Granulomatous diseases of the breast and axilla: radiological findings with pathological correlation

Abstract

ObjectivesThis article reviews our experience and describes the literature findings of granulomatous diseases of the breast and axilla.MethodsAfter approval of the Institutional Review Board was obtained, the surgical pathological records from January 2000 to January 2017 were searched for the keyword granulomatous. Clinical, imaging and histology findings were reviewed by both a fellowship-trained radiologist and a breast-imaging consultant radiologist, reviewing 127 patients (age range, 32–86 years; 126 women and 1 man).ResultsMost common causes of granulomatous lesions of the breast and axilla included silicone granulomas 33% (n = 42), fat necrosis 29% (n = 37) and suture granulomas 11% (n = 14). In 16% (n = 20), no cause could be found and clinical history was consistent with idiopathic granulomatous mastitis. Other granulomatous aetiologies included granulomatous infections, sarcoidosis and Sjögren’s syndrome. Causes of axillary granulomatous disease were similar to the breast; however, a case of cat-scratch disease was found that only involved the axillary lymph nodes. They can have a variable appearance on imaging and may mimic malignancy with irregular masses seen on mammography, ultrasound and magnetic resonance imaging. Fistulas to the skin and nipple retraction can suggest chronicity and a granulomatous aetiology. Combination of clinical history, laboratory and imaging findings can be diagnostic.ConclusionsGranulomatous processes of the breast are rare. The diagnosis can, however, be made if there is relevant history (prior trauma, silicone breast implants, lactation), laboratory (systemic or infectious processes) and imaging findings (fistula, nipple retraction). Recognising these entities is important for establishing pathological concordance after biopsy and for preventing unnecessary treatment.Teaching points Breast granulomatous are rare but can mimic breast carcinoma on imaging Imaging with clinical and laboratory findings can correctly diagnosis specific granulomatous breast diseases Recognition of the imaging findings allows appropriate pathological concordance and treatment

Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge

“…Inflammation that extends into adjacent lobules can indicate a higher severity. The involved parenchyma mostly shows loss of acinar structures and damaged ducts [18,19]. …”

“…Some reports describe normal titers of rheumatoid factors (RF) and serum complement [26], others show positive RF and in some cases presence of anti-neutrophil cytoplasmic autoantibody (ANCA) and anti-dsDNA antibodies [19] which are connected to Lupus erythematosus. No correlation with ANCA, c-ANCA, interleukin 2 receptor, or angiotensin-converting enzyme is described; however, information on these factors can be useful to exclude other autoimmune diseases [27].…”

Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players

“…Two main groups of breast diseases may share granulomatous patterns: breast cancer and infectious diseases. Among granulomatous breast infections, tuberculosis mastitis is the most common [71] ( Figure 3C), followed by various infections (cat-scratch disease, Proprionibacterium, or Corynebacterium) [72,73]. A third etiologic group is represented by autoimmune diseases and includes well-defined clinicopathological granulomatous diseases such as Crohn's disease, granulomatosis with polyangiitis (Wegener's disease), or sarcoidosis, as well as more recently described conditions such as IgG4-related disease, systemic erythematosus lupus, or SjS [74][75][76].…”

“…According to Ojeda and coll., 35 cases of breast sarcoidosis with histological documentation, all in women, were reported in literature from 1921 to 1997 [75]. Our literature search has found 30 other cases to date, also presenting as lumps in the breast [5,72,. Painless breast masses were the main presentation, sometimes associated with skin with an "orange peel" aspect.…”

Lactation Effect on Findings of Contrast-Enhanced and Diffusion-Weighted Magnetic Resonance Imaging in Patients with Idiopathic Granulomatous Mastitis

“…Idiopathic granulomatous mastitis (IGM) categorized as granulomatous disease of breast is relatively rare, benign, chronic inflammatory breast lesion which clinically and radiographically could misdiagnose as a inflammatory breast carcinoma [3]. However cause of IGM is not clear, its frequency is increasing with lactation, pregnancy and hyperprolactinemia [4].…”