1
|
Clark A, Bachert S. Unknown Case: Sixty-Four-Year-Old with a Screening Mammogram-Detected Oval Mass. JOURNAL OF BREAST IMAGING 2024:wbae015. [PMID: 38564231 DOI: 10.1093/jbi/wbae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Indexed: 04/04/2024]
Affiliation(s)
- Aurela Clark
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Sara Bachert
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
2
|
Letter H, Komforti M, Maxwell R, Maimone S. Cholesterol granuloma of the breast: A case report. Radiol Case Rep 2023; 18:3009-3013. [PMID: 37441453 PMCID: PMC10333115 DOI: 10.1016/j.radcr.2023.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 07/15/2023] Open
Abstract
Cholesterol granuloma of the breast is a rare entity that can be indistinguishable from cancer on physical exam and imaging. We present the case of a 58-year-old woman who developed a new enhancing mass on high-risk screening magnetic resonance imaging (MRI). Interestingly, this mass developed in the same area as a previously noted benign-appearing inflammatory cyst that had been decreasing in size on MRI and mammogram over many years. Ultrasound-guided biopsy was performed which revealed cholesterol granuloma. We will discuss the nonspecific imaging findings and the characteristic histopathological features that confirm diagnosis.
Collapse
Affiliation(s)
- Haley Letter
- Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Miglena Komforti
- Department of Pathology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Robert Maxwell
- Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Santo Maimone
- Department of Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| |
Collapse
|
3
|
Al Horani O, Al-Ghotani B, Albelal D, Alabdallah E, Kamil H, Al-Mahasna S. A case report of a bullet in the breast of a woman for four years without any complications. Int J Surg Case Rep 2023; 105:108049. [PMID: 36996708 PMCID: PMC10070636 DOI: 10.1016/j.ijscr.2023.108049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A bullet stabilized in a breast for more than 4 years without causing any complication due to its presence is not a common case. Sometimes breast isolated injury could be seen without symptoms like pain, or palpable mass, or it could present with abscess formation and fistula. In addition, the bullet - if it's small - could mimic calcifications seen in malignancy when performing mammography. CASE PRESENTATION We report a case of a 46-year-old well-being female who came to resect a superficial gunshot she got in her left breast in one of the armed conflict areas in Syria. The bullet has been settled there for more than 4 years without causing any inflammation-related signs at the wound's site and without causing any symptoms or complications. CLINICAL DISCUSSION The tissue damage caused by the gunshot is associated with several factors such as the bullet caliber, speed, range of shooting, and energy flux. Frequently, gunshot injuries are most serious in friable solid organs like the liver and brain, whereas dense tissues such as bones and loose tissues like subcutaneous fat are more tolerant and resistant to that kind of insult. When a foreign body (bullet) enters the body without causing tremendous tissue damage and settles there for enough period of time we expect seeing signs of inflammation (heat, swelling, pain, tenderness, and redness). CONCLUSION Such cases must be taken into consideration and not be neglected without intervention due to the increased risk of many fearful complications including Squamous Cell Carcinoma.
Collapse
Affiliation(s)
- Osama Al Horani
- Faculty of Medicine of Damascus University, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Basel Al-Ghotani
- Faculty of Medicine of Damascus University, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic.
| | - Douaa Albelal
- Stemosis for Scientific Research, Damascus, Syrian Arab Republic; Faculty of Medicine, Hama University, Hama, Syrian Arab Republic
| | - Ebaa Alabdallah
- Faculty of Medicine of Damascus University, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Hazem Kamil
- Faculty of Medicine of Damascus University, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Souheb Al-Mahasna
- Al-Mouwasat University Hospital, Department of General Surgery, Damascus, Syrian Arab Republic
| |
Collapse
|
4
|
Jin M, Wu Q, Miao B, Jin J, Gao C, Xu X, Luo Y, Chen Z. Multiple cholesterol granulomas of the breast: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e33084. [PMID: 36827045 PMCID: PMC11309624 DOI: 10.1097/md.0000000000033084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
RATIONALE Cholesterol granuloma of the breast is a rare disease defined as chronic reactive inflammation of cholesterol crystals and foreign body giant cells. This disease can mimic breast cancer in the clinic as painless palpable hard nodules, and imaging shows irregular hypoechoic nodules with unclear boundaries. Therefore, the uncommon lesions can be easily misdiagnosed as breast cancer. Meanwhile, it can be easily neglected by clinicians because of poor understanding. PATIENT CONCERNS In this report, we present a rare case of multiple cholesterol granulomas of the breast, which was analyzed retrospectively and combined with all 11 relevant available studies in the last 50 years. INTERVENTIONS The patient had undergone multiple breast imaging inspections for breast nodules and had the local resection of nodules. DIAGNOSES The patient was confirmed to have a final diagnosis of benign cholesterol granulomas but was initially considered as breast cancer. OUTCOMES The patient did not complain of discomfort after surgery, and ultrasound reexamination 5 months after surgery showed no recurrence. LESSONS By retrospective analysis, dynamic contrast-enhanced magnetic resonance imaging and core needle biopsy can synergistically help clinicians distinguish it from other breast disease. To raise awareness of such a rare disease and reduce related misdiagnoses, we summarize the characteristics of cholesterol granulomas and recommend appropriate novel diagnosis and treatment regimens for patients with cholesterol granulomas.
Collapse
Affiliation(s)
- Menglei Jin
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Wu
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Surgery, Pangang Xichang Hospital, Xichang, China
| | - Bingliang Miao
- Department of Breast Surgery, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Jing Jin
- Department of Obstetrics and Gynecology, Shaoxing Maternity and Childcare Hospital, Shaoxing, China
| | - Chenyi Gao
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoming Xu
- Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yingbo Luo
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhigang Chen
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
5
|
Lahbacha B, Chaabane A, Chelly B, Douggaz A, Mfarrej MK, Jbir I, Nechi S, Chelbi E. Cholesterol Granuloma of the Breast Mimicking Cancer: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2023; 11:23247096231193275. [PMID: 37565689 PMCID: PMC10422883 DOI: 10.1177/23247096231193275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/21/2023] [Accepted: 07/23/2023] [Indexed: 08/12/2023] Open
Abstract
Cholesterol granuloma of the breast is an infrequent benign lesion with clinical and radiological findings suggestive of cancer. Herein, we present the case of a 52-year-old woman with no significant past medical history, who presented to the outpatient department for her routine breast screening. Physical examination revealed a painless palpable nodule in the upper external quadrant of the left breast, measuring 0.7 cm. On imaging, the mass met the criteria for Breast Imaging Reporting and Data System (BI-RADS) category 4B. Subsequently, a core needle biopsy of the mass was performed. Despite the alarming radiologic features, microscopic findings were consistent with breast cholesterol granuloma.
Collapse
Affiliation(s)
| | - Abir Chaabane
- Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
| | - Beya Chelly
- Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
| | - Amel Douggaz
- Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
| | | | - Ichraf Jbir
- Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
| | - Salwa Nechi
- Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
| | - Emna Chelbi
- Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia
| |
Collapse
|
6
|
Ishikawa Y, Fujio A, Tokodai K, Kashiwadate T, Miyazawa K, Sasaki K, Matsumura M, Saitoh Y, Tsuruoka M, Inoue J, Miyagi S, Fujishima F, Unno M, Kamei T. Cholesterol Granuloma of the Liver Mimicking Malignant Tumor: A Case Report. TOHOKU J EXP MED 2022; 256:235-240. [PMID: 35321967 DOI: 10.1620/tjem.256.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cholesterol granuloma is a benign, tumor-like lesion with an accumulation of cholesterol crystals in the tissue and is a consequence of a chronic inflammatory reaction. It commonly occurs in the middle ear but rarely in the liver. There is only one previous case report of cholesterol granuloma of the liver, which was caused by cholesterol hepatolithiasis. We report a case of cholesterol granuloma of the liver in a patient with no intrahepatic cholesterol stones; it was difficult to rule out malignant liver tumor preoperatively. The patient was a 79-year-old woman in whom a lesion in the liver was detected on abdominal ultrasonography. She was referred to our hospital for detailed examination and treatment. Abdominal contrast-enhanced computed tomography showed a 20 mm lesion with ring enhancement in the lateral segment of the liver during the arterial and delayed phases. Since a malignant tumor could not be ruled out radiologically, laparoscopic lateral segment hepatectomy was performed for definitive diagnosis and treatment. The resection specimen showed a yellowish-white lesion measuring 15 mm in diameter. Pathological examination showed a granulomatous lesion with cholesterol crystals surrounded by foreign body giant cells. The lesion was diagnosed as cholesterol granuloma of the liver. The postoperative course was good, and the patient was discharged on postoperative day 5. She was healthy, and no recurrence of the cholesterol granuloma was detected at the 5-month follow-up. This is the first case report of cholesterol granuloma of the liver mimicking a malignant liver tumor in a patient with no intrahepatic cholesterol stones.
Collapse
Affiliation(s)
- Yuki Ishikawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Atsushi Fujio
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Kazuaki Tokodai
- Department of Surgery, Tohoku University Graduate School of Medicine
| | | | - Koji Miyazawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Kengo Sasaki
- Department of Surgery, Tohoku University Graduate School of Medicine
| | | | - Yoshikatsu Saitoh
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Mio Tsuruoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Shigehito Miyagi
- Department of Surgery, Tohoku University Graduate School of Medicine
| | | | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine
| |
Collapse
|
7
|
Chung HL, Leung JW. Foreign body granuloma from a gunshot injury to the breast. Clin Imaging 2020; 68:197-201. [DOI: 10.1016/j.clinimag.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
|
8
|
Nam G, Singer TM, Lourenco AP, Wang Y. Cholesteroloma of the breast: A 10 year retrospective review of 79 cases with radiology correlation. Breast J 2019; 25:1177-1181. [PMID: 31280486 DOI: 10.1111/tbj.13441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/27/2022]
Abstract
A cholesteroloma or cholesterol granuloma of the breast is an uncommon lesion representing an inflammatory/reactive process with unclear etiology. In this study, we reviewed our 10-year experience with cholesteroloma of the breast with clinical, radiologic, and histopathological correlation. Seventy-nine cases were selected. The mean patient age was 57.7 (range 25-90) years old. Patients had hypercholesterolemia with mean blood cholesterol level of 201 mg/dL (P < 0.001). The mean body mass index (BMI) was 26.7 kg/m2 (P = 0.1976). The indications for the breast biopsies were mass lesion on radiology (85.5%, n = 65) and microcalcifications (10.5%, n = 8). Of the 65 cases of the mass lesions, 52 presented as solid masses and 13 were cystic. On the diagnostic mammogram or ultrasound, 81.9% were BI-RADS 4% and 6.9% were BI-RADS 5. Macrocysts were the most common pathological finding associated with cholesteroloma suggesting the etiology of cholesteroloma may be the result of repair process from obstruction and rupture of the macrocysts. Six cases (9.2%) of cholesterolomas had persistent masses during follow-up. The recognition of this lesion and radio-pathological correlation can help us better understand this entity and distinguish it from its mimickers.
Collapse
Affiliation(s)
- Gahie Nam
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tisha M Singer
- Department of Diagnostic Imaging, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ana P Lourenco
- Department of Diagnostic Imaging, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
9
|
Kim SJ. Increasing Size of Cholesterol Granuloma of the Breast in the Vicinity of a Previous Breast Biopsy: Imaging Features and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:370-376. [PMID: 30894505 PMCID: PMC6439936 DOI: 10.12659/ajcr.914282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Female, 52 Final Diagnosis: Cholesterol granuloma of the breast Symptoms: None Medication: — Clinical Procedure: Core needle biopsy Specialty: Radiology
Collapse
Affiliation(s)
- Suk Jung Kim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| |
Collapse
|
10
|
Hu CC, Chang TH, Hsu HH, Pen YJ, Yu JC. T1-Weighted Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) to Distinguish Between Concurrent Cholesterol Granuloma and Invasive Ductal Carcinoma of the Breast: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:593-598. [PMID: 29789520 PMCID: PMC5994963 DOI: 10.12659/ajcr.909161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient: Female, 52 Final Diagnosis: Cholesterol granuloma of the breast Symptoms: Follow up Medication: — Clinical Procedure: Surgical excision Specialty: Radiology
Collapse
Affiliation(s)
- Cheng-Chuan Hu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsun-Hou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Radiology, Kang-Ning General Hospital, Taipei, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Jen Pen
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Services General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|