Anatomical and immunological factors drive pathogenesis in plasma cell mastitis cases

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Frontiers in Medicine Published June 9, 2026 Medically reviewed June 9, 2026 Study authors: Hong Xu, Buxilite Da, Yuanqing Li, Hao Zheng, Lihua Xue, Fengxia Zhao, Yajing Wang, Lihua Hou, Xing … DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Recognize that anatomical obstructions and pro-inflammatory cytokines drive plasma cell mastitis pathogenesis.

This narrative review explores the complex pathogenesis of plasma cell mastitis (PCM), focusing on anatomical, immunological, microbial, and lifestyle factors. The authors synthesize evidence suggesting that structural abnormalities, such as inverted nipples and ductal obstructions, trigger a pathological chain of inflammation. Immunologically, the condition is characterized by elevated pro-inflammatory cytokines including IL-6, TNF-alpha, IL-1beta, and IL-17, alongside over-activated Th1/Th17 cells.

The role of microbial factors remains controversial as most cultures are sterile, though some cases involve anaerobic bacteria or mycobacteria. Additionally, lifestyle factors like smoking and obesity are noted to contribute to pathogenesis through hormonal disorders and chronic inflammation. The review concludes that while the exact cause remains clinically challenging, a multi-factorial approach is necessary for understanding the disease.

Limitations identified include a lack of reliable animal models and the need for multi-omics studies to fully map the causal chain. For clinical practice, the review provides diagnostic criteria and outlines treatment strategies involving glucocorticoids and surgery. The evidence regarding microbial involvement is noted as uncertain.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Plasma cell mastitis (PCM), a complex and refractory chronic inflammatory-like breast disease, remains a critical global female healthcare challenge. Over the past decade, although considerable effects have been gained on understanding of the clinical and pathological features of PCM, the exact cause of PCM remains clinically challenging, as the pathogenesis of this disease involves multiple factors. This narrative review systematically synthesizes current evidence on PCM, mainly focusing on its etiology, clinical manifestations, diagnosis, and treatment strategies, which aims to unravel the etiological landscape of PCM from ductal microecology to systemic autoimmunity. We comprehensively demonstrated the etiology of PCM including the anatomical factors, immunological factors, microbial infections, and other factors. Anatomically, inverted nipples and duct structural abnormalities lead to a pathological chain of ductal obstruction - dilation - rupture - stromal inflammation; Immunologically, pro-inflammatory factors such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-17 (IL-17) are significantly elevated, and helper T cell 1 (Th1)/Th17 cells are overly activated, supporting the possibility that PCM may be an immune-mediated disease; The role of microbial factors is controversial, with most cultures being sterile and a few associated with anaerobic bacteria or mycobacteria; Smoking and obesity are involved in the pathogenesis through hormonal disorders and chronic inflammation. This review also provides diagnostic criteria and key points for differential diagnosis of PCM, and summarizes the current treatment strategies mainly based on glucocorticoids and surgery. Future research needs to establish reliable animal models and conduct multi-omics studies to reveal the complete causal chain.