.316115521. PMID   21997989., abstract
  7. ↑ Rizzo M, Gabram S, Staley C, Peng L, Frisch A, Jurado M, Umpierrez G (March 2010). "Management of breast abscesses in nonlactating women". The American Surgeon. 76 (3): 292–5. doi: 10.1177/000313481007600310 . PMID   20349659. S2CID   25120670.
  8. ↑ Verghese BG, Ravikanth R (May 2012). "Breast abscess, an early indicator for diabetes mellitus in non-lactating women: a retrospective study from rural India". World Journal of Surgery. 36 (5): 1195–8. doi:10.1007/s00268-012-1502-7. PMID   22395343. S2CID   23073438.
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