Presentation
Lactating female with left breast pain for 1 year. No fever, night sweats, anorexia or weight loss.
Patient Data
Heterogeneous echogenicity of the left central breast parenchyma, suggestive of an inflammatory process. A dilated duct containing heterogeneous echogenicity contents (inspissated secretions or pus?) is seen in the retro-areolar region. Small reactive lymph node in the left axilla.
A lobulated avascular hypoechoic lesion measuring about 2.5 x 1.5 cm is seen at 4 o'clock position in the left breast. A few mildly dilated ducts are seen in the left retro-areolar region.
Asymmetry in the size and density of both breasts (left breast being slightly smaller and denser than the right). Increased density in the left retroareolar region with retracted left nipple. Few scattered micro and macrocalcifications in the left breast. No suspicious focal lesion, calcifications, abnormal skin thickening or nipple retraction is seen on the right side. Small sub centimeter lymph nodes in both axilla.
Ultrasound-guided biopsy of the left breast lesion.
Histopathology report of the left breast lesion shows chronic granulomatous mastitis without necrosis.
Case Discussion
Quantiferon-TB: Negative, Brucella Abortus titer: <1:160 (negative), Brucella Melitensis titer: <1:160 (negative). No clinical or radiological suspicion of TB and sarcoidosis (normal chest radiograph). Based on these imaging and clinical features, she was labeled as a case of idiopathic granulomatous mastitis. She is doing fine and has been on active clinical surveillance for the last three years.
Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory disease of the breast of unknown etiology 1-3. It is characterized by noncaseating granulomatous inflammation and is most frequently seen in the young female of childbearing age 1-3. Clinically and radiologically, it is challenging to differentiate IGM from infectious etiologies (such as tuberculosis, sarcoidosis and fungal infections) as well as breast malignancy. Hence, an early definitive histopathological diagnosis is mandatory to avoid misdiagnosis, unnecessary delay in the management and unnecessary mastectomies 1,3. The commonest clinical presentation of IGM is a palpable unilateral breast mass (with or without pain) 1-3. It has variable and non-specific appearance on the imaging. It is generally seen as an ill-defined heterogeneous, hypoechoic lesion with multiple tentacles on the ultrasound, focal asymmetric density on the mammogram and ill-defined heterogeneous masses, rim-enhancing lesions or non mass enhancement (NME) with mixed kinetics on the MRI 1-3. The treatment of IGM is controversial and includes options ranging from conservative management with antibiotics to wide local excision (WLE) and corticosteroid therapy 3.
Unable to process the form. Check for errors and try again.