Periarteritis nodosa presenting as a breast lesion: report of a case and review of the literature

Trüeb, Ralph M.; Scheidegger, E. Paul; Pericin, Marcus; Singh, Avneet; Hoffmann, Ulrich; Sauvant, G.; Burg, G

doi:10.1046/j.1365-2133.1999.03216.x

Cited by 38 publications

(17 citation statements)

References 20 publications

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“…Systemic vasculitis involving the breast has been sporadically reported as a component of different systemic vasculitides, such as GCA [57], PAN [58], Churg-Strauss syndrome [59], Behçet's disease [60] and Wegener's granulomatosis [52,61,62].…”

Section: Single-organ Vasculitis Involving the Breastmentioning

confidence: 99%

Single-organ vasculitis

Hernández‐Rodríguez

Molloy

Hoffman

2008

Current Opinion in Rheumatology

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Section: Single-organ Vasculitis Involving the Breastmentioning

confidence: 99%

Single-organ vasculitis

Hernández‐Rodríguez

Molloy

Hoffman

2008

Current Opinion in Rheumatology

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“…Localized forms of PAN can affect various organs, such as the skin [26], gallbladder [27], and cervix [28]. PAN of the breast is a rare disease that usually does not involve other organs [19,20]. WG is characterized by distinct clinical and pathological features that include necrotizing granulomatous vasculitis of the arteries and veins in the upper and lower respiratory tracts, accompanied by glomerulonephritis.…”

Section: Discussionmentioning

confidence: 99%

Giant cell arteritis of the breast: a case report with a review of literatures

et al. 2009

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Although giant cell arteritis (GCA), clinically designated as temporal arteritis, is recognized as a systemic disease, the breast may be the primary organ in which it is manifested. GCA of the breast is a rare disease that mainly occurs in postmenoposal elderly women. It manifests as nodules or pain in the breast, with or without tenderness, and is associated with significant constitutional symptoms that resemble those of polymyalgia rheumatica (PMR). These symptoms can be treated with or without prednisone therapy and can improve without the development of organ dysfunction. The clinical manifestations can often be recognized only by retrospective analysis after excisional biopsy. GCA of the breast occasionally mimics carcinoma, and its initial manifestations may be similar to those of other forms of vasculitis involving the breast, such as polyarteritis nodosa and Wegener granulomatosis. Biopsy is indispensable for establishing a definitive diagnosis. Thus far, the findings of imaging procedures, such as mammography and ultrasonography, for patients with mammary GCA have not been reported in detail, and no distinctive findings associated with this condition have been identified. Considering this and the fact that spontaneous remission may occur in some cases, mammary GCA probably often goes undiagnosed or may be misdiagnosed as an ordinary mammary disease. GCA of the breast should be considered as a potential diagnosis in the case of elderly women presenting with PMR-like symptoms and tenderness, lumps, or pain in the breast. We report a case of GCA affecting the breast and review previous reports on this condition in an attempt to summarize the features that distinguish this disease from other vascular diseases of the breast.

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“…This concept receives further support by noting that a disproportionately high rate of "isolated vasculitis" occurs in the male genital tract (testis, epididymis, and spermatic cord) compared with other organ systems in which isolated vasculitis is more rare than involvement by systemic vasculitis. [54][55][56][57][58][59][60][61][62][63][64][65][66][67] In 12 cases, varying combinations of testicular hemorrhage, necrosis, and reactive changes in residual germ cells caused concern on the part of referring pathologists for germ cell neoplasia, and in some cases a regressed germ cell tumor, a possibility enhanced by the well-known tendency of testicular tumors to undergo spontaneous regression. 33 These cases differed, however, from a necrotic neoplasm by showing numerous ghost outlines of necrotic, germ cell-containing seminiferous tubules rather than the unorganized coagulum containing remnant tumor cells that typify a necrotic neoplasm.…”

Section: Discussionmentioning

confidence: 99%

Testicular Hemorrhage, Necrosis, and Vasculopathy

Kao

Zhang

Ulbright

2014

American Journal of Surgical Pathology

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We report 30 cases of testicular hemorrhage and/or necrosis with associated vascular damage that caused clinical concern for a neoplasm and that raised the question of a vasculitis syndrome on pathologic examination. The patients were 12 to 66 years old (median, 33 y) and presented with pain (n=15), mass (n=12), or both (n=2); 1 case had no available clinical information. Ultrasonographic interpretations included a neoplasm in the differential diagnoses in 14 of 18 cases in which this information was available, and most (n=24) had orchiectomy because of this possibility. Only 4 were clinically suspected to represent testicular infarction. Circumscribed, hemorrhagic lesions occurred in 10 cases, less demarcated hemorrhagic foci in 5, and discrete nodules or ill-defined foci of varying color and consistency in the remainder. No clear testicular lesion was described in 2, with 1 of these having a "dusky" appearance. On microscopic examination all but 1 case showed damaged blood vessels (vasculopathy), with either associated hemorrhage/hematoma (n=24) and/or areas of parenchymal necrosis (n=21). One case showed only segmental tubular atrophy with interstitial inflammation and vasculopathy; no infarct or hemorrhage was identified. A variety of vascular changes was identified, including prominent intimal thickening in arteries (n=22) and fibrinoid change in both arteries (n=5) and vessels of indeterminate type (n=8). Medial fibrosis was present in veins (n=12) and vessels of indeterminate type (n=4), whereas thrombi (remote, recanalized, and/or recent) occurred in arteries (n =7), veins (n=9), and vessels of indeterminate type (n=11). Dilated, blood-filled vessels were present in the testis and/or paratestis in 15 cases. In addition, 7 cases showed arteriolar hyalinization, and 19 had inflammation of blood vessels. The latter was lymphohistiocytic and mostly light but occasionally prominent (n=5). Interstitial inflammation was seen adjacent to damaged testicular parenchyma in all 30 cases. Clinical follow-up in 20 patients (4 to 131 mo, mean 38 mo) showed no evidence of recurrence in the contralateral testis or later development of systemic vasculitis. The histologic findings were compared with those in 11 orchiectomies resected for clinical acute torsion. All clinical acute torsion cases showed both parenchymal and fibrinoid vascular necrosis, and 10 had hemorrhage/hematoma; they lacked vasculitis, interstitial inflammation, and chronic vascular changes. Testicular vasculopathy, characterized by acute and chronic vascular injury, commonly occurs in testes with parenchymal hemorrhage and necrosis that clinically mimic a tumor. It shares the acute features of recent torsion but also has findings indicative of chronic injury. Testicular vasculopathy is most likely a result of chronic intermittent torsion that leads to localized hemorrhage/necrosis and should be distinguished from cases of systemic vasculitis given the significantly different clinical implications.

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Periarteritis nodosa presenting as a breast lesion: report of a case and review of the literature

Cited by 38 publications

References 20 publications

Single-organ vasculitis

Single-organ vasculitis

Giant cell arteritis of the breast: a case report with a review of literatures

Testicular Hemorrhage, Necrosis, and Vasculopathy

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