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Mastitis
Classification and external resources
ICD-10 N61.
ICD-9 611.0
DiseasesDB 7861
MedlinePlus 001490
MeSH D008413

Mastitis is the inflammation of breast tissue.[1] S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.[2]

Contents

Terminology

Popular usage of the term mastitis varies by geographic region. Outside the US it is commonly used for puerperal and nonpuerperal cases, in the US the term nonpuerperal mastitis is rarely used and alternative names such as duct ectasia, subareolar abscess and plasma cell mastitis are more frequently used.

Chronic cystic mastitis is a different (older) name for fibrocystic disease.

American usage: mastitis usually refers to puerperal (occurring to breastfeeding mothers) mastitis with symptoms of systemic infection. Lighter cases of puerperal mastitis are often called breast engorgement.

In this wikipedia article mastitis is used in the original sense of the definition as inflammation of the breast with additional qualifiers where appropriate.

Types

It is called puerperal mastitis when it occurs in lactating mothers and non-puerperal otherwise. Mastitis can occur in men, albeit rarely. Inflammatory breast cancer has symptoms very similar to mastitis and must be ruled out.

The popular misconception that mastitis in humans is an infection is highly misleading and in many cases incorrect. Infections play only a minor role in the pathogenesis of both puerperal and nonpuerperal mastitis in humans and many cases of mastitis are completely aseptic under normal hygienic conditions. Infection as primary cause of mastitis is presumed to be more prevalent in veterinary mastitis and poor hygienic conditions.[citation needed]

The symptoms are similar for puerperal and nonpuerperal mastitis but predisposing factors and treatment can be very different.

Puerperal

Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. It is caused by blocked milk ducts or milk excess. It is relatively common, estimates range depending on methodology between 5-33%. However only about 0.4-0.5% of breastfeeding mothers develop an abscess.

Nonpuerperal

The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding. This article includes description of mastitis as well as various kinds of mammary abscesses. Skin related conditions like dermatitis and foliculitis are a separate entity.

Names for non-puerperal mastitis are not used very consistently and include Mastitis, Subareolar Abscess, Duct Ectasia, Periductal Inflammation, Zuska's Disease and others.

Breast cancer

Breast cancer may coincide with or mimic symptoms of mastitis. Only full resolution of symptoms and careful examination are sufficient to exclude the diagnosis of breast cancer.

Lifetime risk for breast cancer is significantly reduced for women who were pregnant and breastfeeding. Mastitis episodes do not appear to influence lifetime risk of breast cancer.

Mastitis does however cause great difficulties in diagnosis of breast cancer and delayed diagnosis and treatment can result in worse outcome.

Breast cancer may coincide with mastitis or develop shortly afterwards. All suspicious symptoms that do not completely disappear within 5 weeks must be investigated.

Breast cancer incidence during pregnancy and lactation is assumed to be the same as in controls. Course and prognosis are also very similar to age matched controls.[3][4] However diagnosis during lactation is particularly problematic, often leading to delayed diagnosis and treatment.

Some data suggests that noninflammatory breast cancer incidence is increased within a year following episodes of nonpuerperal mastitis and special care is required for followup cancer prevention screening.[5] So far only data from short term observation is available and total risk increase can not be judged. Because of the very short time between presentation of mastitis and breast cancer in this study it is considered very unlikely that the inflammation had any substantial role in carcinogenesis, rather it would appear that some precancerous lesions may increase the risk of inflammation (hyperplasia causing duct obstruction, hypersensitivity to cytokines or hormones) or the lesions may have common predisposing factors.

A very serious type of breast cancer called inflammatory breast cancer presents with similar symptoms as mastitis (both puerperal and nonpuerperal). It is the most aggressive type of breast cancer with the highest mortality rate. The inflammatory phenotype of IBC is thought to be mostly caused by invasion and blocking of dermal lymphatics, however it was recently shown that NF kappaB target genes activation may significantly contribute to the inflammatory phenotype. Case reports show that inflammatory breast cancer symptoms can flare up following injury or inflammation making it even more likely to be mistaken for mastitis. Symptoms are also known to partially respond to progesterone and antibiotics, reaction to other common medications can not be ruled out at this point.[6][7][8][9][10]

In domestic animals

Serous exudate from bovine udder in E. coli mastitis at left. Normal milk at right.

Mastitis occurs in domestic animals as in human beings, and is especially a concern in livestock, since milk from the affected udders of livestock may enter the food supply and pose a health risk.

It is a major condition in some species, like dairy cows. It has a tremendous economic importance for the dairy industry. It is also of concern for public health. The same considerations apply to mastitis in sheep and goats and other milk producing females. It is also of economic importance in the sow, but, in this species, it is not related to public health. In other domestic females (queen, mare, etc.), it is more an individual illness dealt with by veterinary practioners.

See also

References

  1. ^ mastitis at Dorland's Medical Dictionary
  2. ^ http://emedicine.medscape.com/article/781116-overview
  3. ^ Middleton LP, Amin M, Gwyn K, Theriault R, Sahin A (2003). "Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features". Cancer 98 (5): 1055–60. doi:10.1002/cncr.11614. PMID 12942575. 
  4. ^ Shousha S (2000). "Breast carcinoma presenting during or shortly after pregnancy and lactation". Arch. Pathol. Lab. Med. 124 (7): 1053–60. PMID 10888783. 
  5. ^ Peters F, Kiesslich A, Pahnke V (2002). "Coincidence of nonpuerperal mastitis and noninflammatory breast cancer". Eur. J. Obstet. Gynecol. Reprod. Biol. 105 (1): 59–63. doi:10.1016/S0301-2115(02)00109-4. PMID 12270566. 
  6. ^ Kusama M, Koyanagi Y, Sekine M, et al. (1994). "[A case of inflammatory breast cancer successfully treated with 5'-DFUR and MPA]" (in Japanese). Gan To Kagaku Ryoho 21 (12): 2049–52. PMID 8085857. 
  7. ^ Yamada T, Okazaki M, Okazaki A, et al. (1992). "[A case of inflammatory breast cancer treated with medroxyprogesterone acetate (MPA) in combination with intra-arterial infusion chemotherapy]" (in Japanese). Gan To Kagaku Ryoho 19 (11): 1923–5. PMID 1387777. 
  8. ^ Van Laere SJ, Van der Auwera I, Van den Eynden GG, et al. (2006). "Nuclear factor-kappaB signature of inflammatory breast cancer by cDNA microarray validated by quantitative real-time reverse transcription-PCR, immunohistochemistry, and nuclear factor-kappaB DNA-binding". Clin. Cancer Res. 12 (11 Pt 1): 3249–56. doi:10.1158/1078-0432.CCR-05-2800. PMID 16740744. 
  9. ^ Van Laere SJ, Van der Auwera I, Van den Eynden GG, et al. (2007). "NF-kappaB activation in inflammatory breast cancer is associated with oestrogen receptor downregulation, secondary to EGFR and/or ErbB2 overexpression and MAPK hyperactivation". Br. J. Cancer 97 (5): 659–69. doi:10.1038/sj.bjc.6603906. PMID 17700572. 
  10. ^ van der Burg B, van der Saag PT (1996). "Nuclear factor-kappa-B/steroid hormone receptor interactions as a functional basis of anti-inflammatory action of steroids in reproductive organs". Mol. Hum. Reprod. 2 (6): 433–8. PMID 9238713. 

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