Xanthogranulomatous Breast Mass: An Unusual Presentation

Abstract

Xanthogranulomatous inflammatory reactions are benign inflammatoryprocesses characterized by aggregating lipid-laden foamy macrophages.Although cases have been reported in different organ systems, these rare reactions predominantly occur in the kidney and gallbladder. We present a 92-year-old female who noticed a palpable, tender mass in the lower inner quadrant of her right breast with no skin changes. She was referred to surgery by her primary care physician on suspicion of malignancy and further evaluation. Ultrasound-guidedbiopsy, ordered by the primary care provider, revealed a suspicious high-grade malignant neoplasm of uncertain origin. Pathological findings include the presence of an unusual population of malignant epithelioid cells with astriking xanthogranulomatous reaction, along with numerous Touton-like histiocytes. These findings are comparable in morphology to a recently reportedxanthogranulomatous epithelial tumor. Given the lack of history of breast carcinomain this patient as well as the lack of immunohistochemical studies suggesting breast carcinoma, treatment involved continuing standard of care for an unusual high-grade sarcoma via lumpectomy. A positron emission tomography (PET) scan was ordered to ensure there was no spread or alternate origins of the cancer tissue. This case report brings to light the findings of a probable xanthogranulomatous tumor in breast tissue, an exceptionally rare phenomenon in breastcancer, especially in the elderly population. Due to the rarity of xanthogranulomatous tumors in the breast, prognosis and standardized treatment haveyet to be established.

Xanthogranulomatous inflammation and spindle cell proliferation in response to silicone breast implant leakage

“…Although xanthogranulomatous changes presented as a suspicious breast mass in previous studies,7 10 the patient in this case study presented incidentally with no initial breast symptoms or complaints. For our patient, abnormal imaging findings of enhancement posterior to breast implants prompted further investigation.…”

“…Although xanthogranulomatous inflammation is recognised as a benign process,6 7 10 there are still limited studies and therefore, limited understanding of the long-term outcomes of patients affected. The understanding of the impact of xanthogranulomatous inflammation is further limited in the breast.…”