OTHER

DIABETIC MASTOPATHY

Usually involves both breasts
Fibrosis gradually causes hardening of breasts in patients with longstanding insulin-dependent DM.
Skin is NOT involved
Firm palpable mass in longstanding type 1 DM in males and females.

Hx of erythema and enlargement of the breast and axillary and/or intramammary LNs
Typically 2/2 from bacteria from infant's mouth entering small cracks in the skin of nipple/areolar complex
Most common in lactating women
US is helpful for identifying an abscess
Typically responds to abx
Important to follow to resolution (typically 2-3 wks) after instituting abx to exclude underlying inflammatory carcinoma
Puerperal mastitis
- Related to childbirth
- Most common during peak reproductive years (20-40)
- Adenopathy is often associated.
- First treat w/ 2 wk course of abx. If sx persist, then a punch bx should be performed. Continued breast feeding or pumping is recommended.
Nonpuerperal mastitis
- High association with heavy smoking which results in squamous metaplasia of lactiferous ducts with resulting duct ectasia, stasis, and recurrent infection
- Can recurr for years

Noninfective granulomatous inflammation of breast typically occuring in parous women characterized by lobulocentric noncaseating granulomas
Can occur anywhere in the breast but does not involve the nipple.
Nipple discharge is not characteristic.
US: irregular solid masses; large ill-defined areas of hypoechogenicicty in women w subacute or relapsing breast inflammation and discharging cutaneous sinuses.
Will NOT respond to abx and requires steroid tx (contraindicated in setting of infection)
50% of cases resolve spontaneously with expectant management and most resolve on oral steroids. Surgery may be needed.
Often relapses intermittently. MTX is useful for resistant or recurrent cases.
Special stains for microorganisms should be performed and must be negative before making dx of IGM.

Erythematous, indurated, &/or painful breast lump near the nipple
Can look identical to a necrotic tumor
RF:
- Half of pts with abscess have no known risk factors
- DM, recent surgery, HIV, nursing mothers
US:
- Hypoechoic mass with heterogeneous texture, complex cystic-solid mass +/- thick wall or septations
- May have fluid-debris level
Edema often present in the tissue surrounding abscesses
TX
- When < 3 cm, can usually be treated successfully with oral abx and US guided drainage
- Open incision and drainage or placement of a drainage catheter may be required for larger collections
Short term FU imaging after course of abx (2-4 wks) should be performed to assess resolution if there was no initial aspiration to confirm abscess.
If there is any suspicion, a core needle bx is warranted.

2/2 ductal hyperplasia and stromal proliferation
Features: subareolar fan or flame shaped density which emanates rom nipple and blends into surrounding fat, usually asymmetric
Not firm of masslike
Pseudogynecomastia is characterized by fatty enlargement without ductal or stromal proliferation

Clinical: manifest with skin thickening and redness w/ hx of breast CA treatment
US: no parenchymal mass

Clinical
- Hx of trauma or intervention
- Ecchymosis without erythema
Features (can be variable depending on age of blood products)
- Usually have thick (>2-3 mm) wall with internal septations and debris
- Rounded with convex borders on mammography
- Most resolve rapidly; can persist for months after a surgery
Short term FU (2-4 wks) would be appropriate if there is any doubt
- Postoperative edema, skin thickening, and hematoma should decrease on subsequent FU.

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