Traumatic Fat Necrosis of the Female Breast and its Differentiation from Cacinoma

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J TRAUMATIC FaT NECROSIS OF THE FEMALE BREAST
AND  ITS DIFFKREMTIATICK  FROM CARCINOMA.
By Burton J. Lee, M. D.,
and
Frank E. Adair, M. D.
of New York, N. Y.
A Third Report Prom The Memorial
Hospital.
7
In May, 1920,    we presented before the American Surgical Association our
first report upon Traumatic Fat Necrosis of the Female Breast.    The object of this
communication was to establish the condition as a new clinical entity and to point
out the striking similarity of this hitherto unrecognized tumor to carcinoma of the
breast.    In May, 1921,** we had collected three additional cases from the Breast
Clinic of the Memorial Hospital, and a further report was made.    Since that time
four additional cases have appeared in the Clinic,  and Bloodgood,  of Baltimore,
Kilgore,  of San Francisco,  and Hyman and Berg,  of New York,  have kindly permitted us
to include unpublished cases of their own in the present aeries.    Meanwhile, Cohen
and Parsons in America and Stulx and Fontaine in France have each published an
additional case.    The present paper represents an effort to place on record all
authentic cases, with some additional considerations concerning the clinical and
pathological features of this disease.
Nature of the Process:    Fat necrosis is a disintegration of fat cells with
the associated tissue reactions  of new connective tissue formation and the production
of foreign body giant cells.    For many years, fat necrosis has been most frequently
encountered as the acute necrosis of fat in the omentum and mesentery secondary to
acute pancreatitis.    These changes in fat tissue have bean produced by the pancreatic fat«
■plittine ferment, and the lesions may be easily reproduced experimentally as Opie^
Wells, *•* and Langerhans5 have shown.
Similarly, we have all recognized that fat necrosis may appear in subcutaneous
tissue following trauma.    In new-born babies the trauma of a difficult  instrumental
delivery sometimes produces a tumor hav^p^the identical microscopical picture of
fat necrosis of the breast.    Occasionally"surgeons encounter fat necrosis of subcutaneous tissue secondary to a hypodermic injection,  or some other form of trauma,
and a similar appearance may be found at times along an old healed suture line.    Farr2
reported several such cases and further produced these lesions experimentally in fat
pig«.
Although the gross and microscopic picture of traumatic fat necrosis occurring
in subcutaneous tissue in other parts of the body closely resembles that occurring
in and about the breast, these lesions are fatuless important clinically than the
particular condition we are describing.    The clinical problem of traumatic fat necrosis
of the breast is an important one,   for this condition must be considered in properly
differentiating tumors of the mammary gland.    The process often seems progressive
for a time, resembling a true tumor growth, and the close simulation to carcinoma
of the breast makes it additionally important from the clinical standpoint.    In the
breast the great bulk of fatty tissue permits after trauma the formation of a tumor
of some size, the largest mass encountered in the present series being 7 cm. in
diameter.
12
Stulz and Fontaine      in September, 1923,  in reporting a personal case,  also
included in their paper,  cases reported by Lanz in 1882,  Berner quoted by Heyde in
1911,  and Kuttner in 1913.
Read before the New York Surgical Society, February 13, 1924.