Idiopathic Granulomatous Mastitis Associated with Erythema Nodosum

Year 2016, Volume: 33 Issue: 2, 228 - 231, 01.03.2016

Tuğba Özlem Kalaycı Melike Bedel Koruyucu Melda Apaydın Makbule Varer Demet Etit

Abstract

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with in-drawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones.

Keywords

Breast cancer, erythema nodosum, fine needle aspiration biopsy, idiopathic granulomatous mastitis, magnetic resonance imaging, ultrasonography

References

• 1. Kessler E, Wolloch Y. Granulomatous mastitis: A lesion clinically simulating carcinoma. Am J Clin Pathol 1972;58:642-6. [CrossRef]
• 2. Anik Y. Radiological findings of idiopathic granulomatous mastitis: Review. Turkiye Klinikleri J Med Sci 2010;30:286-92. [CrossRef]
• 3. Adams DH, Hubscher SG, Scott DG. Granulomatous mastitis - a rare cause of erythema nodosum. Postgrad Med J 1987;63:581-2. [CrossRef]
• 4. Vinayagam R, Cox J, Webb L. Granulomatous mastitis: A spectrum of disease. Breast Care (Basel) 2009;4:251-4. [CrossRef]
• 5. Koufakis T, Gabranis I. Erythema nodosum leads to the diagnosis of pulmonary tuberculosis. Pan Afr Med J 2014;18:291. [CrossRef]
• 6. Nakamura T, Yoshioka K, Miyashita T, Ikeda K, Ogawa Y, Inoue T, et al Granulomatous mastitis complicated by arthralgia and erythema nodosum successfully treated with prednisolone and methotrexate. Intern Med 2012;51:2957-60. [CrossRef]
• 7. Larsen LJH, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: Imaging, diagnosis, and treatment. AJR Am J Roentgenol 2009;193:574-81. [CrossRef]
• 8. El Khouli RH, Macura KJ, Jacobs MA, Khalil TH, Kamel IR, Dwyer A, et al. Dynamic contrast-enhanced MRI of the breast: Quantitative method for kinetic curve type assessment. AJR Am J Roentgenol 2009;193:295-300. [CrossRef]
• 9. Kocaoglu M, Somuncu I, Ors F, Bulakbası N, Tayfun C, Ilkbahar S. Imaging findings in idiopathic granulomatous mastitis. A review with emphasis on magnetic resonance imaging. J Comput Assist Tomogr 2004;28:635-41. [CrossRef]