idiopathic granulomatous mastitis

Granulomatous

mastitis • Granulomatous mastitis - Ganzer Fall bei Radiopaedia

Abidin N, Granulomatous mastitis. Case study, Radiopaedia.org (Accessed on 07 May 2023) https://doi.org/10.53347/rID-50808 • CC by-nc-sa 3.0 (modified)

Granulomatous

mastitis • Chronic granulomatous mastitis - Ganzer Fall bei Radiopaedia

González Traslosheros K, Chronic granulomatous mastitis. Case study, Radiopaedia.org (Accessed on 07 May 2023) https://doi.org/10.53347/rID-95331 • CC by-nc-sa 3.0 (modified)

Granulomatous

mastitis • Idiopathic granulomatous mastitis - Ganzer Fall bei Radiopaedia

Ashraf A, Idiopathic granulomatous mastitis. Case study, Radiopaedia.org (Accessed on 07 May 2023) https://doi.org/10.53347/rID-161021 • CC by-nc-sa 3.0 (modified)

Mimickers of

breast malignancy: imaging findings, pathologic concordance and clinical management. Granulomatous mastitis. A 34-year-old woman who is 2 years post-partum presented with a palpable left breast mass, diffuse breast swelling, tenderness, and erythema for several weeks. Bilateral mediolateral oblique mammogram (a) show diffuse skin thickening (solid arrow), global asymmetry, and trabecular thickening (dashed arrows) in the left breast, asymmetric from the right breast. Extended field of view grayscale ultrasound (b) shows an ill-defined hypoechoic, irregular mass (arrows). Color Doppler ultrasound (c) shows increased vascularity, edema (arrow head), and skin thickening (dashed arrow). T1weighted axial delayed post-contrast (d) and sagittal subtraction (e) post-contrast MRI shows diffuse skin thickening (solid arrow) and trabecular thickening with heterogenous enhancement involving the left superior breast (dashed arrows). There is associated axillary adenopathy (solid arrow in e). Axial PET/CT (f) shows diffuse fluorodeoxyglucose avidity involving the left breast (arrow). Findings and clinical presentation were suspicious for inflammatory breast cancer. The patient underwent three core needle breast biopsies of the mass in the left breast over the span of a month, and a skin punch biopsy. All biopsies showed dense stromal fibrosis, chronic inflammation, and features suggestive of granulomatous mastitis without atypia or malignancy

insightsimaging.springeropen.com • CC-by-4.0

Idiopathic

granulomatous mastitis. US revealed heterogenicity containing hypoechoic tubuler and spheric lesions with irreguler margins in periareolar region of left breast.

www.eurorad.org • CC by-nc-sa-4.0

Idiopathic

granulomatous mastitis. T2 STIR axial images showed a heterogeneous hyperintense regional non-mass on the left breast.

www.eurorad.org • CC by-nc-sa-4.0

Idiopathic

granulomatous mastitis. Post-contrast subtraction delayed phase axial images revealed progressive heterogeneous non-mass ehnacement.

www.eurorad.org • CC by-nc-sa-4.0

Idiopathic

granulomatous mastitis—our experience. Ultrasound of a 28-year-old female diagnosed with idiopathic granulomatous mastitis, who presented with pain and swelling in the left breast. a, b Ultrasound showing an ill-defined irregular hypoechoic lesion with tubular tentacle-like extensions (red arrows). c Color flow imaging showing increased internal vascularity. d Histopathology shows Langhans type of giant cells admixed with inflammatory cells, predominantly lymphocytes (H&E × 100)

ejrnm.springeropen.com • CC-by-4.0

Idiopathic

granulomatous mastitis—our experience. A 38-year-old female diagnosed with idiopathic granulomatous mastitis, who presented with pain and swelling in the left breast. a Clinical picture showing swelling and redness in the left breast in areolar region. b Ultrasound showing irregular hypoechoic collection and inflammatory changes in surrounding breast parenchyma. c Enlarged lymph node in axilla showing irregularly thickened cortex. d Histopathology showing foreign body and Langhans type of giant cells with epithelioid cells, admixed with granulation tissue—H&E × 100

ejrnm.springeropen.com • CC-by-4.0

Idiopathic

granulomatous mastitis—our experience. A 29-year-old female diagnosed with idiopathic granulomatous mastitis, who presented with complaints of pus discharge from sinus tract in the left breast with associated pain. a Clinical picture showing external sinus tract with redness and swelling in the left breast. b A sinus tract (green arrow) between the parenchymal collection and subcutaneous collection to the skin surface. c Ultrasound showing subcutaneous edema and significant skin thickening. d Histopathology showing epithelioid granuloma with Langhans type of giant cells—H&E × 200

ejrnm.springeropen.com • CC-by-4.0

Idiopathic

granulomatous mastitis—our experience. A 31-year-old female diagnosed with idiopathic granulomatous mastitis, who presented with complaints of pus discharge from sinus tract in the left subareolar region with associated pain. a Clinical picture showing external sinus tracts with redness in the surrounding breast. b Extended view on high resolution ultrasound showing multiple collections (green arrow), surrounding heterogenous parenchyma (black arrow) & skin thickenning (red arrow head)

ejrnm.springeropen.com • CC-by-4.0

Idiopathic

granulomatous mastitis—our experience. a X-ray mammogram in medio-lateral oblique view showing irregular equal density lesion with partially obscured borders. b High resolution ultrasound showing hypoechoic irregular lesion with tentacles

ejrnm.springeropen.com • CC-by-4.0

Idiopathic

granulomatous mastitis—our experience. a MRI breast post-contrast images showing regional non-mass-like enhancement with prominent duct with wall thickening and surrounding inflammatory changes. b Sonomammogram showing long ectatic lesion with surrounding inflammatory changes

ejrnm.springeropen.com • CC-by-4.0

Idiopathic

granulomatous mastitis—our experience. a, b MRI breast post-contrast images showing multiple abscesses and inflammatory mastitis. c, d Sonomammogram showing the same

ejrnm.springeropen.com • CC-by-4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Idiopathic granulomatous mastitis is a very rare breast inflammatory disease of unknown origin that can clinically mimic carcinoma of the breast.

Clinical presentation

The condition generally manifests as a distinct, firm to hard mass that may involve any part of the breast. The subareolar regions may be relatively spared. The relationship of granulomatous mastitis to pregnancy or lactation has been strongly emphasized because this disease entity typically affects younger women, usually within 6 years of pregnancy. Reactive lymph nodes may be present in up to 15% of cases.

Pathology

Immunologic factors have been postulated as possible causes; however, the absence of vasculitis or of a prominent lymphocytic component in pathologic specimens favors against this hypothesis.

The diagnosis of idiopathic granulomatous mastitis is based on exclusion, since it depends on the demonstration of a particular histologic pattern combined with the exclusion of other granulomatous reactions such as:

especially tuberculosis
sarcoidosis
granulomatosis with polyangiitis
fungal infections
and those other benign inflammatory disorders found in association with carcinomas

At pathologic analysis, idiopathic granulomatous mastitis manifests as a non-caseating, non-vasculitic granulomatous inflammatory reaction centered on lobules. Fat necrosis, abscess formation, and fibrosis are commonly associated end-stage features that can disrupt the normal lobular anatomy.

Radiographic features

Mammography

Mammographic features can be variable, ranging from normal findings in patients with dense breasts to masses with benign or malignant features and focal asymmetric density. The most common mammographic appearance of the lesion is an asymmetrically increased density, which is not characteristic for this entity .

Breast ultrasound

Sonographic patterns of the disease are also varied and appear to relate to the histologic features. Findings include a mass-like appearance, tubular/nodular hypoechoic structures and focal decreased parenchymal echogenicity with acoustic shadowing.

Breast MRI

On MRI, the most frequent finding is focal or diffuse asymmetrical signal intensity changes without significant mass effect. Nodular lesions can also be seen .

T1: regions tends to be hypointense
T2: regions tend to be hyperintense
dynamic contrast-enhanced MRI: can show mass-like enhancement, ring-like enhancement, and/or nodular enhancement while time-intensity curves can differ from patient to patient and from lesion to lesion

Treatment and prognosis

The prognosis is usually good, although local recurrence has been reported. Primary treatment usually comprises of excisional biopsy. Corticosteroid therapy has also proved effective.