Bone formation within a breast abscess (original) (raw)
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This case report highlights a rare instance of osseous metaplasia in a breast abscess, diagnosed in an 87-year-old woman following persistent symptoms and standard treatment failures. Surgical excision revealed bone formation within the abscess, a finding not previously documented in the literature for non-malignant breast conditions. The case emphasizes the need for surgical intervention when conservative management fails and underlines the potential for chronic inflammation to contribute to metaplastic changes in soft tissue.
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Laboratory Investigation, 2014
Background: Traditional breast conservation therapy consists of partial mastectomy followed by radiotherapy. Thus, previous studies of radiation-induced changes in the breast have focused on residual extratumoral breast tissue that remains after excision, often long after radiotherapy. A current phase 1 trial of single-dose pre-operative radiotherapy followed by partial mastectomy has yielded a novel specimen type-acutely irradiated primary breast tumor and surrounding benign breast tissue. Review of such cases revealed a high rate of atypical squamous metaplasia (ASM). Design: The ongoing trial has recruited 32 women with clinical stage Tis/T1N0M0 breast cancer, predominantly invasive ductal carcinoma and DCIS. Three cohorts of 8, 8, and 16 women received single radiotherapy doses of 15 Gy, 18 Gy, and 21 Gy, respectively, followed by partial mastectomy. Excisions were submitted entirely for histologic review. HE stained slides for each case were evaluated for 1) presence or absence of ASM and 2) if present, spatial relationship to the tumor/biopsy site. Results: This series included 31 cases of postmenopausal women treated with preoperative radiotherapy. Average interval between radiotherapy and excision was 5.9 days (range 3-10.) ASM was identifi ed in 18 cases (58%), both within the tumor area and away from it. It was more frequent in the highest radiation dose group (13/15) compared to the two lower dose groups (5/16). ASM ranged from focal to diffuse, involving terminal ducts as well as lobules. It typically affected the myoepithelial layer, but a subset of cases demonstrated involvement of luminal epithelium. Importantly, in several cases, ASM mimicked ADH or even DCIS. No ASM was identifi ed in 30 control cases of non-irradiated partial mastectomies. Conclusions: Atypical squamous metaplasia in the breast is commonly observed in excisions following neoadjuvant radiotherapy. The variable appearance of ASM and its regular presence beyond the tumor bed location creates a diagnostic challenge which may be associated with overestimation of tumor size and incorrect margin assessment, possibly leading to inappropriate additional treatment. Awareness of this phenomenon is important since pre-and peri-operative radiotherapy continue to take on an increased role in treating early breast cancers given the practical appeal of an intact tumor target and the opportunity to improve our understanding of the effect of radiation on breast cancer cells.
In Shortly about Breast Diseases
In most women, breast pain is not severe and disappears very quickly on its own. Severe pain, which is rare, can be relieved with medication. Benign breast diseases are common in young and older women, and malignant breast diseases most commonly occur around and after menopause. Although much rarer than benign changes, breast cancers are the most common cancers in women and represent a significant health problem. When she feels pain in her breast, the woman immediately thinks she has got breast cancer. Pain is not always a symptom of cancer. This paper discusses breast cancer, as the most common type of cancer in women, but also some other breast diseases that are not so common.
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