Breast abscess pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Following untreated mastitis, breast abscess could occur. Breast abscess is usually caused by staphylococcus aureus bacterial infection to an injured breast skin. Staphylococcus aureus could form abscess by secretion of several killing agents like enzymes and toxins which causes breast tissue necrosis. In a reaction to these bacterial substances, assembled white blood cells in this tissue produces anti-bacterial anti-bodies that help in killing the bacteria. However, these cells cause damage to the soft tissue contributing in the abscess formation. As the breast abscess is the complicated form of mastitis, the pathophysiology is mostly like the mastitis pathophysiology.[1]

Pathophysiology

Pathogenesis

Breast abscess is the result of underlying inflammation (mastitis) in the breast skin. Injury may happen either during the lactation process from the infant or in the non-lactaion state of the patient as a cracking in the breast skin. This injury accelerates the entry of the causative bacteria which by its role form the abscess. [2]
In neglected cases, there may be necrosis in the abscess location leads to fibrosis, scarring and nipple retraction.

  • Non-Lactional:
    • Non lactational breast abscess is less common than lactational form. It can be subgrouped into central, peripheral and skin associating.
    • Cracking in the skin will overtly help the bacteria to enter and form the abscess.

Associated diseases

There is no associated diseases with breast abscess.

Gross Pathology

The gross findings can be confused with other malignant diseases.

  • Ill-defined with overlying skin thickening
  • Lymphadenopathy
  • Nipple retraction

Microscopic pathology

The following findings can be demonstrated on a pathology slide

References

  1. Kobayashi SD, Malachowa N, DeLeo FR (2015). "Pathogenesis of Staphylococcus aureus abscesses.". Am J Pathol. 185 (6): 1518–27. PMC 4450319Freely accessible. PMID 25749135. doi:10.1016/j.ajpath.2014.11.030. 
  2. Kataria K, Srivastava A, Dhar A (2013). "Management of lactational mastitis and breast abscesses: review of current knowledge and practice.". Indian J Surg. 75 (6): 430–5. PMC 3900741Freely accessible. PMID 24465097. doi:10.1007/s12262-012-0776-1. 
  3. Marchant DJ (2002). "Inflammation of the breast.". Obstet Gynecol Clin North Am. 29 (1): 89–102. PMID 11892876. 
  4. Bundred NJ, Dixon JM, Lumsden AB, Radford D, Hood J, Miles RS; et al. (1985). "Are the lesions of duct ectasia sterile?". Br J Surg. 72 (10): 844–5. PMID 4041720. 

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