Wegener's granulomatosis is a multisystem disorder characterized by necrotizing granulomatous inflammation and vasculitis of small vessels and can affect any organ system. The most common sites of involvement are upper and lower respiratory tracts, and kidneys. Breast involvement is unusual and very rare. We report a case of breast Wegener's granulomatosis in a 32-year-old woman who presented with pulmonary lesions and palpable masses in the left breast. Mammography showed multiple, sharply delineated nodules without microcalcifications. Ultrasonography revealed multiple hypoechoic solid lesions, some of them with anechoic areas of necrosis. Computed tomography showed multiple nodules. Histopathology of excision biopsy specimens of breast lesions revealed necrotizing granulomatous material consistent with Wegener's granulomatosis. Twenty reports of breast involvement in this rare disease were found in the literature; however, the respective ultrasonographic and computed tomography findings have not hitherto been described.

A 39-year-old woman was admitted to the pulmonary clinic with dyspnea, haemoptysis and fever. Three years previously, she had been diagnosed with nodular sclerosis Hodgkin's disease (HD) with cervical and mediastinal adenopathy. She was treated with chemotherapy and irradiation. A year ago she had been hospitalized because of cavitation in her right upper pulmonary lobe. Relapse of HD was confirmed at thoracotomy. Six months after surgery, a chest x-ray revealed thin-walled, ring-like lesions ( Fig. 1; white arrows) with right-sided pleural effusion. A chest radiogram showed further deterioration with thick-walled, inflamed lesions, one of them with intracavitary level ( Fig. 2; open arrow). Fiber-optic bronchoscopy and bronchoalveolar lavage were normal. Transbronchal lung biopsy showed no proof of malignant or infectious disease. All microbiology samples were negative. Trans-thoracic fine-needle aspiration of the target lesion confirmed relapse of the HD. The patient underwent chemotherapy and is alive achieving partial remission.Incidence of pulmonary involvement in HD is estimated to be 20% at presentation and 40% during clinical course [1]. Most of these patients have nodular sclerosis. The most common radiographic manifestation is mediastinal or hilar lymphadenopathy, which may be accompanied by parenchymal, pleural or chest wall involvement. Radiographic features of intrathoracic relapse were studied and include both single and multiple nodules, with or without cavitation [2,3]. Similar clinical presentation can also be found in primary lung or metastatic carcinoma, abscesses, mycobacterium infection, Wegener's granulomatosis, rheumatoid arthritis and should be always taken into consideration. Ivan Aleric, Miroslav Krpan, and Inja Neralic-Meniga References 1. Colby TV, Hoppe RT, Warnicke RA (1981) Hodgkin's disease: a clinico-pathologic study of 659 cases. Cancer 49: 1848-1858 2. Costello P, Mauch P (1979) Radiographic features of recurrent intrathoracic Hodgkin's disease following radiation therapy. AJR 133: 201-206 3. Hwang GL, Leung AL, Zinck SE (2005) Recurrent lymphoma of the lung: computed tomography appearance. J Comput Assist Tomogr 29 (2): 228-30