I. Definition
Plasmacytoid mastitis (PCM), also known as mammary duct dilatation (MDE), is a non-infectious inflammatory disease of the breast, which is a chemical inflammatory lesion of the breast tissue, with plasma cells predominating. It is called “acne canker sore” in Chinese medicine. The incidence of this disease accounts for 4.1% to 4.5% of benign breast diseases, and the misdiagnosis rate is as high as 60% to 90% because of the difficulty in distinguishing it from breast cancer. The clinical manifestations are complex and varied, and the delayed treatment results in the formation of multiple abscesses, multiple sinus tracts or fistulas, and a complex intractable plasma cell mastitis with multiple stages of chronic stiffness.
Etiology
The pathogenesis of PCM is unknown, but the pathological basis for PCM is the retention of dilated ducts in the breast. The pathogenesis is mainly related to nipple dysplasia, which inevitably causes distortion and deformation of the ducts. The ducts are then easily blocked and the duct contents are lipidic substances that leach into the duct wall causing overflow, causing chemical inflammation and a large number of lymphocytes and plasma cells to react and form small inflammatory masses. Foreign reports related to smoking, it is believed that the accumulation of metabolites such as lipid-like peroxides, cotinine, and niacin in the breast, provoke restricted tissue damage, allowing anaerobic bacteria to breed in the milk ducts and cause the typical manifestation of septicemia.
Main clinical symptoms
1, nipple overflow: in clinical terms is often the earliest symptom, spontaneous, intermittent, the overflow is clear, light yellow or brownish yellow.
2. Breast lump: It is the most common clinical manifestation and may be followed by pain, abscess, milk duct fistula and enlarged axillary lymph nodes.
(1) The history of the disease is different, as there is a history of recurrent acute inflammation during the non-lactation period, while the symptoms of breast cancer are often not obvious; (2) The disease is relatively younger and has a longer history; (3) There is a history of congenital nipple invagination, surgery and poor breastfeeding; (4) The lumps are mostly around the areola, while the lumps of breast cancer are mostly in all quadrants, especially the upper outer quadrant; (5) The needle aspiration biopsy is mainly plasma cells with a large number of inflammatory cells; (6) The surgical procedure is different from that of breast cancer. (7) Intraoperative freezing examination is a reliable basis for the diagnosis of the disease, but when the freezing is obviously inconsistent with the clinical manifestations, a paraffin report should be awaited.
Fourth, auxiliary examination
1. Routine blood test: blood picture is higher than normal.
2.B ultrasound examination: solid or cystic solid mixed occupancy with unclear boundary and occasional sand-like calcification.
3.Near infrared scan: dilated vascular shadow was seen at the edge of the mass.
4. Needle aspiration cytology of breast lumps and nipple spill smear cytology did not show malignant cells.
V. Treatment principles
Treatment of acellular mastitis depends on the different clinical manifestations, but the main point of treatment is surgical excision of the diseased breast ducts in order to achieve thoroughness in the treatment of plasmacytoid mastitis. The lump may be excised in the case of a limited mass, excised in the case of an abscess, or excised in the case of a fistula. In some cases, a unit mastectomy may be considered for most chronic fistulas or severe breast deformities of long duration.
Six, care measures
1, the condition of observation: regular measurement of body temperature, pulse, respiration, to understand the blood white blood cell count and classification changes, if necessary to do bacterial culture and drug allergy test.
2.Prevent infection: keep the incision dressing clean and dry after surgery, and return to the hospital to change the medication on time.
3.Health education: inform the patient of the etiology of nipple overflow, the necessity of surgical treatment, and contact the patient’s ideological concerns.
4, dietary care: prohibit spicy food, hairy food such as shrimp, squid, pineapple, leek, etc. Planned intake of adequate nutrition and calories, such as lean meat with a little sand ginseng stew, more food rich in vitamin C, more green vegetables and fruits, to develop good eating habits.
5.Psychological care: enlighten them to release their mental pressure and face the reality. Encourage the patient to face life with optimism and positive attitude, and control the impulse with the power of reason.
Seven, preventive care
1, pay attention to personal hygiene, keep the nipples clean, remove the accumulation of acne-like material in the nipple is an important preventive measure for this disease.
2, with the help of nipple extractor or nipple inversion correction device, correcting the sunken and indented nipples can prevent secondary infection, which is of positive significance to the prevention of this disease.
3, keep a happy mood, avoid emotional impatience, worry and anger and other factors that promote and aggravate the disease. Instruct patients to divert negative emotions through ball games, yoga, walking, contact with nature, reading, etc.
4, diet should be light, eat more fresh fruits and vegetables and high-fiber food, avoid spicy and stimulating food.