Sarcoidosis presenting initally as breast mass: Report of two cases

doi:10.1016/S0046-8177(85)80259-8

Human Pathology

Volume 16, Issue 8, August 1985, Pages 851-852

https://doi.org/10.1016/S0046-8177(85)80259-8 Get rights and content

The cases of two patients who presented with breast masses suggesting carcinoma and no other clinical features of sarcoidosis are reported. Biopsies in both patients revealed noncaseating, epithelioid granulomas. Mycobacteria, fungi, and foreign material were not identified. In une of the patients, other sites of involvement were discovered five years later. These cases illustrate that sarcoidosis should be considered in patients with granulomatous breast disease, even without evidence of disease elsewhere.

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Cited by (34)

Cystic neutrophilic granulomatous mastitis: A clinicopathologic study of a distinct entity with supporting evidence of a role for Corynebacterium-targeted therapy
2018, Annals of Diagnostic Pathology
Citation Excerpt :
Patients with CNGM are usually young parous women of reproductive age group and are more likely to be Hispanic and born outside of the United States [4]. Other causes of granulomatous mastitis such as sarcoidosis, tuberculosis, fungal infections and Wegener's granulomatosis should be excluded in patients with CNGM [12-14]. Corynebacterium kropenstedtii, a lipophilic corynebacteria, is the species most frequently isolated in CNGM patients [2,6].
Cystic neutrophilic granulomatous mastitis (CNGM) is a distinct histopathologic entity characterized by neutrophilic and granulomatous inflammation surrounding clear cystic spaces. Rare gram-positive bacilli are sometimes identified within these cystic spaces. Studies in the literature have identified these gram-positive bacilli to be Corynebacterium species. We describe the clinicopathologic features of 7 cases of CNGM, including a case with evidence of Corynebacterium amycolatum. Patients were young to middle aged parous women ranging in age from 28 to 53 years (median age: 41 years). Gram-positive bacilli were identified in 4 cases, all within cystic spaces. Microbial culture from a 41-year old Hispanic woman grew Corynebacterium species on multiple occasions and Corynebacterium amycolatum was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) on two separate occasions. Antibiotic susceptibility testing performed both times showed resistance to multiple antibiotics and susceptibility to vancomycin. Follow-up of all patients (range 3–12 months, median 6 months) showed a widely variable clinical course and varying response to a variety of treatment modalities. Five of the seven CNGM patients were parous, reproductive-aged Hispanic women who were born outside of the United States. Our findings further support the association of CNGM with corynebacteria and gram-positive bacilli. Furthermore, this study shows that Corynebacterium amycolatum, a nonlipophilic and multidrug-resistant corynebacterium can be associated with CNGM, hence the need for targeted antibiotic therapy. We propose identifying corynebacteria to the species level and performing antibiotic susceptibility testing in patients with CNGM because of the varied susceptibility testing profile that has been reported among different species of corynebacteria.
Primary sarcoidosis of the breast, a case study in connection with Propionibacterium acnes infection
2017, Human Pathology: Case Reports
Citation Excerpt :
In the breast, ductal spread of P. acnes infection was suspected because this indigenous bacterium was detected not only in the inflammatory macrophages but also in the ductal space and ductal epithelium, and some granulomatous lesions that were randomly located along or around the mammary ducts. Sarcoidosis of the breast may be a part of systemic sarcoidosis or a primary lesion restricted to the breast [6,8–10]. Systemic sarcoidosis involving the breast is more common.
A 77-year-old female underwent screening mammography with abnormal results. Core needle biopsy revealed a granulomatous lesion without necrosis, and sarcoidosis was considered although tuberculosis and granulomatous mastitis could not be ruled out. Three months later, the patient detected breast and axillary masses. Malignancy was suspected and both lesions were excised. The specimens contained epithelioid cell granulomas with no necrosis. Her angiotensin-converting enzyme level was normal, and radiographic examination revealed no evidence of involvement of other organs, including the lungs and mediastinal lymph nodes. Although sarcoidosis was highly suspected, it was not definitive. Immunohistochemistry with the PAB antibody, which specifically reacts with Propionibacterium acnes, the most commonly implicated causative agent of sarcoidosis, showed positive signals in granulomatous inflammation of the breast and within granulomas of the sentinel lymph node. This is the first case report of primary sarcoidosis of the breast involving the draining lymph node with confirmed P. acnes infection.
Granulomatous mastitis: Presentation, treatment and outcome in 43 patients
2010, Surgeon
Citation Excerpt :
Histopathological evaluation plays a crucial role in the diagnosis of GM. Other causes of granulomatous lesions in the breast must be excluded25–27 and foreign-body reaction, fat necrosis and duct ectasia must also be excluded.4,14 The optimal treatment of GM remains controversial.10,13,28,29
Granulomatous mastitis is a rare benign breast condition commonly affecting women of child-bearing age. It is characterised histopathologically by the presence granuloma and microabscess formation. It is frequently mistaken for inflammatory breast carcinoma both clinically and mammographically. The aim of this study was to retrospectively review the clinical presentation, radiological investigation, histopathological features, treatment and outcome of granulomatous mastitis of women presenting to Ripas Hospital between October 1997 and June 2009.
Forty-three patients with a mean age of 34 years presented with a diagnosis of granulomatous mastitis. All patients presented with a palpable breast lump; 24 (56%) patients also experienced pain in the lump and 3 (7%) patients also had associated nipple discharge on presentation. The role of radiological imaging is found to be limited in differentiating GM from other inflammatory and malignant conditions of the breast. Forty (93%) patients underwent a surgical procedure as the main treatment; in the form of excision or incision and drainage of the breast lesions. Mean follow-up was 15 (range 1–80) months with recurrence in 10 (23%) patients.
Granulomatous mastitis presents clinically with a palpable breast lump. The diagnosis is often only made histopathologically after surgical excision or core biopsy. Complete surgical excision or incision and drainage of the lesion are the main treatment modalities. Treatment with corticosteroids and immunosuppression remains controversial and there is tendency for this condition to recur after treatment.
Idiopathic Granulomatous Mastitis: A 25-Year Experience
2008, Journal of the American College of Surgeons
Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast that can mimic inflammatory breast cancer and periductal mastitis (PDM). Eighteen patients with a histopathologic diagnosis of IGM, seen over a period of 25 years, were retrospectively reviewed and compared with 133 patients with PDM and 100 normal patients.
The unit’s pathology database and clinic letters for this time period were used to identify patients who had presented with IGM. A retrospective review of the notes was used to extract reproductive factors, cigarette smoking habits, and ethnicities that were recorded at presentation. These were compared with data from a similar group of patients with PDM and a control group.
All IGM patients were women. Median age was 36 years (range 18 to 67 years) compared with 52 years (range 20 to 77 years) for PDM patients (p < 0.001). Seventeen percent of IGM patients were smokers at the time of presentation, as compared with 60% of PDM patients (p < 0.001). Although parity was similar for all groups, 10 IGM patients (56%) had given birth in the last 5 years, compared with 6 (5%) PDM patients (p < 0.001) and 20 (20%) in the control group (p = 0.0194). Two IGM patients had recurrences after pregnancy. The course of IGM varied from 11 to 105 weeks and was not affected by any treatment modalities.
IGM patients are younger, have given birth more recently, and are less likely to be Caucasian as compared with PDM patients. IGM is not related to smoking and can recur. Treatment should be supportive.
A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis
2003, Pathology
Granulomatous mastitis is a rare condition of unknown aetiology. The great majority of cases has not been associated with bacterial pathogens if women with mammary tuberculosis are excluded. We noted that some women in Auckland with a histological diagnosis of granulomatous mastitis had both microbiological and histological evidence of corynebacteria infection and aimed to study this further.
Thirty-four women were reviewed who presented with inflammatory breast disease and had microbiological specimens from which corynebacteria were isolated and/or histological specimens containing coryneform bacteria. These 34 cases were compared with 28 controls with similar histology but no evidence of corynebacteria infection.
Twenty-seven (79%) of the cases and 21 (75%) of the controls had histological and/or cytological evidence of suppurative granulomas. Fourteen of the 34 cases also had Gram-positive bacilli (GPB), recognisable as coryneform bacteria, in histological sections. In all cases the bacilli were confined to empty spaces, consistent with dissolved lipid, and were surrounded by neutrophils and, frequently, suppurative granulomas. Corynebacterium species were isolated from 52 of 116 microbiological specimens taken from the 34 cases. Forty of these 52 cultures were pure. Twenty-four of the cultures were further classified biochemically and using 16S rRNA gene sequencing. Twenty of the 24 were lipophilic Corynebacterium species and 14 were identified as Corynebacterium kroppenstedtii. The cases were more likely to present with fever or neutrophilia and more often formed sinuses than the controls but other clinical features were similar. Maori and Pacific Islanders accounted for 77% of the women across both groups.
We suggest granulomatous mastitis can be associated with corynebacteria infection, particularly infection by C. kroppenstedtii. The significance of this finding, which has previously been described in only a single case report, is discussed.
Granulomatous mastitis in pregnancy
2000, Obstetrics and Gynecology
Background: Granulomatous mastitis, a rare, benign breast condition characterized by granulomas and abscess formation, is mistaken frequently for inflammatory breast carcinoma. Although it has been reported in reproductive-age women, it is unusual in pregnancy.
Case: A 25-year-old black gravida 4 para 2 developed a tender, indurated 20 × 15 × 15 cm multilobulated breast mass at 17 weeks’ gestation. After not responding to antibiotics and incisional drainage, the biopsy-proved granulomatous mastitis improved with corticosteroid treatment. A postpartum recurrence also responded to steroid therapy.
Conclusion: Granulomatous mastitis is diagnosed clinically and histologically. Early recognition and initiation of steroid treatment might prevent repetitive, deforming breast biopsies.

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¹: from the Departments of Pathology and Surgery, The Hospital of the Good Samaritan, Los Angeles, California.

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Sarcoidosis presenting initally as breast mass: Report of two cases

Med Clin North Am

Sarcoidosis

Sarcoid lesion in breast after probable sarcoidosis in lungs

Br Med J