a 39-year-old female with a 5-year history of recurrent bilateral breast abscesses
Chen Zhang, MD, PhD
Department of Pathology and Laboratory Medicine
Indiana University School of Medicine
Clinical history:The patient is a 39-year-old female with a 5-year history of recurrent bilateral breast abscesses. She first noticed breast erythema on the left side in November 2016 accompanied by "bumps" which resolved with antibiotics. The erythema and lesions then appeared on the right side after the left side resolved. She had a recurrence of her abscesses again and underwent a right breast central duct excision with bilateral drainage. Her work up included a diagnostic mammogram, which showed right breast calcifications. She also had a right breast US, which showed stable calcifications, a simple cyst and a complex cyst. Her left breast US showed a hypoechoic subareolar lesion and a complex cyst. She subsequently underwent a left breast core biopsy.
Microscopic examination of the breast core biopsy showed infiltration of predominantly mononuclear inflammatory cells obliterating the normal lobular architecture. Mixed chronic and acute inflammation with variable sized neutrophilic microabscesses were present. Suppurative, lobulocentric granulomatous inflammation composed of epithelioid histiocytes and multinucleated giant cells surrounding cystic spaces and neutrophilic microabscesses were identified. No microorganisms were seen on AFB, GMS and Gram stain.
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Figure 1a. Low magnification. A cystic space containing neutrophilic microabscess is surrounded by epithelioid histiocytes and multinucleated giant cells. H&E, 40X
Figure 1b: High magnification view of the cyst wall consisting of epithelioid histiocytes and multinucleated giant cells. H&E, 200X.