Tumors, Tumor-like Masses and Anomalies of the Thoracic Wall Inflammatory and Non-Inflammatory Enlargement of the Breast | |
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Incidence | |
Mastitis occurs mainly in neonates and during adolescence but may be observed rarely at any time of childhood. Non-inflammatory enlargement of the breast occurs at any time even in the neonate. | |
Clinical significance | |
Mastitis of the newborn may have a considerable morbidity requiring antibiotics and/or abscess incision, and conceals the danger of septicemia and osteomyelitis or underdevelopment of the involved breast. On the other hand a general non-inflammatory engorgement of the breast is first of all a challenge of differential diagnosis, for instance differentiation from a malignancy. |
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Etiology | |
Mastitis: Staphylococcus aureus and other pyogenic and gram-negative germs are the causative organisms. Diffuse non-inflammatory enlargement of the breast: Mainly endocrinological or developmental causes are observed. | |
Pathology, anatomical types | Illustrations |
Mastitis: Mastitis of the neonate without or combined with a physiological breast enlargement (the latter has no causative effect on the inflammation). Mastitis in adolescence following sport or pregnancy. Non-inflammatory enlargement of the breast: Breast enlargement of the neonate due to stimulation by maternal hormones. Premature thelarche in girls under 8 years without other signs of precocious puberty. Macromastia and juvenile hypetrophy: Overgrowth of the breast in puberty and adolescence, in the latter lesion extreme breast hypertrophy. | show details |
Pathophysiology | |
The pathophysiological mechanism is not well known in some types of enlargement of the breast without inflammation (premature thelarche, macromastia in puberty and adolescent gynecomastia); in some types maternal or own hormones are responsible. | |
Clinical presentation, Mastitis | Illustrations |
Depending on the stage of the inflammatory disease the overlying skin may be involved with redness, swelling, warmth and suppuration besides the infectious brest bud enlargement. | show details |
Clinical presentation, Diffuse non-inflammatory enlargement of the breast | Illustrations |
Diffuse non-inflammatory enlargement of the breast: It may be uni- or bilateral and there are no inflammatory signs of the skin. | show details |
Natural history | |
Mastitis: Development of an abscess or a chronic inflammation. | |
Differential diagnosis, Mastitis | Illustrations |
Mastitis: Other inflammatory processes of the thoracic wall. | show details |
Differential diagnosis diffuse non-inflammatory enlargement of the breast | Illustrations |
Diffuse non-inflammatory enlargement of the breast: Depending on the age of occurrence no differential diagnosis, or precocious or pseudoprecocious puberty, tumor-like benign masses or semimalignant or malignant tumors. | show details |
Work-up examinations | |
Mastitis: White blood cell count and differentiation, erythrocyte sedimentation rate and C-reactive protein and blood and pus cultures. | |
Therapy | |
Mastitis: Antibiotics and in case of abscess formation incision. | |
Prognosis | |
In general favourable prognosis concerning survival except for rare cases of breast cancer as in adults.
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