DOI: 10.1148/rg.252045077
Radiologic Evaluation of Uncommon Inflammatory and Reactive Breast Disorders1
Josep M. Sabaté, MD,
Montse Clotet, MD,
Antonio Gómez, MD,
Pilar De las Heras, MD,
Sofia Torrubia, MD and
Teresa Salinas, MD
1 From the Unit of Breast Imaging, Department of Diagnostic Radiology, Hospital de Sant Pau, Avda Sant Antoni Maria Claret 167, Barcelona 08025, Spain (J.M.S., M.C., A.G., S.T., T.S.); and the Departments of Breast Imaging (J.M.S., A.G.) and Breast Pathology (P.D.l.H.), CEDIMMA, Barcelona, Spain. Presented as an education exhibit at the 2003 RSNA Scientific Assembly. Received April 19, 2004; revision requested June 16 and received July 30; accepted August 5. All authors have no financial relationships to disclose.
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Figure 1a. Churg-Strauss syndrome in a 32-year-old woman with clinically suspected bilateral mastitis. The diagnosis of Churg-Strauss syndrome had been established 19 years earlier on the basis of asthma, fever, purpuric cutaneous disease, tachycardia, lung disease, blood eosinophilia, and findings at transbronchial biopsy. (a) Right mediolateral mammogram shows a diffuse increase in parenchymal density. (b) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) reveals an inflammation-rich eosinophilic process (arrows) with extensive ductal cellularity (*). (c) Right mediolateral mammogram obtained after corticosteroid therapy demonstrates almost complete resolution of breast involvement.
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Figure 1b. Churg-Strauss syndrome in a 32-year-old woman with clinically suspected bilateral mastitis. The diagnosis of Churg-Strauss syndrome had been established 19 years earlier on the basis of asthma, fever, purpuric cutaneous disease, tachycardia, lung disease, blood eosinophilia, and findings at transbronchial biopsy. (a) Right mediolateral mammogram shows a diffuse increase in parenchymal density. (b) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) reveals an inflammation-rich eosinophilic process (arrows) with extensive ductal cellularity (*). (c) Right mediolateral mammogram obtained after corticosteroid therapy demonstrates almost complete resolution of breast involvement.
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Figure 1c. Churg-Strauss syndrome in a 32-year-old woman with clinically suspected bilateral mastitis. The diagnosis of Churg-Strauss syndrome had been established 19 years earlier on the basis of asthma, fever, purpuric cutaneous disease, tachycardia, lung disease, blood eosinophilia, and findings at transbronchial biopsy. (a) Right mediolateral mammogram shows a diffuse increase in parenchymal density. (b) Photomicrograph (original magnification, x400; hematoxylin-eosin [H-E] stain) reveals an inflammation-rich eosinophilic process (arrows) with extensive ductal cellularity (*). (c) Right mediolateral mammogram obtained after corticosteroid therapy demonstrates almost complete resolution of breast involvement.
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Figure 2a. Amyloidosis of the breast. (a) Mammogram shows an ill-defined lobular mass with microcalcifications and large calcifications. The patient underwent needle localization and surgical excision. (b) Photomicrograph (original magnification, x10; H-E stain) shows diffuse deposits of dense amorphous material (*) surrounding ductal structures (arrows).
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Figure 2b. Amyloidosis of the breast. (a) Mammogram shows an ill-defined lobular mass with microcalcifications and large calcifications. The patient underwent needle localization and surgical excision. (b) Photomicrograph (original magnification, x10; H-E stain) shows diffuse deposits of dense amorphous material (*) surrounding ductal structures (arrows).
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Figure 3a. Wegener granulomatosis in a post-menopausal woman with well-known systemic disease. The diagnosis was confirmed at subsequent core-needle biopsy. (a) Mammogram shows a suspicious focal asymmetric density (arrowheads). (b) Ultrasonographic (US) image demonstrates an irregular hypoechoic mass. (c) Photomicrograph (original magnification, x400; H-E stain) reveals a severe inflammatory reaction with numerous eosinophils and a prominent granulomatous component.
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Figure 3b. Wegener granulomatosis in a post-menopausal woman with well-known systemic disease. The diagnosis was confirmed at subsequent core-needle biopsy. (a) Mammogram shows a suspicious focal asymmetric density (arrowheads). (b) Ultrasonographic (US) image demonstrates an irregular hypoechoic mass. (c) Photomicrograph (original magnification, x400; H-E stain) reveals a severe inflammatory reaction with numerous eosinophils and a prominent granulomatous component.
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Figure 3c. Wegener granulomatosis in a post-menopausal woman with well-known systemic disease. The diagnosis was confirmed at subsequent core-needle biopsy. (a) Mammogram shows a suspicious focal asymmetric density (arrowheads). (b) Ultrasonographic (US) image demonstrates an irregular hypoechoic mass. (c) Photomicrograph (original magnification, x400; H-E stain) reveals a severe inflammatory reaction with numerous eosinophils and a prominent granulomatous component.
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Figure 4a. Sarcoidosis in a 47-year-old woman who presented with a palpable mass. Systemic disease had been diagnosed 5 years earlier. (a) Mammogram of the right breast shows a round mass with well-circumscribed margins in the upper outer quadrant. (b) Photomicrograph (original magnification, x600; H-E stain) shows nonnecrotizing granulomatous inflammation involving a lobule.
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Figure 4b. Sarcoidosis in a 47-year-old woman who presented with a palpable mass. Systemic disease had been diagnosed 5 years earlier. (a) Mammogram of the right breast shows a round mass with well-circumscribed margins in the upper outer quadrant. (b) Photomicrograph (original magnification, x600; H-E stain) shows nonnecrotizing granulomatous inflammation involving a lobule.
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Figure 5a. Diabetic mastopathy in a 26-year-old woman with long-standing insulin-dependent type 1 diabetes mellitus who presented with a palpable mass. (a) Craniocaudal mammogram of the left breast shows subtle foci of asymmetric density in the outer quadrant at the location of the palpable mass (arrows). (b) US image reveals an irregular hypoechoic mass with ill-defined margins and discrete acoustic shadowing. (c) Photomicrographs (original magnification, x400 [left] and x200 [right]; H-E stain) reveal extensive collagenous stromal fibrosis (*) accompanied by the characteristic perivascular (left) and periductal (right) lymphocytic inflammatory infiltration.
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Figure 5b. Diabetic mastopathy in a 26-year-old woman with long-standing insulin-dependent type 1 diabetes mellitus who presented with a palpable mass. (a) Craniocaudal mammogram of the left breast shows subtle foci of asymmetric density in the outer quadrant at the location of the palpable mass (arrows). (b) US image reveals an irregular hypoechoic mass with ill-defined margins and discrete acoustic shadowing. (c) Photomicrographs (original magnification, x400 [left] and x200 [right]; H-E stain) reveal extensive collagenous stromal fibrosis (*) accompanied by the characteristic perivascular (left) and periductal (right) lymphocytic inflammatory infiltration.
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Figure 5c. Diabetic mastopathy in a 26-year-old woman with long-standing insulin-dependent type 1 diabetes mellitus who presented with a palpable mass. (a) Craniocaudal mammogram of the left breast shows subtle foci of asymmetric density in the outer quadrant at the location of the palpable mass (arrows). (b) US image reveals an irregular hypoechoic mass with ill-defined margins and discrete acoustic shadowing. (c) Photomicrographs (original magnification, x400 [left] and x200 [right]; H-E stain) reveal extensive collagenous stromal fibrosis (*) accompanied by the characteristic perivascular (left) and periductal (right) lymphocytic inflammatory infiltration.
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Figure 6a. Necrobiotic xanthogranulomatosis diagnosed with screening mammography in a 68-year-old woman. (a) Bilateral mammograms show multiple ill-defined asymmetric densities involving both breasts (arrows). (b) Bilateral US images demonstrate multiple solid hypoechoic masses with a teardrop or wavelike configuration. (c) Photomicrographs (original magnification, x400 [left, upper right] and x200 [lower right]; H-E stain) show an extensive area of central necrosis (*) surrounded by an inflammatory process with xanthic cells (arrows) and giant Touton cells (arrowhead).
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Figure 6b. Necrobiotic xanthogranulomatosis diagnosed with screening mammography in a 68-year-old woman. (a) Bilateral mammograms show multiple ill-defined asymmetric densities involving both breasts (arrows). (b) Bilateral US images demonstrate multiple solid hypoechoic masses with a teardrop or wavelike configuration. (c) Photomicrographs (original magnification, x400 [left, upper right] and x200 [lower right]; H-E stain) show an extensive area of central necrosis (*) surrounded by an inflammatory process with xanthic cells (arrows) and giant Touton cells (arrowhead).
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Figure 6c. Necrobiotic xanthogranulomatosis diagnosed with screening mammography in a 68-year-old woman. (a) Bilateral mammograms show multiple ill-defined asymmetric densities involving both breasts (arrows). (b) Bilateral US images demonstrate multiple solid hypoechoic masses with a teardrop or wavelike configuration. (c) Photomicrographs (original magnification, x400 [left, upper right] and x200 [lower right]; H-E stain) show an extensive area of central necrosis (*) surrounded by an inflammatory process with xanthic cells (arrows) and giant Touton cells (arrowhead).
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Figure 7a. Granulomatous mastitis in a 35-year-old woman 2 years after pregnancy. (a) Mammogram of the left breast shows a subtle asymmetric density in the upper outer quadrant at the location of the palpable mass (arrows). (b) US image reveals a heterogeneously hypoechoic tubular mass with ill-defined margins surrounded by hyperechoic boundaries. (c) Photomicrograph (original magnification, x200; H-E stain) shows lobular lymphocytic inflammatory infiltrate with abundant multinucleate histiocytes centrally.
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Figure 7b. Granulomatous mastitis in a 35-year-old woman 2 years after pregnancy. (a) Mammogram of the left breast shows a subtle asymmetric density in the upper outer quadrant at the location of the palpable mass (arrows). (b) US image reveals a heterogeneously hypoechoic tubular mass with ill-defined margins surrounded by hyperechoic boundaries. (c) Photomicrograph (original magnification, x200; H-E stain) shows lobular lymphocytic inflammatory infiltrate with abundant multinucleate histiocytes centrally.
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Figure 7c. Granulomatous mastitis in a 35-year-old woman 2 years after pregnancy. (a) Mammogram of the left breast shows a subtle asymmetric density in the upper outer quadrant at the location of the palpable mass (arrows). (b) US image reveals a heterogeneously hypoechoic tubular mass with ill-defined margins surrounded by hyperechoic boundaries. (c) Photomicrograph (original magnification, x200; H-E stain) shows lobular lymphocytic inflammatory infiltrate with abundant multinucleate histiocytes centrally.
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Figure 8a. M tuberculosis of the breast (nodular type) in a 45-year-old woman with a previous history of pulmonary tuberculosis. (a) Mammogram of the left breast shows a lobular mass with indistinct margins (although the mass is partially well defined) in the inner quadrant. The patient underwent surgical biopsy. (b) Photomicrograph (original magnification, x200; H-E stain) shows extensive granulomatous inflammation with epithelioid and Langhans giant cells. Foci of necrosis are seen in one of these granulomas (*).
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Figure 8b. M tuberculosis of the breast (nodular type) in a 45-year-old woman with a previous history of pulmonary tuberculosis. (a) Mammogram of the left breast shows a lobular mass with indistinct margins (although the mass is partially well defined) in the inner quadrant. The patient underwent surgical biopsy. (b) Photomicrograph (original magnification, x200; H-E stain) shows extensive granulomatous inflammation with epithelioid and Langhans giant cells. Foci of necrosis are seen in one of these granulomas (*).
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Figure 9a. M tuberculosis of the breast (diffuse type) in a 47-year-old woman with a 9-year history of systemic tuberculous disease. (a) Mammogram shows a diffuse lymphatic pattern, with thickening of the Cooper ligaments and superficial fascia. (b) Axillary mammogram demonstrates calcified nodes, a finding that is highly suggestive of tuberculosis in the appropriate clinical setting (as in this case).
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Figure 9b. M tuberculosis of the breast (diffuse type) in a 47-year-old woman with a 9-year history of systemic tuberculous disease. (a) Mammogram shows a diffuse lymphatic pattern, with thickening of the Cooper ligaments and superficial fascia. (b) Axillary mammogram demonstrates calcified nodes, a finding that is highly suggestive of tuberculosis in the appropriate clinical setting (as in this case).
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Figure 10. M tuberculosis of the breast (sclerosing type) in a 64-year-old woman with a previous history of pulmonary tuberculosis. The patient presented with a palpable, painful mass, with marked glandular and cutaneous retraction. Mammogram shows a central asymmetric mass with architectural distortion and secondary nipple and cutaneous retraction.
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Figure 11. Mammary and chest wall tuberculosis and breast carcinoma in a 64-year-old woman. Mammogram of the left breast reveals a mass involving the posterior region of the breast secondary to chest wall tuberculosis. FNA cytologic analysis was performed (arrow indicates needle) and helped confirm that the mass was a result of chest wall tuberculosis. In addition, a small focus of architectural distortion was found in the outer quadrant (circle) that corresponded to an invasive ductal carcinoma. Square outlines a magnified view of the area of architectural distortion.
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Figure 12a. Mondor disease in a 35-year-old woman who presented with the characteristic clinical finding of a palpable, painful cordlike structure on the lateral aspect of the breast. (a) Mammogram of the left breast shows a superficial linear density in the outer quadrants (arrows) corresponding to the cordlike area seen at clinical examination. (b) US image reveals an echogenic tubular structure corresponding to the thrombophlebitic vein.
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Figure 12b. Mondor disease in a 35-year-old woman who presented with the characteristic clinical finding of a palpable, painful cordlike structure on the lateral aspect of the breast. (a) Mammogram of the left breast shows a superficial linear density in the outer quadrants (arrows) corresponding to the cordlike area seen at clinical examination. (b) US image reveals an echogenic tubular structure corresponding to the thrombophlebitic vein.
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Copyright © 2005 by the Radiological Society of North America.
