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A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples.

D'Alfonso TM, Ginter PS, Shin SJ - J Pathol Transl Med (2015)

Bottom Line: Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging.Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa.These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.

ABSTRACT
Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging. Such lesions can simulate a malignant process, based on both clinical and radiographic findings, and core biopsy is often performed to rule out malignancy. Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa. Diagnostic difficulty may arise due to the small and fragmented sample of a core biopsy. This review will focus on the pertinent clinical, radiographic, and histopathologic features of the more commonly encountered inflammatory lesions of the breast that can be characterized in a core biopsy sample. These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess. The microscopic differential diagnoses for these lesions when seen in a core biopsy sample will be discussed.

No MeSH data available.


Related in: MedlinePlus

Mammary duct ectasia. (A) Core biopsy performed for an “intraductal mass” shows a portion of a fibrotic duct wall lined with foamy histiocytes. (B) Disrupted/ruptured duct wall with histiocytes in periductal stroma. (C) Flattened epithelium and fragments within the proteinacious luminal contents. The sample lacks prominent inflammatory features. (D) Brown histiocytes, or “ochrocytes,” are seen in the periductal stroma. Intraepithelial foamy histiocytes are also present. (E) An older lesion shows intraductal calcification. (F) Intraductal “cholesteroloma” formed within a duct with rupture into surrounding stroma.
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f2-jptm-49-4-279: Mammary duct ectasia. (A) Core biopsy performed for an “intraductal mass” shows a portion of a fibrotic duct wall lined with foamy histiocytes. (B) Disrupted/ruptured duct wall with histiocytes in periductal stroma. (C) Flattened epithelium and fragments within the proteinacious luminal contents. The sample lacks prominent inflammatory features. (D) Brown histiocytes, or “ochrocytes,” are seen in the periductal stroma. Intraepithelial foamy histiocytes are also present. (E) An older lesion shows intraductal calcification. (F) Intraductal “cholesteroloma” formed within a duct with rupture into surrounding stroma.

Mentions: The microscopic appearance of duct ectasia is variable and depends on the disease stage. In early stages, mild ductal dilatation with luminal histiocytes is seen (Fig. 2A, B). Ductal epithelium is not hyperplastic and may be flattened or completely absent. Sloughed epithelium may be seen in ductal lumens (Fig. 2C). Lipid-laden foamy histiocytes can be seen within the duct lumen and in adjacent stroma. Intraepithelial histiocytes can also be seen. “Ochrocytes” refers to histiocytes in periductal stroma that show accumulation of lipofuscin pigment, which imparts a brown color to the cells (Fig. 2D) [18]. A periductal chronic inflammatory cell infiltrate composed of lymphocytes and plasma cells is also present, particularly when leakage of duct contents into the surrounding stroma has occurred. In the later stages of duct ectasia, fibrosis of duct walls, sometimes accompanied by elastosis, is the predominant histologic feature. The fibrotic wall of the duct may calcify, and can result in calcifications within duct lumens (Fig. 2E). A small portion of a fibrotic duct, with or without accompanying inflammation, may be the only finding in a limited core biopsy sample. Cholesterol granulomas, or “cholesterolomas,” may form within ducts and rupture, spilling contents into the surrounding stroma (Fig. 2F).


A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples.

D'Alfonso TM, Ginter PS, Shin SJ - J Pathol Transl Med (2015)

Mammary duct ectasia. (A) Core biopsy performed for an “intraductal mass” shows a portion of a fibrotic duct wall lined with foamy histiocytes. (B) Disrupted/ruptured duct wall with histiocytes in periductal stroma. (C) Flattened epithelium and fragments within the proteinacious luminal contents. The sample lacks prominent inflammatory features. (D) Brown histiocytes, or “ochrocytes,” are seen in the periductal stroma. Intraepithelial foamy histiocytes are also present. (E) An older lesion shows intraductal calcification. (F) Intraductal “cholesteroloma” formed within a duct with rupture into surrounding stroma.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4508565&req=5

f2-jptm-49-4-279: Mammary duct ectasia. (A) Core biopsy performed for an “intraductal mass” shows a portion of a fibrotic duct wall lined with foamy histiocytes. (B) Disrupted/ruptured duct wall with histiocytes in periductal stroma. (C) Flattened epithelium and fragments within the proteinacious luminal contents. The sample lacks prominent inflammatory features. (D) Brown histiocytes, or “ochrocytes,” are seen in the periductal stroma. Intraepithelial foamy histiocytes are also present. (E) An older lesion shows intraductal calcification. (F) Intraductal “cholesteroloma” formed within a duct with rupture into surrounding stroma.
Mentions: The microscopic appearance of duct ectasia is variable and depends on the disease stage. In early stages, mild ductal dilatation with luminal histiocytes is seen (Fig. 2A, B). Ductal epithelium is not hyperplastic and may be flattened or completely absent. Sloughed epithelium may be seen in ductal lumens (Fig. 2C). Lipid-laden foamy histiocytes can be seen within the duct lumen and in adjacent stroma. Intraepithelial histiocytes can also be seen. “Ochrocytes” refers to histiocytes in periductal stroma that show accumulation of lipofuscin pigment, which imparts a brown color to the cells (Fig. 2D) [18]. A periductal chronic inflammatory cell infiltrate composed of lymphocytes and plasma cells is also present, particularly when leakage of duct contents into the surrounding stroma has occurred. In the later stages of duct ectasia, fibrosis of duct walls, sometimes accompanied by elastosis, is the predominant histologic feature. The fibrotic wall of the duct may calcify, and can result in calcifications within duct lumens (Fig. 2E). A small portion of a fibrotic duct, with or without accompanying inflammation, may be the only finding in a limited core biopsy sample. Cholesterol granulomas, or “cholesterolomas,” may form within ducts and rupture, spilling contents into the surrounding stroma (Fig. 2F).

Bottom Line: Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging.Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa.These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.

ABSTRACT
Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging. Such lesions can simulate a malignant process, based on both clinical and radiographic findings, and core biopsy is often performed to rule out malignancy. Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa. Diagnostic difficulty may arise due to the small and fragmented sample of a core biopsy. This review will focus on the pertinent clinical, radiographic, and histopathologic features of the more commonly encountered inflammatory lesions of the breast that can be characterized in a core biopsy sample. These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess. The microscopic differential diagnoses for these lesions when seen in a core biopsy sample will be discussed.

No MeSH data available.


Related in: MedlinePlus