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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

Diabetic mastopathy. (A) Lymphoid infiltrates surround ducts, lobules, and small vessels. The stroma has a hyalinized appearance. (B, C) Plump epithelioid fibroblasts are present in the stroma (C inset, high power). Perilobular (B) and perivascular (C) chronic inflammation is seen. (D) Fibroblasts in diabetic mastopathy compared with granular cell tumor (E) and multinucleated stromal giant cells (F).
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f4-jptm-49-4-279: Diabetic mastopathy. (A) Lymphoid infiltrates surround ducts, lobules, and small vessels. The stroma has a hyalinized appearance. (B, C) Plump epithelioid fibroblasts are present in the stroma (C inset, high power). Perilobular (B) and perivascular (C) chronic inflammation is seen. (D) Fibroblasts in diabetic mastopathy compared with granular cell tumor (E) and multinucleated stromal giant cells (F).

Mentions: Tomaszewski et al. [32] were the first to put forth criteria for the microscopic diagnosis of diabetic mastopathy. The characteristic constellation of findings includes lymphocytic lobulitis and ductitis, lymphocytic perivasculitis, and stromal fibrosis with epithelioid fibroblasts [32]. Lymphocytic infiltrates, which can be fairly dense, surround ducts, lobules, and small vessels, and may sometimes be associated with plasma cells (Fig. 4A–C). Immunohistochemical characterization of these infiltrates reveals mature B-lymphocytes with a small population of T cells [43]. Germinal centers are not typically seen here. Involved lobules may be atrophic or unremarkable. The stroma in diabetic mastopathy is dense and has a keloidal appearance. Intra-stromal epithelioid fibroblasts appear as plump cells with eosinophilic cytoplasm (Fig. 4B–D). Nuclei are oval to round with vesicular nuclei. Neither significant nuclear atypia nor mitotic figures are seen. The distribution of fibroblasts within the stroma can be heterogeneous, and show a whorled or nodular growth pattern [35]. These distinctive fibroblasts are not present in all cases of diabetic mastopathy. In a series by Ely et al. [35], epithelioid fibroblasts were absent in five of 19 (26%) cases, including the two cases occurring in men. However, these fibroblasts were present in all three non-diabetic patients in their study.


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)

Diabetic mastopathy. (A) Lymphoid infiltrates surround ducts, lobules, and small vessels. The stroma has a hyalinized appearance. (B, C) Plump epithelioid fibroblasts are present in the stroma (C inset, high power). Perilobular (B) and perivascular (C) chronic inflammation is seen. (D) Fibroblasts in diabetic mastopathy compared with granular cell tumor (E) and multinucleated stromal giant cells (F).
© Copyright Policy
Related In: Results  -  Collection

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

f4-jptm-49-4-279: Diabetic mastopathy. (A) Lymphoid infiltrates surround ducts, lobules, and small vessels. The stroma has a hyalinized appearance. (B, C) Plump epithelioid fibroblasts are present in the stroma (C inset, high power). Perilobular (B) and perivascular (C) chronic inflammation is seen. (D) Fibroblasts in diabetic mastopathy compared with granular cell tumor (E) and multinucleated stromal giant cells (F).
Mentions: Tomaszewski et al. [32] were the first to put forth criteria for the microscopic diagnosis of diabetic mastopathy. The characteristic constellation of findings includes lymphocytic lobulitis and ductitis, lymphocytic perivasculitis, and stromal fibrosis with epithelioid fibroblasts [32]. Lymphocytic infiltrates, which can be fairly dense, surround ducts, lobules, and small vessels, and may sometimes be associated with plasma cells (Fig. 4A–C). Immunohistochemical characterization of these infiltrates reveals mature B-lymphocytes with a small population of T cells [43]. Germinal centers are not typically seen here. Involved lobules may be atrophic or unremarkable. The stroma in diabetic mastopathy is dense and has a keloidal appearance. Intra-stromal epithelioid fibroblasts appear as plump cells with eosinophilic cytoplasm (Fig. 4B–D). Nuclei are oval to round with vesicular nuclei. Neither significant nuclear atypia nor mitotic figures are seen. The distribution of fibroblasts within the stroma can be heterogeneous, and show a whorled or nodular growth pattern [35]. These distinctive fibroblasts are not present in all cases of diabetic mastopathy. In a series by Ely et al. [35], epithelioid fibroblasts were absent in five of 19 (26%) cases, including the two cases occurring in men. However, these fibroblasts were present in all three non-diabetic patients in their study.

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