Granulomatous mastitis

Case contributed by Dr Noriza Zainol Abidin

Presentation

Breastfeeding mother, presented with left breast pain and swelling for 1 week duration.

Patient Data

Age: 40 years
Gender: Female

Initial ultrasound

Modality: Ultrasound

Initial ultrasound shows thick walled hypoechoeic lesion located at 9 o’clock position of left breast. Presence of echogenic debris within. Hypervascularity within the lesion as well as adjacent breast parenchyma depicted on colour Doppler study. Findings suggestive of mastitis with early abscess formation.

The patient was treated with antibiotics for 7 days. The inflammatory process had resolved clinically.

Follow up ultrasound after 7 days

Modality: Ultrasound

On follow up ultrasound, there are a few hypoechoic nodules with echogenic debris within. The previously seen hypervascularity in the parenchyma has resolved.

Performed after 2 months of initial presenting symptoms

Modality: Mammography

Mammogram shows few lobulated oval densities seen in the left mid inner quadrant concordant with previously seen multifocal lesions on ultrasound. No architectural distortion. No suspicious cluster microcalcifications. The overlying skin and nipples are normal.
Bilateral benign looking axillary nodes.

Impression:

Left breast lesions - BI-RADS 3.

With the mammogram and sonographic findings, the patient underwent fine needle aspiration cytology.

The tissue cytology smear shows several epitheloid granulomas, foamy macrophages, a few multinucleated giant cells, abundant neutrophils, a few lymphocytes, plasma cells and histiocytes. The findings are consistent with granulomatous mastitis.

Case Discussion

Granulomatous mastitis is a rare inflammatory breast disease. It should be considered in the differential if a patient presents with an inflammatory breast mass.

It usually occurs in young parous women with a recent history of pregnancy or breastfeeding.

Idiopathic granulomatous mastitis was first described by Kessler and Wolloch in 1978.

Other causes of granulomatous mastitis include tuberculosis, sarcoidosis, Wegener's granulomatosis or fungal infection.

Definitive diagnosis is made using histopathology result as clinical findings and imaging studies are non-specific.

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Case Information

rID: 50808
Case created: 23rd Jan 2017
Last edited: 30th Jan 2017
System: Breast
Inclusion in quiz mode: Included

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