Presentation
Breastfeeding mother, presented with left breast pain and swelling for 1 week duration.
Patient Data
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 color 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.
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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
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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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