Eosinophilic mastitis masquerading as breast carcinoma

Abstract

We report the sixth case of Eosinophilic Mastitis, presenting similarly enough to be confused with breast carcinoma. A 50 year old lady presented with a six month history of progressively enlarging asymptomatic breast lump, cough and breathlessness. Clinical examination, mammography and axillary lymphadenopathy suggested malignant disease. Ronchi were heard on chest auscultation. Needle cytology was twice inconclusive and Tru-cut biopsy showed acute on chronic inflammation. Blood investigations revealed significant peripheral eosinophilia. Open biopsy reported eosinophilic mastits, correlating with peripheral eosinophilia and pulmonary symptoms. The patient responded to conservative management. Eosinophilic infiltration of the breast is a rare manifestation of tissue involvement in peripheral eosinophilia. Asthma, Churgh-Strauss Syndrome and hyper-eosinophilic syndromes are associated. Importantly, if a clinically and radiologically malignant breast lump in asthmatic ladies with peripheral eosinophilia is not confirmed on cytology, this entity could be a diagnosis, potentially saving the patient from surgery.

Bilateral eosinophilic mastitis: An uncommon unheard entity

“…Bilateral eosinophilic mastitis is an extremely rare clinico-pathological entity associated with peripheral eosinophilia, with little evidence regarding proper diagnosis and treatment modalities. It is considered to be a benign inflammatory condition, which can be successfully managed non-operatively [1,2,5]. The many causes of peripheral eosinophilia include inflammatory allergic diseases, parasitic infestations, collagen vascular diseases and haematological malignancies.…”

“…Eosinophilic mastitis needs to be distinguished from carcinoma breast because of therapeutic implications. Eosinophilic mastitis though responds well to steroids, is known to recurs even after surgery indicating the importance of basic disease control and that of eosinophilia [1][2][3][4][5]. Komenalka et al [4] described a case where a patient after undergoing surgery presented with a large mass after 2 years in the same breast.…”

“…Komenalka et al [4] described a case where a patient after undergoing surgery presented with a large mass after 2 years in the same breast. A clinical and/or radiologically suspi- cious breast lump in an asthmatic woman with peripheral eosinophilia should be diagnosed as Eosinophilic mastitis if malignancy is ruled out on cytological analysis thus avoiding an unnecessary surgery [1]. The only indication of surgery is to rule out malignancy in those patients not responding to medical therapy [4,5].…”

“…Eosinophilic infiltration of the breast is a rare manifestation of tissue involvement in peripheral eosinophilia. Clinical and radiological findings of these cases are nonspecific and can mimic breast carcinoma [1]. Diagnosis is difficult due to the rarity and non-specificity of the pathology.…”

“…Diagnosis is difficult due to the rarity and non-specificity of the pathology. However, timely diagnosis based on history, clinical examination, radiology and cytology can prevent unnecessary surgery [1][2][3][4].…”