Plasmacytoid mastitis is a rare aseptic-like specific type of benign breast lesion characterized by marked dilatation of collecting ducts at the areola, periductal fibrosis and massive inflammatory cell, especially plasma cell, infiltration. The incidence is low, accounting for approximately 1.41% to 5.36% of benign breast diseases in the same period. The etiology of this disease is unclear, one believes that the early stage may be caused by an anaerobic bacterial infection and that common antibiotic therapy is ineffective. The other believes that it may have started as an autoimmune disease. However, surgical findings almost always include dilated ducts with pimple-like or cheese-like fillings within the dilated ducts. The disease is difficult to differentiate from breast cancer, which can lead to misdiagnosis and misdiagnosis, or be treated as general mastitis with repeated incisions and drains, long-lasting wounds, and recurrent episodes. It is a difficult disease of benign breast disease. It is also medically known as ductal dilatation, occlusive mastitis, chemical mastitis, and acne mastitis.
In general, ductal dilatation is named after the stagnation of drainage from the dominant duct near the nipple. When the lesion has progressed to a certain stage, inflammation with predominantly plasma cell infiltration around the ducts at all levels is called plasmacytoid mastitis.
I. The clinical features of plasmacytoid mastitis include the following.
1, the age of onset is young, mostly seen in 30-40 year old non-pregnant lactating women.
The lumps are often located deep in the areola or in the various quadrants of the breast. The lump is often located in the deep areola or in all quadrants of the breast. Its long axis is consistent with the course of the breast ducts, and its texture is hard with unclear borders.
Most patients have non-periodic breast pain. In the acute stage, there may be redness, swelling, heat and pain, accompanied by enlarged ipsilateral axillary lymph nodes, often with tenderness, which can be easily misdiagnosed as acute mastitis.
4, can be accompanied by nipple overflow, mostly watery plasma or purulent, there may be bloody overflow. The smear of the overflow can show a large number of plasma cells or inflammatory cells. The affected breast often has nipple invagination or deformation.
5. The duration of the disease varies, and can be between several months or years.
6. Mammography shows ductal dilatation – but this test is not recommended, as it may aggravate the disease.
7. Fine needle aspiration cytology reveals hyperplastic and inflammatory cells.
8. Mammography and magnetic resonance imaging show a uniform dense mass in the subareolar area (MRI is recommended for women younger than 40 years of age; mammography is difficult to identify).
Second, the principles of surgical treatment of plasmacytoid mastitis.
Plasmacytoid mastitis is a benign disease that rarely heals spontaneously and often has a prolonged course over several years and lacks a particularly effective approach. The disease is a non-bacterial inflammatory disease, its anti-inflammatory efficacy is not obvious, surgery has the following modalities.
1, conservative treatment: for acute inflammatory phase plasmacytoid mastitis, first with a combination of anti-anaerobic and cephalosporin antibiotics, to be treated with triamcinolone acetonide (tamoxifen) for those who still have breast lumps after the acute phase of inflammation has improved. For breast effusion or combined with more pus, all need to be incised and drained, and actively treated as acute suppurative mastitis before considering later surgery to improve the efficacy. The development of female breast is mainly due to the action of estrogen. Taking triamcinolone acetonide can block the stimulating effect of estrogen on the breast in women’s body, making the breast tissue in a relatively dormant period of inactivity. This can make the tissue of plasma cell mastitis caused by autoimmune diseases in a dormant state and make the exudation decrease and the inflammation subside.
2. Simple mastectomy: huge masses, diffuse lesions, sinus tract formation with recurrent infections, or strong desire of the patient and family and older age can be considered. This method is chosen as a last resort, so it is necessary to consider the postoperative family-social-psychological factors that the patient has to bear, and it is recommended to use prosthetic implants to improve aesthetic problems.
3.Enlarged resection or quadrant resection: local resection or segmental resection centered on the mass is not recommended because it is easy to recur after surgery; enlarged resection or quadrant resection of the lesion is recommended – enlarged resection is mainly to remove the entire lobule where the duct is located and the surrounding part of the normal lobule together with the lesion, sometimes the lobular quadrant, sometimes larger than the quadrant. Sometimes the lobular quadrant, sometimes larger than the quadrant.
The surgical treatment of plasmacytoid mastitis includes the following considerations.
1. The surgery should ensure complete excision of the lesion including some of the surrounding normal breast tissue, and there should be no grayish lesion tissue to prevent recurrence. The trauma is repeatedly flushed with 3% hydrogen peroxide → saline → surgical Ertai (available), and the suture wound is not left dead, but for excision of too much can not be sutured gland end to end, it is recommended to use negative pressure suction tube to drain for 1 week or more to allow the field to close on its own. If there is an abscess, the abscess is first incised and drained, and then the lesion is enlarged and excised after the inflammation has subsided.
2.Most of the patients with this disease have recurrent attacks or have undergone multiple surgical treatments, and their conditions are more complicated. The scope and depth of the lesions involved are large, and some appear to have a small surface area of redness and swelling, but invade the posterior space of the breast. If the inflammation invades 1/2 to 4/5 of the breast, the entire mammary gland should be considered for mastectomy. For those who operate during the acute inflammation period, implants need to be performed after 3~6 months, and for those who do not have acute inflammation, one stage implantation.
3.Breast ultrasound should be done before surgery, and it is best to perform breast magnetic resonance scanning and strengthening examination if possible, so as to have a comprehensive understanding of the scope, number and depth of the lesion, which is beneficial to the physician’s preoperative assessment more accurately, and also to the patient’s mental preparation.
4. It is better to obtain accurate pathological diagnosis through coarse needle aspiration equipment such as McMurdo or Bard’s needle before the enlarged resection, and pathological examination must be done again after the enlarged resection to provide a reliable diagnostic basis for the clinic. In order to prevent missed diagnosis of breast cancer.