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MAMMOGRAPHY: MASTITIS AND INFLAMMATORY BREAST
CANCER
Fayzullayeva Madina Baxshullo qizi
Tashkent Medical Academy, Uzbekistan
Khusenov Azizbek Alisherovich
Tashkent State Medical University
Najimova Shakhzoda Ulugbek kizi
Tashkent State Medical University
Annotation: Breast cancer is more common in women over the age of 45.
Infiltrative breast cancer accounts for 1-5% of all breast cancers. This article
reviews the diagnosis of infiltrative breast cancer, mammography and sonoscopy,
and the differential diagnosis with mastitis.
Key
words:
sonography,
x-rays,
IBC,
mastitis,
mammography,
antibioticotherapy, thickness of skin, immunohistochemistry.
Аннотация: Рак молочной железы чаще встречается у женщин
старше 45 лет. Инфильтративный рак молочной железы встречается в 1–
4% случаев среди всех опухолей данной локализации. В статье
рассматриваются
методы
диагностики
этого
заболевания
с
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использованием маммографии и сонографии, а также проводится
дифференциальный анализ инфильтративного рака и мастита.
Ключевые
слова:
рентгенография,
сонография,
ИРМ
(инфильтративный рак молочной железы), мастит, маммография,
антибиотикотерапия, утолщение кожи, иммуногистохимия
Annotatsiya: Ko‘krak bezi saratoni ko‘pincha 45 yoshdan oshgan ayollarda
uchraydi. Infiltrativ ko‘krak bezi saratoni barcha ko‘krak saratoni holatlarining
1–5% ni tashkil qiladi. Ushbu maqolada infiltrativ ko‘krak bezi saratonining
diagnostikasi, mammografiya va sonografiya usullari, shuningdek, mastit bilan
qiyosiy diagnostikasi ko‘rib chiqiladi.
Kalit so’zlar: sonografiya, rentgen, infiltrativ ko‘krak saratoni, mastit,
mammografiya, antibiotikoterapiya, terining qalinlashishi, immunogistologik
tekshiruv.
Abstract: Currently, breast cancer is among the most prevalent malignancies
worldwide. In 2022, 2,296,840 individuals were affected by this disease.
Inflammatory breast cancer is a rare yet highly aggressive form, accounting for 2–
5% of all cases. Our objective is to investigate the clinical, pathological, and
mammographic characteristics of this condition and to differentiate it from mastitis
at Tashkent Regional Oncology Dispensary. At the Tashkent Regional Oncology
Dispensary, we examined 1,000 non-breastfeeding women from March 4, 2024 to
November 11, 2024 and 12 of them had IBC. The median age of IBC was 40 years
(range 31-65).
Introduction
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Inflammatory breast cancer (IBC) is a rare and fast-progressing type of
epithelial breast tumor. It accounts for 1% to 3,2% of all breast cancer cases in the
Uzbekistan. Signs of IBC may involve redness, swelling, diffuse pain on whole
surface, enlargement of one breast and breast skin that resembles an orange peel.
Unique symptoms for IBC are nipple inverted or retracted, diffusion pain across a
breast, skin thickening is usually extensive and affect a larger portion. Diagnosis
of IBC is like as mastitis, such as thickness skin, expanded lymph nodes and
mammography’s picture. Based on the date, IBC has not been studied in
Uzbekistan. Our goal is to study the diagnostic methods of infiltrative breast cancer
and differentiate it from mastitis. (1)
Distribution of patients by ages (table 1)
Age of patients pathological
types
Abc (350 out of 1000)
Percentage n=35%
35-45
198
56,6%
45-55
97
27,7%
55-65
50
14,3%
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65
5
1,4%
Age of patients of
malignant tumor types
Abc (650 out of 1000)
Percentage n=65%
35-45
61
9,4%
45-55
356
54,7%
55-65
184
28,3%
65
49
7,6%
Total
1000
100,0
Methods and Materials
We screened 1000 patients registered from March 2024 to November 2024
and found 12 cases of IBC. Mammograms allow to look skin thickness, loss of fatty
lymph nodes hilum. IBC poses significant clinical challenges due to its rapid
progression, atypical presentation, and complex management requirements. Unlike
most breast cancers, IBC rarely presents as a distinct lump (3). Instead, it manifests
with diffuse swelling, redness, and warmth of the breast, resembling inflammatory
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conditions such as mastitis or cellulitis. This resemblance often leads to delayed
diagnosis or misdiagnosis, as it may initially be treated as an infection rather than
a malignancy. Differential diagnosis between IBC and conditions like mastitis is a
significant challenge. Both conditions can present with similar clinical symptoms,
such as: breast swelling and redness, pain and warmth. Inflammatory breast cancer
(IBC) is classified as a T4d tumor, yet in nearly one-third of cases, it is only
detected once distant metastases have already developed. The risk of
misdiagnosing IBC is considerably high due to multiple contributing factors (2). A
key challenge is the variability in clinical and pathological manifestations; not all
cases present with the same symptoms. For example, while some patients display
both breast inflammation and dermal lymphatic invasion, others may exhibit only
one of these features. Additionally, IBC cannot be diagnosed solely through
histopathological examination. Instead, its identification depends on recognizing a
distinct combination of clinical symptoms.Nipple retraction or invasion in IBC, in
mastitis milk or clear fluid and sometimes pus, it is convenient way to avoid
misdiagnosing. All non-metastatic IBC patients underwent neoadjuvant
chemotherapy (NACT) as the initial treatment, followed by modified radical
mastectomy (MRM), radiotherapy, and hormonal therapy when necessary (2).
Result
Table 1 outlines the age features of the patients. 35-45 years patients more
suffered by non-cancerous types of breast pathology. Women between the ages of
45 and 55 have a higher risk of developing breast cancer compared to other age
groups.
Breast cancer was primarily found in the left mammary gland, particularly in
the upper outer quadrant. A total of 650 patients were diagnosed through
sonography, mammography, and biopsy. Among them, 39 cases required
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differential diagnosis to distinguish between infiltrative breast cancer (IBC) and
mastitis. In our study, biopsy confirmed the presence of the infiltrative type of
breast cancer in 12 cases out of these 39 patients. Mastitis was diagnosed in the
remaining patients and the patients were sent for antibacterial therapy. Patients with
infiltrative type of breast cancer were submitted to IGH testing and the following
were obtained. The patients had a median age of 40 years, with an age range of 31
to 65 years, and a median symptom duration of 5 months. The positivity rates for
estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth
factor receptor 2 (HER2/neu) were 50%, 46%, and 60%, respectively. Additionally,
mucinous breast carcinoma was identified in cases of IBC in 1,4%.
We see the radiological signs of breast cancer. We differentiated signs of
breast cancer and mastitis by skin thickening, infiltration and retraction or invasion
of nipple and also contours and structure of lymph nodes in axillary side.
Pic.1 X-mammography of patient M. 45 years old. Diagnosis by
histological: IBC in left breast
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Pic.2 X-mammography of patient H. 53 years old. Diagnosis by
histological: mastitis in right breast
Discussion
The diagnosis of IBC requires pathological confirmation of invasive
carcinoma alongside specific clinical criteria. These include widespread redness,
swelling involving more than two-thirds of the breast, increased warmth,
tenderness, and rapid breast enlargement. However, in some cases, a mistake is
made in the comparative diagnosis with mastitis, since both have the same clinical
course and appearance. Diagnosis on biopsy is somewhat difficult due to the
presence of inflammation in the tissue.
References:
[1] Barkataki S, Javadekar MJ, Bradfield P, Murphy T, Witmer DD, Van
Golen KL: Inflammatory Breast Cancer: A Panoramic Overview. J Rare Dis Res
Treat. (2018) 3(2): 37-43
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[2] Ajay Gogia, Vinod Raina, Suryanarayan Vishnu Deo, Nootan Kumar
Shukla, Bidhu kalyan Mohanti, Daya Nand Sharma: Inflammatory Breast Cancer:
a Single Centre Analysis: Asian Pac J Cancer Prev, 15 (7), 3207-3210
[3] Massimo Cristofanilli, Naoto T.Ueno: Inflammatory Breast Cancer: An
Update: 2012
