Lupus mastitis: radiologic and pathologic features

"What Do You Mean It's Not Cancer?" A Review of Autoimmune and Systemic Inflammatory Diseases Involving the Breast

Autoimmune and systemic inflammatory diseases represent a heterogeneous group of immune-mediated conditions with a wide range of clinical presentations and various affected organs. Autoimmune diseases can present in the breast as localized disease or as part of systemic involvement. Although breast involvement is uncommon, the spectrum of imaging findings can include breast masses, axillary adenopathy, calcifications, and skin changes, the appearance of which can mimic breast cancer. Common etiologies include diabetic mastopathy, systemic lupus erythematosus, scleroderma, rheumatoid arthritis, idiopathic granulomatous mastitis, sarcoidosis, and Immunoglobulin-G4 related mastopathy. This educational review will present multimodality imaging findings of breast manifestations of systemic inflammatory and autoimmune diseases and coexisting complications. It will also review how these disorders may affect breast cancer risk and breast cancer treatment options, including radiation therapy.

Systemic diseases affecting the breast: Imaging, diagnosis, and management

Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions. This review aims to discuss the clinical presentations, imaging features, pathologic findings, and management of systemic conditions that may affect the breast.

Lupus mastitis of the male breast

A 39-year-old male with no known co-morbid conditions presented with gradually increasing bilateral breast lumps for 1.5 years. Clinically, tender subcutaneous masses were detected. Mammograms revealed masses on both sides that on ultrasound were hyperechoic and showed internal vascularity. An MRI was suggested to assess the extent of the disease that confirmed bilateral masses but was otherwise inconclusive. Core biopsy revealed evidence of panniculitis with likely autoimmune aetiology. Evaluation of autoimmune markers was carried out that was positive and multidisciplinary team discussion concluded the diagnosis as lupus mastitis. Male breast pathology and lupus mastitis are both uncommon conditions, making lupus mastitis of male breast an extremely unusual presentation. However, its close clinical and radiological similarity with malignancy makes it important in spite of its rarity. Here we report a case of bilateral lupus mastitis in male breast with its radiological features.

Interchanging Autoimmunity - Lupus Mastitis Coexisting with Systemic Polyarteritis Nodosa

Lupus mastitis is an uncommon presentation of lupus erythematosus profundus (LE profundus), characterized by inflammation of the subcutaneous fat. LE profundus occurring as initial manifestation of LE is rare. We report a case where the patient presented with lupus mastitis and years later, she developed disseminated discoid LE (DLE) and polyarteritis nodosa (PAN). PAN and DLE are connective tissue diseases with different etiologies, clinical, immunological, and histopathological features. One connective tissue disease evolving into another is rare, and the reasons remain unexplained. This woman had histopathologically proven DLE and lupus mastitis with a negative antinuclear antibody profile. She satisfied the American College of Rheumatology criteria for PAN.

Mammographic signs of systemic disease

Although mammography is primarily used for the detection of breast cancer, it can occasionally reveal breast abnormalities related to extramammary disease. Cardiovascular diseases such as congestive heart failure and central venous obstruction may manifest as venous engorgement and breast edema at mammography. Pathologic arterial calcifications seen at mammography can indicate an underlying risk factor for accelerated atherosclerosis such as chronic renal failure. Connective tissue diseases including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis-polymyositis, and systemic scleroderma typically manifest with bilateral axillary lymphadenopathy, and stromal calcifications are also seen in the latter three disease processes. Some diseases such as neurofibromatosis type 1 and filariasis may manifest with pathognomonic findings at mammography, whereas other systemic diseases such as Wegener granulomatosis, sarcoidosis, and amyloidosis can manifest as nonspecific breast masses that are indistinguishable from breast cancer and usually require tissue biopsy for confirmation. Knowledge of the imaging characteristics of various systemic diseases affecting the breast will aid the radiologist in differentiating systemic disease from suspect breast lesions, thereby helping ensure appropriate follow-up. Furthermore, recognition of systemic diseases such as Cowden syndrome that are associated with an increased risk of breast cancer will allow the radiologist to recommend appropriate surveillance.

Lupus mastitis in systemic lupus erythematosus: a rare condition requiring a minimally invasive diagnostic approach

Breast involvement is a rare event in SLE patients. The most frequent presentation is lupus panniculitis with skin erythema, tenderness, and parenchymal nodules. However, when breast masses are detected in SLE patients without significant superficial inflammation, it is mandatory to rule out breast carcinoma. Here, we report the case of a 47-year-old woman with an 18-year-long history of SLE, who presented with a suspicious breast mass. Since surgical trauma has been reported to be able to exacerbate breast inflammation in lupus mastitis, an ultrasound-guided minimally invasive Mammotome biopsy was performed to obtain tissue samples for histological and immunohistochemical examinations. Histology was consistent with lupus mastitis. The patient was already on mycophenolate mofetil and hydroxychloroquine. At the latest follow-up visit 6 years later, no progression of the breast lesion was observed.

Lupus mastitis: an uncommon complication of systemic or discoid lupus

Lupus mastitis is an uncommon presentation of lupus erythematosus profundus or lupus panniculitis, a rare variant of lupus erythematosus characterized by inflammation of the subcutaneous fat. Lupus mastitis can present as single or multiple subcutaneous or deep breast masses, often clinically mimicking malignancy. Although lupus mastitis is rare, with less than 25 cases reported, the histologic features are distinct. Awareness of the entity and familiarity with the histologic features allow for accurate diagnosis and appropriate patient management. It most commonly affects women with a mean age at diagnosis of 40 years and an age range of 18 to 70 years. Typical histologic findings in lupus mastitis include a lymphocytic lobular panniculitis with plasma cells and hyaline fat necrosis. The lymphocytic infiltrate can be nodular, diffuse, periductal, and/or perilobular and germinal centers can frequently be identified. Lymphocytic vasculitis is also common. Immunohistochemistry shows a mixed T and B-cell population, with predominantly CD3+ CD4+ T cells intermixed with CD20-positive B cells and polyclonal plasma cells. Most commonly, lupus mastitis is seen in patients with a previous diagnosis of systemic or discoid lupus; however, it can also be the initial presentation of lupus in some patients. We report on 2 cases of lupus mastitis where the clinical impression was to rule out malignancy and review the literature to highlight the key clinicopathologic features.

Lupus mastitis - peculiar radiological and pathological features

Lupus mastitis is a form of lupus profundus that is seen in patients with systemic lupus erythematosus. It usually presents as a swelling (or swellings) in the breasts, with or without pain. The condition is recurrent and progresses along with the underlying disease, with fat necrosis, calcification, fibrosis, scarring, and breast atrophy. Lupus mastitis is often confused with malignancy and lymphoma and, in our part of the world, with tuberculosis. Confusion is especially likely when it occurs in an unusual clinical setting. In this article, we present a case that presented with unique radiological, pathological, and clinical features. Awareness of the various manifestations of lupus mastitis is essential if unnecessary interventions such as biopsies and surgeries, and their consequences, are to be avoided.

Lupus mastitis: a clinicopathologic review and addition of a case

Lupus mastitis (LM) is a rare presentation of lupus erythematosus profundus or lupus panniculitis, an unusual and rare clinical variant of lupus erythematosus itself in which the inflammatory reaction occurs primarily in the deep subcutaneous adipose. Although not required for diagnosis, essentially all cases of LM present with systemic or discoid lupus. The etiology is uncertain. Histologically it is defined by a lymphocytic lobular panniculitis and a characteristic hyaline sclerosis of the adipose tissue. Treatment is primarily medical due to exacerbation of disease by surgical intervention. A high index of suspicion, and familiarity of the histologic findings, is therefore required to make an accurate diagnosis and prevent further unwarranted diagnostic procedures. Herein, we provide a literature-based review of the clinical, radiologic, and pathologic findings of LM and its treatment and prognosis with the addition of a case for the literature.

Lupus Mastitis Is Not a Surgical Disease

A 23-year-old woman with a 2-year history of discoid lupus (SLE) presented with a right lateral upper quadrant breast mass. Physical examination revealed a 5 cm irregular, hard lesion suggestive of a breast malignancy. Ultrasound-guided fine needle aspiration biopsy of the mass confirmed the diagnosis as lupus mastitis. Differential diagnosis of a breast mass in a patient with SLE must include the possibility of lupus mastitis. Surgical resection is usually not necessary, and medical treatment can be implemented successfully.

Lupus mastitis

We report a case of a 28-year-old female with the diagnosis of systemic lupus erythematosus (SLE) referred to our breast pathology consultancy in 2002 due to a left breast nodule. Further investigation revealed bilateral coarse calcifications. Biopsy was consistent with a diagnosis of lupus mastitis.

Dystrophic breast calcifications in patients with collagen diseases

We report the mammographic and ultrasonographic findings of characteristic dystrophic breast calcifications in three patients with collagen disease: The diagnoses were scleromyositis, dermatomyositis, and systemic lupus erythematosus. We regard the coarse, bizarre, lacy, and reticular patterns of breast calcifications seen on mammography and located in the subcutaneous fat layer on ultrasonography as characteristic findings for these patients.