Actinomycosis of the breast is a chronic specific lesion of the mammary glands, a form of visceral mycosis that proceeds with the formation of granulomas and abscesses. The clinic of actinomycosis of the breast is characterized by the formation of individual small nodules, then ulcers, which are opened with the formation of long-term non-healing fistulas. The diagnosis of actinomycosis of the breast is established based on the detection of actinomycetes in the separated fistula. Treatment includes resection of the affected breast area, the appointment of actinolysates, penicillins, vitamins, immunomodulators.
ICD 10
A42.8 Other actinomycoses
General information
In clinical mammology, actinomycosis occurs in 0.05-0.1% of all cases of inflammatory diseases of the breast. The attribution of the disease to the group of mycoses is rather conditional; it is based on the morphological similarity of the pathogen with fungi and the course characteristic of mycotic lesions. Pathogens – radiant fungi (actinomycetes) are bacterial cells. Isolated cases of actinomycosis are rare; as a rule, a combined or systemic lesion is usually observed. Actinomycosis can affect one or both breast, accompanied by the formation of single or multiple ulcers.
Causes of actinomycosis of the breast
For actinomycosis of the breast, the endogenous pathway of penetration of the pathogen is primary. In the body, actinomycetes can be present in the oral cavity – in teeth affected by caries, crypts of the tonsils. Pathogens enter the breast tissue through cracked nipples and damaged skin.
In secondary actinomycosis, the primary focus is located in other organs, for example, in the lungs. In this case, the ribs and soft tissues of the chest are involved in the process first, and then the mammary glands. Hematogenic spread of actinomycetes is possible with a generalized infectious process. In their development, actinomycotic lesions successively undergo the following stages: infiltrative, abscess formation and fistula.
Pathogenesis
At the site of the introduction of actinomycetes, edema and hyperemia of tissues initially develop, young fibroblasts, plasma and xanthoma cells, and new vessels are formed. This is how an actinomycotic nodule is formed – a granuloma (actinomycoma), around which additional nodules are formed in the future. When individual foci merge, an infiltrate is formed with zones of purulent melting. Gradually, the purulent process spreads through the fiber towards the skin and opens outwards with the formation of fistulas.
In case of breast disease, a destructive form of actinomycosis may develop with a predominance of tissue destruction and the formation of large ulcers, or a destructive-proliferative form characterized by the proliferation of connective tissue and destructive changes. Actinomycotic granuloma has a dense consistency, its honeycomb structure, yellow-green color, whitish inclusions – druses (clusters of actinomycetes) are determined on the section.
Symptoms of actinomycosis of the breast
Usually, patients note the appearance of small hyperemic nodules in the nipple area, which then turn into dense and painful infiltrates, and subsequently into ulcers. The skin above the ulcers acquires a purple color.
In place of the opened breast abscesses, fistulous passages that do not heal for a long time are formed, from which pus is periodically released. Actinomycosis is a non-contagious disease; without treatment, it can last for years and tend to progress.
Diagnostics
When examining the breast by a mammologist, the presence of infiltrative foci of bluish-red color, numerous fistula passages, from which purulent discharge flows out when squeezed. In the presence of actinomycosis of other localizations, the diagnosis is not in doubt.
The study of the breast separated from the fistula (smear microscopy, bacteriological culture on nutrient media) allows us to identify actinomycetes and clusters of fungi in the form of radiant formations – thickened filaments of mycelium with characteristic flask-like extensions at the end. Serological methods (ELISA) are also used in laboratory diagnostics.
Specific research methods that mammology usually uses to diagnose breast diseases (ultrasound of the breast, mammography, breast MRI, CT, etc.) are uninformative in actinomycosis. Differential diagnosis of actinomycosis is carried out with tuberculosis, breast syphilis, chronic mastitis.
Treatment of actinomycosis of the breast
In case of actinomycosis of the breast, complex conservative and surgical treatment is carried out. Penicillin antibiotics, actinolysates, immunocorrectors, vitamins, physiotherapy (UFO, UHF) are prescribed for a long time, for several months.
With a progressive or therapy-resistant course of actinomycosis, the opening and emptying of breast ulcers, excision of fistulas after preliminary staining of fistula passages is performed. With an extensive lesion, a sectoral resection of the breast is indicated. In the case of a total purulent process accompanied by gangrene of the breast, a mastectomy is performed followed by reconstructive mammoplasty.
Forecast
Treatment is usually difficult and lengthy. Clinical recovery can again be replaced by relapses, stretching for many years. The prognosis for life with actinomycosis is favorable, but the features of the course negatively affect the ability to work of patients and their social adaptation.
Prevention
Prevention of actinomycosis involves timely treatment of cracked nipples and foci of actinomycosis of other visceral localization, prevention of breast injuries, treatment of caries, diseases of the oropharynx and gastrointestinal tract.
