The cause of disease
The etiology of this disease is not clear, but it is more common in middle-aged and elderly people. It may be a degenerative change, which is related to nipple invagination or deformity, squamous epithelium extending into the inner wall of the catheter, causing keratinized scales to block, or lipid secretion stimulating the wall of the catheter, causing inflammation, scar hyperplasia and secondary infection. Autoimmune diseases are also possible, because plasma cell mastitis often occurs in the late stage of the disease, and a large number of plasma cells infiltrate pathologically, and the lesions appear repeatedly, so some people think it is an autoimmune disease.
express
The early manifestations are brownish yellow nipple secretion or yellowish secretion, and a few cases have bloody secretion, involving multiple catheters. When squeezing at areola, light yellow liquid can often be squeezed out. In the later stage, there are lumps of different sizes near the areola, or the lumps are adhered to the skin, or the nipples are invaginated. Sometimes the skin on the surface of the lump is red, swollen, painful and tender. In severe cases, abscess around areola may appear, which is often difficult to heal after incision. There will also be repeated infections, prolonged breast fistula or severe breast deformation. Repeated illness, the medical history can be as long as 10 years.
Diagnosis and differential diagnosis
Middle-aged and elderly women have nipple discharge, involving multiple catheters, which can form inflammatory masses and abscesses in the later stage. It is often difficult to heal after incision, and those who often have fistula can be diagnosed.
The following shall be determined:
Intraductal papilloma (or cancer): The patient may be a little young, showing painless single or occasional 2-3 catheter exudates, sometimes touching small nodules near the areola, with a history of yellowish or bloody exudates. The diagnosis can be confirmed by mammography or biopsy.
Breast cancer: more common in middle-aged and elderly women. The lump in the breast is single and solid, with unclear boundary, progressive growth, axillary lymph node metastasis and less nipple discharge. B-ultrasound, fine needle biopsy and pathological examination can make a definite diagnosis.
Tuberculosis of breast: It can also be manifested as inflammatory lump and chronic ulcer or fistula in the breast, which often depends on pathological diagnosis. But in clinic, after the ulcer or fistula of breast tuberculosis is formed, there are often hidden edges, pale granulation tissue and bean dregs-like thin secretions, and acid-fast bacilli are sometimes seen in pus smear.
treat cordially
Ductal ectasia and plasma cell mastitis are manifestations of the same disease in different periods, and the treatment scheme depends on different clinical manifestations. However, the key point of treatment is to remove the diseased mammary duct in order to achieve the goal of radical cure.
In the early stage of mammary duct dilatation, if there is only nipple discharge or cyst or small lump in areola, duct dilatation and tumor resection should be performed, inflammatory tissue and communication duct around the tumor should be removed, and the duct should be separated from nipple to avoid postoperative recurrence. Keep the nipple.
After eliminating the possibility of malignancy, nipple discharge and recurrent infection should be widely removed. If the lesion is concentrated in areola and central area, it can be used as wedge resection of central breast to achieve the goal of radical cure.
Inflammatory mass or abscess should be treated according to inflammation, antibiotics should be used, and local incision and drainage should be made, including dilated catheter with suspected lesion.
For patients with chronic fistula or severe breast malformation, simple mastectomy can be considered.
References:
Plasma cell mastitis was broadcast by Jiangsu People's Broadcasting Station (702) on September 5th17:10-18: 00.
In recent years, the number of patients with plasma cell mastitis has gradually increased. Because the initial breast lump is very similar to breast cancer, the lump softens to form abscess, and it is easy to form fistula after collapse, which is not easy to heal or fester repeatedly, bringing great pain to patients. Plasma cell mastitis is a mammary duct disease called inflammation, but it is not a bacterial infection. Its clinical manifestations can be roughly divided into three stages.
1, galactorrhea: nipple discharge is an early manifestation of plasma cell mastitis, which is intermittent and spontaneous and can last for a long time. Patients or doctors often ignore a small amount of intermittent nipple discharge. Some patients have complete or incomplete nipple depression, a considerable number of them are congenital nipple depression, and some patients gradually sag after onset.
2, mass stage: often sudden onset, rapid development. The patient felt local pain and discomfort in the breast, which may be tingling or dull pain, and found a lump. Most of the masses are located under the areola or extend in a certain direction. The masses vary in size, irregular in shape, hard and tough in texture, nodular in surface and unclear in boundary. The tumor may be red, swollen and hot locally, with obvious pain. The swelling range can be extended to 1/4- 1/2 breast, and the breast skin is edematous, some of which may be orange peel-like, and the lateral axillary lymph nodes of the patient are swollen and tender. There are also some patients who can always concentrate on the breast lump, and the lump gradually increases for 3 years, 5 years or longer, but there is no obvious redness and swelling.
3. Fistula stage: later breast mass becomes soft and forms abscess. Acne-like substances or grease-like substances are often sandwiched in the pus flowing out after rupture. Often form a fistula leading to the nursing hole, the wound does not converge or fester repeatedly for a long time, the local tissue is hard and uneven, and the nipple is more concave. Fistula is simple and complicated. The external orifice is mostly located in the areola and partly in the breast, but it is connected with the nipple hole after all.
The disease can occur in women of any age after puberty, and it does not occur during lactation. Most patients have totally or partially congenital nipple depression. There are many patients with unilateral onset, and there are also patients with double breasts. The onset is slow, and the course of disease can last for months or years. The diagnosis of this disease can be clearly diagnosed according to the following aspects. ① The onset period is not lactation or pregnancy; ② Most patients have all or part of congenital nipple depression; (3) The breast mass begins to be located in areola, and the local mass may be red and swollen when suppurating, but the systemic inflammatory response is atypical; ④ After abscess rupture, pus is often mixed with powder residue, and the wound recurs, forming a fistula leading to nipple; ⑤ molybdenum target photography, needle aspiration cytology and other auxiliary examinations are helpful to make a definite diagnosis.
In terms of treatment, western medicine mainly adopts surgical method to treat plasma cell mastitis. According to different situations, mastectomy, segmental mastectomy and simple mastectomy were used respectively. Plasma cell mastitis has reached a very serious stage, often partial mastectomy can not solve the problem, only simple mastectomy can be done. Traditional Chinese medicine (TCM) has its own characteristics in the treatment of this disease, especially the external treatment of TCM has outstanding advantages in the treatment of this disease. Combined with TCM syndrome differentiation treatment, the curative effect is good, and simple mastectomy is rare.