RAMB - Julho 2016

15 / 99

Imaging features of idiopathic granulomatous mastitis – Case report
Rev Assoc Med B ras 2016; 62(4):303-306 303
IMAGE IN MEDICINE
Imaging features of idiopathic granulomatous mastitis – Case report
Luciana Graziano1, Almir Galvão Vieira Bitencourt2*, Caroline Baptista da Silva3, Camila Souza Guatelli1, Juliana Alves Souza1,
Miriam Rosalina Brites Poli 1, Elvira Ferreira Marques1
1MD – Physician, Member of the Department of Imaging, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
2PhD – Physician, Member of the Department of Imaging, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
3MD – Resident Physician of the Department of Imaging, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
Summary
Study conducted at A.C. Camargo Cancer
Center, São Paulo, SP, Brazil
Article received: 7/4/2015
Accepted for publication: 7/6/2015
*Correspondence:
Address: Rua Prof. Antonio Prudente,
211, Liberdade
São Paulo, SP – Brazil
Postal code: 09015-010
Idiopathic granulomatous mastitis is a rare disorder of unknown etiology. This
disease occurs mostly in young women and often after the lactation period. Wom-
en usually present with a fixed, painful mass, sparing the retroareolar region, as-
sociated with skin thickening and possible ulceration that mimics carcinoma.
Nipple discharge can be present and bilateral involvement may occur in up to
25% of cases. In this case report, we present a typical case of histologically con-
firmed idiopathic granulomatous mastitis, highlighting the imaging findings,
including magnetic resonance imaging (MRI), which may favor this diagnosis
and enable better clinical management of these patients.
Keywords: breast, mastitis, granulomatous mastitis, magnetic resonance imaging.
Introduction
Idiopathic granulomatous mastitis, also known as gran-
ulomatous lobular mastitis, is a rare disease of unknown
etiology. This disease was first described by Kessler and
Wollocb in 1972, and its diagnosis is made by ruling out
other known causes of granulomatous disease. It occurs
mostly in young women and often after the lactation
period.1-3
The primary cause of the disease is speculated to be
an injury to the ductal epithelium, leading to extravasa-
tion of glandular secretions into the lobe tissue, creating
inflammatory lesions. An autoimmune process has been
suggested in patients after pregnancy, with the disease
generally occurring within 6 years after pregnancy.1,3
Clinically, these women present with a hardened,
fixed and painful mass, sparing the retroareolar region,
with 0.5 cm to 15 cm in size, associated with skin thick-
ening and possible ulceration that mimics carcinoma.
Nipple discharge can be present and bilateral involve-
ment may occur in up to 25% of cases. Secondary axil-
lary lymphadenopathy may occur in up to 40-60% of
cases.4,5
The aim of this study is to report a case of idiopath-
ic granulomatous mastitis, highlighting the image as-
pects, especially magnetic resonance imaging (MRI), and
conduct a literature review.
Case report
Female patient, 38 years old, G2P2A0, last delivery two
years earlier, admitted to an oncological reference center
with complaints of pain and volume increase of the left
breast for 30 days associated with fever. She reported use
of hot compresses, anti-inflammatory drugs and oral an-
tibiotics without clinical improvement. She reported hav-
ing thalassemia minor. She denies any family history of
breast or ovary cancer. On physical examination, the
breasts showed areas of asymmetric bulging with areas
that were hardened, mobile and painful on palpation, and
discreet erythema on the skin in the upper-lateral quad-
rant of the left breast.
Mammogram revealed heterogeneously dense breasts
and focal asymmetry in upper-outer quadrant of the left
breast (Figure 1). Ultrasonography revealed heteroge-
neous, predominantly hypoechoic areas, with indistinct
margins and increased echogenicity of the adjacent tis-
sues in the upper-outer quadrant of the left breast, with
internal vascularization on color Doppler (Figure 2). Ax-
illary and intramammary lymph nodes were found, with
unusual appearance, rounded and hypoechoic with pre-
served dimensions and reactive appearance.
Breast MRI showed, on the left, an area of non-mass-
like enhancement, heterogeneous and poorly defined,
occupying the lateral quadrants, with low signal inten-