IS Case 138: Breast Sarcoid
Imaging Sciences URMC 2008
Publication Date: 2009-05-21
Patient is a 39-year-old female who presents with cough for approximately two weeks duration and a palpable mass in her left breast. Skin lesions were found by her OB/GYN who noticed some thickening in her breasts. These lesions were subsequently biopsied after an ultrasound. The patient denied exposure to anyone with tuberculosis and is otherwise healthy with no specific complaints.
Ultrasound findings of a palpable mass in the left breast demonstrated an irregular hypoechoic mass measuring approximately 2.2 x 1.4 cm transverse diameter and 2.4 x 0.7 cm longitudinal diameter. An uncomplicated ultrasound core biopsy was performed which revealed fibroglandular breast tissue with non-necrotizing granulomatous inflammation, suggestive of sarcoidosis. No malignancy was identified.
Sarcoidosis is a chronic granulomatous multisystemic disease of unknown etiology with a diverse clinical spectrum of symptoms. Despite this, sarcoid rarely affects the breast. Breast sarcoid was first described in 1921 by Stransberg. The earliest documented cases affected the breast and the lymph nodes. No clinical or radiological findings can distinguish it from a breast carcinoma. The most common early manifestation is a palpable mass. Mammographic manifestations may consist of a spiculated mass. Ultrasound findings are usually inconclusive, unable to distinguish breast granuloma from carcinoma. These include an irregular hypoechoic mass or masses. A CT scan may show breast, mediastinal and pulmonary involvement found in sarcoidosis. However, these anomalies may mimic metastatic breast cancer when no previous history of sarcoidosis is known. MRI subtraction images may reveal a solitary signal intensive inhomogeneous tumor with irregular contours, fast contrast enhancement, and an early "washout" phenomenon often observed in carcinomas or in inflammatory lesions of the breast. Although fine needle aspiration may contribute to the correct diagnosis, it is not sufficient to establish the definitive diagnosis since a coexistent carcinomatous focus can be overlooked by an unrepresentative sampling. Therefore, large core needle biopsy is recommended for the diagnosis and excisional biopsy may be limited to cases where diagnosis remains doubtful.
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