Plasmacytoid mastitis, a chronic non-bacterial inflammatory disease of the breast.
Plasmacytoid mastitis occurs mostly in middle-aged and older women, with a peak age of 50-60 years, and most patients have nipple invagination deformity. Plasmacytosis is different from the usual septic mastitis during lactation. Many people do not recognize this disease and mistake him for a general bacterial infection, or misdiagnose it as breast tuberculosis, or most frighteningly, misdiagnose it as breast cancer mistakenly cutting the breast.
Plasmacytoid mastitis is a more complex inflammatory disease of the breast, named for the large number of plasma cells infiltrating the tissue surrounding the inflammation. In addition, it has many different names, the most common being “ductal dilatation syndrome”, “occlusive mastitis”, “non-lactating mastitis” and “Chronic mastitis”, etc. The disease is caused by irregular proliferation of the epithelium of the breast ducts, secretion dysfunction, and accumulation of lipid-containing secretions in the large milk ducts under the nipples and areola, causing dilation of the milk ducts, and later decomposition of the accumulation, which produces chemicals that constantly stimulate the surrounding tissues and cause inflammation. Sometimes the inflammation can become acute and become an abscess, so the pus is often laden with bean curd-like or powder-like material, so it is also called “acantholytic mastitis” or “acantholytic canker sore” in Chinese medicine.
Plasma cell mastitis, also known as ductal dilatation, is called acantholytic canker sore in Chinese medicine, and is commonly referred to as ductitis, or plasma milk. It is not caused by bacterial infection, but by the accumulation and overflow of fatty material in the ducts, which causes chemical irritation and an immune response around the ducts, resulting in a large number of plasma cell infiltrates, hence the name plasmacytosis. Repeated episodes and fistulas are formed after rupture, which can be followed by bacterial infections that do not heal for a long time. Therefore, it is a special kind of mastitis.
Plasmacytoid mastitis occurs in association with nipple dysplasia, like nipple entropion and nipple splitting, where the entropion becomes a hiding place for dirt, often with pimple-like things and sometimes a bad smell. Nipple deformities also inevitably cause distortion and deformation of the ducts. The ducts are then easily blocked, and the duct contents are lipidic substances that leach the duct walls causing overflow, causing chemical inflammation, and a large number of lymphocytes and plasma cells react to form small inflammatory masses.
The lesions are mostly in the vicinity of the areola and are locally red, swollen and painful. Usually there is no fever. It may subside on its own after a few days and then reappear when the resistance is low such as exertion or cold, but it is heavier than once and the mass gradually becomes larger.
The lesions can also occur in multiple places, forming multiple fistulas and even interconnecting with each other, leaving the breast with a lot of holes. This is very similar to breast tuberculosis. If the lump is far away from the nipple and adheres to the skin, it is very much like breast cancer. So one should know about plasma breast, not delay the diagnosis and try to cure it once and for all.
Plasmacytoid mastitis has a sudden onset and develops rapidly. The patient feels localized pain and discomfort in the breast, and a lump can be palpated. The lump is located under the areola or extends into one quadrant. The masses are hard and tough. The surface is nodular, with poorly defined borders and no adhesions to the chest wall. The skin of some breasts is edematous and orange peel-like, and there are usually no systemic symptoms such as fever. The nipples are often edematous and orange peel-like, usually without fever and other systemic symptoms. The nipples often secrete powder-like material with a foul odor. A small number of patients have nipple discharge, which is bloody or watery, and may be accompanied by enlargement of the axillary lymph nodes on the affected side. In the late stage, the lump becomes softened and forms an abscess. The abscess breaks down and flows pus mixed with powder-like pus and causes fistulas in the areola, resulting in recurrent wounds and scarring, which causes the nipple to sink into a concave position.
The clinical manifestations of plasmacytoid mastitis are varied, with some patients presenting with chronic nipple discharge, nipple invagination alone, or localized lumps that persist for years.
Clinical features
1. It is not associated with pregnancy and breastfeeding, i.e., it does not develop during lactation.
2. Most patients have various deformities of the nipple or dilated ducts.
3. There are many young women and many unmarried ones.
4. Recurrent, long-lasting paramametrial fistulas or chronic inflammatory masses. There is a case with a history of up to 13 years.
5, This disease is not uncommon, accounting for about 10% of breast patients.
Treatment
1, the acute phase of anti-inflammatory, because it is not caused by bacteria, so there is no need to use antibacterial, Chinese medicine to clear heat and detoxification, and
The Chinese herbal medicine clears the heat and detoxifies the swelling and disperses the knots. However, it should not be too bitter and cold, the colder the medicine, the less the lump will disappear.
2, the chronic period with warming medicine – Yang He Tang plus or minus.
3, choose the best time for surgery is most important
The best time to operate is during the interictal period, i.e., the wound healing period, but some people think that the disease is well and still do what surgery? Wait until the redness and swelling again, broken, so delayed a long time.
If the wound can not heal, to wait for the acute inflammation to subside, the most superficial wound when surgery, this time there is the possibility of infection after surgery.
4. The key to successful surgery is to flip the areola, remove the lesion thoroughly and clean all traumatic surfaces.
5. The technical key to the surgery is to maintain the perfection of the shape. It is necessary to do the plastic surgery for nipple invagination.
The treatment depends on the different clinical manifestations, but the main point of treatment is to surgically remove the diseased breast ducts in order to achieve complete eradication. If there is an abscess, an incision is made to drain the abscess, and if there is a fistula, the fistula is removed. In some cases, a unit mastectomy may be considered for most chronic fistulas or severe breast deformities that are too long in duration. Which diseases are confused with plasmacytoid mastitis.
Plasmacytoid mastitis is easily confused with non-lactating septic mastitis, breast tuberculosis, and especially with fistulas formed by the breakdown of breast tuberculosis. When there is nipple invagination combined with a lump, it can be easily confused with breast cancer, so sometimes a local biopsy is needed to differentiate.