Subcutaneous nodule in female breast

Introduction In the upper quadrant of the female breast, the superficial, hard subcutaneous nodules, like the skin, should consider the possibility of filarial nodules.

Cause

(1) Causes of the disease

Mosquitoes infected with silkworms bite the skin of the human body and become sick.

(two) pathogenesis

After the mosquito infected with the silkworm bites the human skin, the microfilaria enters the lymphatic vessels, and the microfilariae and adult insects enter the lymphatic vessels of the breast, causing filarial lymphangitis, followed by lymphatic endovascular inflammation, forming a habit Acid granuloma and a series of pathological changes.

Lesion

The lymphatic vessels of the breasts of adult women are extremely rich, and there are abundant lymph nodes under the lobules of the breasts and under the areola. Most of the lymphocytes of the two breasts flow through the lymphatic vessels to the axillary lymph nodes outside the breast. Therefore, the disease has more chances in the upper quadrant of the breast.

2. Pathological morphology

(1) General form: Filaria-like intra-milk masses are mostly irregular nodules, with a diameter of 1 to 5 cm and an average diameter of 2 to 3 cm. The mass can be single or multiple, the texture is soft in the early stage and hard in the late stage. There are several small sacs in the center of the cut surface. The sac is filled with gray-yellow or gray-white cheese-like material, sometimes with jelly and bleeding, and the filamentous debris can be seen in the blood. The small sac is surrounded by a hyperemic granulation tissue, which is then dense fibrous tissue.

(2) Seen under the microscope: see the congested area lymphatic wall congestion and edema, eosinophils, mononuclear cell infiltration, lymphatic wall thickening, fibrin, lymphocytes, eosinophils and other agglutination in the lumen The formed embolus embolizes the lumen. Following the lymphatic wall, granulomatous lymphangitis with a dead body as the core and an eosinophilic abscess can be seen. In the abscess, adult worms and microfilariae worm fragments can be seen. Tuberculosis-like granuloma formed by epithelioid cells, multinucleated giant cells, and fibroblasts can be seen around the eosinophilic abscess, and its periphery is surrounded by granulation tissue. Late stage lesions fibrosis, calcification, lymphatic vessel occlusion, lymphatic stasis. Small lymphatic vessels are flexed and expanded, ruptured, and lymph fluid enters the interstitial space. In the localized deposition of lymph fluid, connective tissue hyperplasia is caused by stimulation of high-protein-containing lymph fluid, forming a solid and swollen elephantiasis, which is rare in the breast. The skin is swollen.

3. Pathological staging

According to pathological changes can be divided into three phases:

1 acute phase: inflammation of the lymphatic intima and adventitia;

2 subacute phase: tuberculous lymphangiitis formation;

3 chronic phase: occlusive lymphangitis occurs and calcification is seen.

an examination

Related inspection

Urine routine chest B blood routine

Single or multiple nodules or masses can be reached in the breast, and the mass is mostly located in the upper quadrant of the breast, followed by the central zone or the outer lower quadrant. The size of the tumor is different, and the diameter is more than 2~3cm. It is mostly located in the subcutaneous or superficial breast tissue, often involving one breast. Early soft, mobile, slow growth, mild skin redness, mild pain and tenderness, ipsilateral axillary lymph nodes, individual acute suppurative mastitis. A small number of tumors close to the skin, often caused by adhesion to the skin with orange peel-like changes, easily misdiagnosed as breast cancer, mastitis lumps. In the late stage, due to fibrosis and calcification of the lesion, the nodules become hard and the activity is limited. It is easily misdiagnosed as breast cancer, fibroadenomas, and hyperplasia of the breast.

The history of filariasis endemic areas, the superficial upper quadrant of the female breast, and the hard subcutaneous nodules, like the skin, should consider the possibility of filarial nodules. You should be asked if you have a history of filariasis and breast inflammation. Men sometimes see this disease, still need to pay attention, especially in popular areas, for male breast lumps, can not ignore the possibility of this disease.

Differential diagnosis

Breast cancer

(1) History: Most patients with mammary glia have a history of filariasis endemic areas.

2) Signs: Although the intramammary mass of the filariasis can adhere to the skin, there is little change in the orientation of the nipple and the "orange peel" of the skin.

(3) The filth cell examination and pathological section of the blood lumps of breast filariasis can be found in the microfilariae of the silkworm, while the fine needle aspiration cytology and pathological section of the breast cancer can be free of cancer cells.

2. Breast tuberculosis

(1) Causes: Breast tuberculosis patients have almost no history of tuberculosis in other organs; breastworm patients have a history of filariasis endemic areas.

(2) The number of breast filarial patients is more than that of breast tuberculosis patients. In the pathological tissue sections of the breast, the former can be found in filamentous or microfilaria, while the latter can be found in typical tuberculosis or tuberculosis.

3. Breast fat necrosis

(1) history of trauma: breast fat necrosis has a history of trauma, physical examination of the mass is hard, more adhesion to the skin, brown spots can be seen at the wound.

(2) Gross specimen: the gross view of the gross fat necrosis of the breast, showing the oil sac and liquefied fat, no bleeding and filth of the silkworm.

(3) Pathological findings: There is no eosinophilic abscess in breast fat necrosis, and there is no excessive amount of eosinophil infiltration and lymphatic lesions.

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