Fat necrosis - Benign disorders of the breast

Fat necrosis

Definition

An uncommon condition in which there is death of fat cells within the breast.

Aetiology/pathophysiology

The aetiology is unclear, it is suggested that the death of fat cells may result from trauma. There is an acute inflammatory response, which in some cases progresses to chronic inflammation and organisation with fibrous tissue. The result may be a hard, irregular mass, which can mimic carcinoma.

Clinical features

Patients present with a hard mass, which may also have skin tethering; often in an obese patient with large breasts. Although the patient may recall trauma, this is not helpful in diagnosis, as many cases of breast carcinoma are discovered after incidental trauma.

Microscopy

Plasma cells predominate. Lipidladen macrophages (foam cells/lipophages) may form multinucleate giant cells.

Investigation/management

As for breast lump, using a triple assessment to exclude malignancy.