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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

Granulomatous lobular mastitis. (A, B) Non-necrotizing granulomas are centered within lobules. Granulomas contain Langhans giant cells, and are associated with lymphocytes and plasma cells. (C) Cystic neutrophilic granulomatous mastitis showing neutrophil-lined cysts within granulomas. (D) Gram-positive coryneform bacilli are present within the cysts.
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f3-jptm-49-4-279: Granulomatous lobular mastitis. (A, B) Non-necrotizing granulomas are centered within lobules. Granulomas contain Langhans giant cells, and are associated with lymphocytes and plasma cells. (C) Cystic neutrophilic granulomatous mastitis showing neutrophil-lined cysts within granulomas. (D) Gram-positive coryneform bacilli are present within the cysts.

Mentions: Microscopically, granulomatous lobular mastitis is characterized by non-necrotizing granulomas concentrated in lobules. The granulomas contain epithelioid histiocytes, Langhans giant cells, and lymphoplasmacytic inflammation (Fig. 3A, B). Neutrophilic microabscesses may also be seen. Granulomatous lobular mastitis may be complicated by frank abscess formation and draining skin sinuses. Cystic vacuoles, representing dissolved lipid, are often present within the granulomas, and can be lined by neutrophils; this has been termed “cystic neutrophilic granulomatous mastitis” (Fig. 3C) [27-29]. In such cases, gram-positive bacilli representing Corynebacterium can be seen within the cystic vacuoles (Fig. 3D). The bacteria show “coryneform” features, such as arrangement into palisades and “V” shapes, as well as clubbing of the organisms. These bacteria are not readily identifiable on hematoxylin and eosin examination, and in most cases only rare (<10) bacteria may be present in one or two vacuoles in one core biopsy sample. In fact, gram stains and microbial cultures of these samples are often negative in these cases, in part due to the fastidious nature of these organisms [27]. We recently reported on a series of twelve patients with histologically identified cystic neutrophilic granulomatous mastitis [29]. All patients presented with a unilateral breast mass that was painful in six of twelve cases. Imaging was either suspicious (BI-RADS 4) or highly suggestive of malignancy (BI-RADS 5) in over half of the studied cases. Gram-positive bacilli were identified in five of twelve cases, and all microbial cultures were negative for bacterial growth. Patients showed a variable response to treatment, with time to resolution of symptoms ranging from two weeks to six months.


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)

Granulomatous lobular mastitis. (A, B) Non-necrotizing granulomas are centered within lobules. Granulomas contain Langhans giant cells, and are associated with lymphocytes and plasma cells. (C) Cystic neutrophilic granulomatous mastitis showing neutrophil-lined cysts within granulomas. (D) Gram-positive coryneform bacilli are present within the cysts.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508565&req=5

f3-jptm-49-4-279: Granulomatous lobular mastitis. (A, B) Non-necrotizing granulomas are centered within lobules. Granulomas contain Langhans giant cells, and are associated with lymphocytes and plasma cells. (C) Cystic neutrophilic granulomatous mastitis showing neutrophil-lined cysts within granulomas. (D) Gram-positive coryneform bacilli are present within the cysts.
Mentions: Microscopically, granulomatous lobular mastitis is characterized by non-necrotizing granulomas concentrated in lobules. The granulomas contain epithelioid histiocytes, Langhans giant cells, and lymphoplasmacytic inflammation (Fig. 3A, B). Neutrophilic microabscesses may also be seen. Granulomatous lobular mastitis may be complicated by frank abscess formation and draining skin sinuses. Cystic vacuoles, representing dissolved lipid, are often present within the granulomas, and can be lined by neutrophils; this has been termed “cystic neutrophilic granulomatous mastitis” (Fig. 3C) [27-29]. In such cases, gram-positive bacilli representing Corynebacterium can be seen within the cystic vacuoles (Fig. 3D). The bacteria show “coryneform” features, such as arrangement into palisades and “V” shapes, as well as clubbing of the organisms. These bacteria are not readily identifiable on hematoxylin and eosin examination, and in most cases only rare (<10) bacteria may be present in one or two vacuoles in one core biopsy sample. In fact, gram stains and microbial cultures of these samples are often negative in these cases, in part due to the fastidious nature of these organisms [27]. We recently reported on a series of twelve patients with histologically identified cystic neutrophilic granulomatous mastitis [29]. All patients presented with a unilateral breast mass that was painful in six of twelve cases. Imaging was either suspicious (BI-RADS 4) or highly suggestive of malignancy (BI-RADS 5) in over half of the studied cases. Gram-positive bacilli were identified in five of twelve cases, and all microbial cultures were negative for bacterial growth. Patients showed a variable response to treatment, with time to resolution of symptoms ranging from two weeks to six months.

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