Breast abscess

Fat necrosis

Chronic fat necrosis with oil cyst formation - left: cystic space formed by necrosis of adipose tissue and lined by foamy macrophages and foreign body giant cells (right).

Chronic fat necrosis. Low power view on left shows a central stellate scar, a large collection of foreign body giant cells in the upper left and a collection of free fat droplets in the lower central area. Right hand image shows (A) free fat droplets, (B) a lipoid granuloma and a foreign body giant cell (arrow).
Fat necrosis - low power Fat necrosis - medium power

Chronic fat necrosis - droplets of free fat (left) with foreign body giant cell and foamy macrophage reaction. Photomicrograph on right shows a central foreign body macrophage with pinkish foamy cytoplasm and an engulfed lipid droplet.
Fat necrosis Fat necrosis - high power view of fbgc

FNA: Fat necrosis - large numbers of foamy macrophages admixed with lymphocytes and polymorphs, debris and free fat droplets. Insert shows foreign body giant cell. Main image PAP stained, insert Giemsa.
FNA - fat necrosis

Duct ectasia

Duct ectasia, early lesion - accumulation of foamy macrophages beneath luminal duct epithelium.
FNA - fat necrosis

Series of images from cases of duct ectasia. The earliest lesions are characterised by the accumulation of foamy macrophages between the basement membrane and the epithelium and also within duct lumens. Later lesions show periductal chronic inflammation whilst the most advanced lesions show marked periductal scarring. Superimposed (dystrophic) calcification may be seen.
Low power view of duct ectasia with minimal inflammation/fibrosis but substantial dilation of ducts - a similar picture can be seen distal to an obstruction e.g. a papilloma Duct lumen containing foamy macrophages with extension to periductal area with inflammation and fibrosis
Duct lumen packed with foamy macrophages in duct ectasia - the duct wall seems to be breaking down with extension of the lumenal foamy cells Intra-epithelial and subepithelial infiltrate of foamy macrophages - an early lesion in duct ectasia
Duct ectasia with persistent subepthelial infiltrate of foamy macrophages and evolving periductal fibrosis Old duct ectasia with dense periductal fibrosis and a small amount of residual inflammation

The following set of photographs show an unusual granulomatous variant of duct ectasia with numerous foreign body giant cells (presumably reacting to lipid) within duct lumina with periductal granulomatous inflammation and stromal chronic inflammation and fibrosis.

Unusual granulomatous variant of duct ectasia
Periductal infiltrate of foamy macrophages High power view of periductal infiltrate
Luminal aggregate of foreign body giant cells with lipoid clefts Luminal foreign body giant cells and periductal infiltrate of foamy macropahges

See also Case of the Month May 2007

Granulomatous Lobular Mastopathy

The following images illustrate the pathology of this uncommon inflammatory condition of unknown aetiology. Its importance relates to the problem that it can be mistaken clinically for carcinoma because it can present as a palpable irregular hard mass and its partial obliteration of lobular units could lead to the mistaken inpression of an infiltrative process histologically. The similarities histologically between this condition, granulomatous duct ectasia and mastitis obliterans suggest to me that these conditions are related.

Granulomatous Lobular Mastopathy
Granulomatous Lobular Mastopathy
Granulomatous Lobular Mastopathy

  • See also Image of the month 2010/6 Granulomatous lobular mastopathy
  • Mammary Duct Fistula

    The images below are from an excised fistula track. The condition may require a number of operations. The track is characteristically lined by keratinising squamous epithelium and granulation tissue with chronic inflammation of surrounding tissues.

    Mammary duct fistula
    Squamous-lined fistula track with surrounding chronic inflammation

    Squamous-lined fistula track with surrounding chronic inflammation Detail of fistula lining
    Area of granulation tissue lining track - this is common

    Radiation injury

    Chronic radiation injury
    Hyalinisation of collagen in chronic radiation injury Collagen changes and elastosis in addition to frequent bizarre fibroblasts
    Bizarre 'radiation' fibroblasts and haemosiderin Bizarre 'radiation' fibroblast adjacent to ectatic vessel

    Diabetic Mastopathy

    See 'Case of the Month' July 2007


    Amyloid tumour of the breast - this was clinically and radiologically suspicious

    For a further example of this see also Image of the Week 2008 (6)

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