VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

23 Plasma Cell Mastitis

Ashley Kwon, DO; Tara Mancl, MD Corresponding author:

Context: Plasma cell mastitis (PCM) is a rare form of mammary duct ectasia that usually occurs in non-pregnant, non-lactating female patients. It causes aseptic inflammation of the breast and is characterized by ductal expansion and plasma cell infiltration. Clinical, microscopic, and macroscopic features of PCM are similar to those of breast cancer. Often, patients present with a breast mass with ipsilateral breast enlargement, skin thickening, and enlarged axillary lymph nodes. Case report: A 31-year-old Middle Eastern female with past medical history of vitamin D deficiency and mixed hyperlipidemia was referred by a primary care physician (PCP), regarding lumps and rashes on the right breast. Patient presented with multiple abscesses that were draining and lumps on the right breast for 6 weeks and was treated with clindamycin by her PCP. She stated that the lumps were painful and the skin on the right breast were itchy and uncomfortable. Patient noted that she had a history of PCM diagnosed on her left breast two years ago, which presented with similar symptoms. Prior to the diagnosis of PCM, patient never had breast symptoms. Patient delivered her first child at age 29 and breastfed without any issues, but she had to stop SOVAH Health Family Medicine Residency Program Edward Via College of Osteopathic Medicine-Virginia Campus

breastfeeding due to her diagnosis. Patient denied tobacco, alcohol, or illicit drug use. Pertinent family history includes breast cancer from patient’s mother at age 48. On physical exam, multiple small scars from previous abscesses were noted on the left breast, without lymphadenopathy or nipple discharge. A 2cm x 1cm open granulating wound at the inferior aspect of the areola at 7 o’clock position on the right breast was also noted. There was no drainage or surrounding erythema upon examination. Otherwise, physical exam was unremarkable. Mammogram and ultrasound which were obtained prior to the visitation supported the diagnosis. Treatment: During her first diagnosis of PCM on the left breast, patient was treated with prednisone 60mg which was tapered to 40mg and then 20mg, but with the lower dosage of steroid, she developed recurrent lesions. Therefore, patient was started on methotrexate 15mg weekly, but she stopped it once the symptoms resolved. During this visitation, the symptoms had improved, the size of the abscess decreased, and the drainage was no longer present. Therefore, it was discussed with the patient to avoid pharmacological or surgical intervention but would continue to monitor closely.

Diagnosis: Recurrent plasma cell mastitis. Mammogram on the right breast showed a retro areolar mass that was consistent with complex partially cystic-appearing mass. The skin in the area demonstrated inflammatory changes and that ominous etiologies such as inflammatory neoplasia could not be excluded. BI-RAD: 3. Conclusion: The incidence rate of PCM has been increasing gradually and, despite the progress in mammographic and ultrasonographic techniques, distinguishing between PCM and breast cancer is still a challenge. Once diagnosed, it can be assured that it is a benign entity without increased risk of malignancy. Therefore, despite no definitive treatment, PCM can be managed in a conservative manner such as surgical drainage, antibiotic therapy, steroids or methotrexate.


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