Lupus Mastitis as Differential Diagnosis of Breast Mass

Abstract

Background: Lupus mastitis is a rare presentation of lupus panniculitis, seen in up to 2 to 3% of the patients and rarely being the initial presentation of systemic lupus erythematosus. It affects the deep subcutaneous adipose tissue of the breast. Case Report: A previously healthy 36-year-old white woman presented with a history of a palpable mass in the right breast that had developed over one year. Physical examination revealed a palpable mass with skin retraction, local erythema and an ulcer in healing in the right breast. Imaging evaluation with mammography and ultrasound classified the findings as suspicious, indicating biopsy. Biopsy revealed findings suggestive of lupus mastitis. Patient was treated with anti-malarial drugs, with clinical improvement. Conclusion: The findings on physical examination and imaging studies of lupus mastitis can be misleading. Depending on the presentation on the onset, it can mimic breast infection or even breast carcinoma. Magnetic Resonance Imaging is useful in evaluating the extent of disease and may have an important role in monitoring treatment response. Histopathology has an important role in suggesting diagnosis, leading to the correct treatment and avoiding erroneous surgical procedures, which can work as triggers for new episodes of mastitis.

Lupus Mastitis in a Young Female Mimicking a Breast Carcinoma; a Rare Entity Through a Case Report and Review of the Literature

“…It affects both sexes, but 90% of the cases occur in women of childbearing age (2). Lupus mastitis is a rare benign inflammation of the deep subcutaneous adipose tissues of the breast, seen in up to 2 to 3% of the patients and rarely being the initial presentation of systemic lupus erythematosus (5,6). It is part of lupus panniculitis but is called lupus mastitis when involving the breast glands.…”

“…It is advisable to avoid biopsy if the diagnosis can be established with the clinical and radiological features (especially the unusual mammographic calcification) because it may worsen the condition. However, FNA will be helpful if there is a doubt about the diagnosis or when the swelling is localized (1,5,8). Accurate patient history and knowledge of the typical imaging appearance of LM may help prevent or minimize biopsy and surgical intervention, which carries the potential for the disease exacerbation (8,9).…”