A 22yo female collegiate soccer player complains of a painful palpable area in her right breast accompanied by a straw- colored nipple discharge. Because she is extremely anxious and has had previous excisional biopsies, you decide to perform a lumpectomy.
After reviewing the H&E stained tissue you decide the most likely diagnosis is:
- No abnormal mammary tissue found
- Fat necrosis
Incidentally, did you notice that there is some foreign material in the tissue section? Use the WSI to try to find it, and what do you think it is?
- Silicone implant material
- Suture material
- Fungal bodies
- None of the above
Scroll below for answers.
Answer 1: c, Fat necrosis.
Answer 2: 2, suture material.
Fat necrosis is not a common lesion found in the breast, although it is of clinical importance since a mass is often produced. The most common cause is trauma, although some patients do not recall an injury. The skin can appear retracted and the nipple can exhibit a bloody or straw colored discharge. The tissue injury results from release of triglycerides and lipases from the adipocytes. With time, saponification of the lipid can occur and there is deposition of a white chalky residue which often becomes infiltrated with calcium.
Lopez JA et al. “MRI Diagnosis and Follow-Up of Subcutaneous Fat Necrosis” JMRI 7:929-932 (1997)
Inna Yu, Y et al. “The Morphology of Apoptosis and Necrosis of Fat Cells after Photodynamic Treatment at a Constant Temperatue in vitro” Proc SPIE 7887, 78870X doi:10:117/12.8787 54 (2001)
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