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Inflammatory Conditions


  1. Infections of the breast are uncommon, usually complications of lactation Q
  2. Duct ectasia can cause nipple discharge, uncommon in younger women
  3. Fat necrosis is due to trauma, more frequent in the obese
  4. Acute pyogenic mastitis  


  1. Acute pyogenic mastitis is a painful acute inflammatory condition which usually occurs in the first few weeks after delivery, and Staphylococcus aureus is the commonest organism. Q
  2. The usual portal of entry is a crack in the nipple, although persistence of the keratotic plug at the orifice of a duct may be a factor. Q
  3. The organisms spread via the lymphatics, and the infection tends to be confined to one segment of the breast, resulting in localised swelling and erythema.
  4. The infection can spread to other segments and, if Streptococcus pyogenes is the causative organism, a more widespread inflammation occurs with systemic symptoms. Q
  5. If antibiotics are given but there is inadequate drainage, a localised breast abscess will result.
Mammary Duct Ectasia
  1. Mammary duct ectasia involves the larger ducts within the breast but, in severe cases, can also extend to the smaller interlobular ducts. Q
  2. It occurs predominantly in women in the second half of reproductive life and after the menopause, and mild degrees of the condition are often an incidental finding in breast tissue excised for other conditions. Q
  3. Severe forms, in which it is the primary presenting condition, are less frequent. Severe cases can be mistaken clinically for a carcinoma as there may be a discharge from the nipple which may be blood-stained.
  4. Fibrosis around the ducts may result in nipple retraction, and there may be a firm palpable mass.
  5. However, mammary duct ectasia is a purely inflammatory condition with no relationship to malignancy. 
Fat necrosis Q
  1. Trauma, e.g. seat belt injury, is thought to be the cause of fat necrosis, although a history is not always obtained.
  2. It is more frequent in obese women and after the menopause, when the breast has a proportionally greater amount of adipose tissue. Q
  3. It usually presents as a discrete lump and can therefore mimic a carcinoma clinically.
  4. Macroscopically, the tissue is yellow and hemorrhagic, with flecks of calcification. Q
  5. Fibrous tissue is also present, the amount depending on the duration of the condition.
  6. Histologically, the appearances are the same as those of any adipose tissue that undergoes necrosis

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