27-year-old woman with right breast pain & lump

 

Images

Doctor's Information

Name : Maryam
Family : Noori
Affiliation :Teb Azma Imaging Center,Ghom,Iran
Academic Degree : Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :

 

Case Section

Breast Imaging

 

Patient's Information

Gender : Female
Age : 27

 

Clinical Summary

A 27 Y/O woman presents with chronic right breast pain & swelling.

 

Imaging Findings

On axial T1w, hypointense large lobulated mass is depicted in subareolar & upper medial portion of right breast with smaller lesions at UOQ. On T2 fat suppressed axial & reconstructed sagital images, the lesion has high signal intensity. On post contrast subtraction images, rim enhancing irregular mass was present which shows moderate initial enhancement in enhancing portions & rising curve.

 

Differential Diagnosis

Rim enhancing lesions: High grade IDC & inflammatory breast cancer may show rim-enhancement due to central necrosis. Medullary carcinoma can be complex cystic mass with thick rim enhancing wall & may be partially indistinct margin. Mucinous carcinoma with rim enhancement & high signal on T2w. Seroma usually has smooth thin<=4mm rim enhancement. Complicated cyst has thin smooth rim, 3mm. Metaplastic carcinoma, sarcoma & hemangioma are rare ddx.

 

Final Diagnosis

Granulomatous lobular mastitis.

 

Discussion (Related Text)

Granulomatous mastitis is a rare disease that occurs in young premenopausal women after their last childbirth. It has been correlated with breast-feeding and oral contraceptive use, and a possible autoimmune component has been implicated in its etiology. Affected patients may have galactorrhea, inflammation, a breast mass, indurations, and skin ulcerations. Women undergoing mammography are found to have asymmetric density, focal asymmetric or ill-defined breast masses, or negative results. Calcifications are not a feature. On ultrasound, findings include irregular masses, focal regions of inhomogeneous patterns associated with hypoechoic tubular/nodular structures, or decreased parenchymal echogenicity with acoustic shadowing, all suggestive of malignancy. Because the mammographic and sonographic features suggest breast cancer, biopsy is frequently performed on women with this condition. Biopsy shows a chronic granulomatous inflammation composed of giant cells, leukocytes, epithelioid cells, macrophages, and abscesses. Treatment consists of surgical excision, oral steroid therapy, anti-inflammatory drugs or colchicines, or methotrexate, as well as antibiotic treatment of any associated abscesses. Recurrence rates of up to 50% have been reported, but they can be reduced by immunosuppressive treatment until complete remission.

 

References

Breast imaging; the requisites, Debra M. ikeda. Practical MR Mammography, Uwe Fischer. Diagnostic Imaging Breast. Berg & Birdwell et al.

 

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