Breast carcinoma occurring from chronic granulomatous mastitis

Abstract

Chronic granulomatous mastitis is known as a benign and relatively rare disorder that is often difficult to differentiate from breast carcinoma. We highlight the case of a 34-year-old woman who had recurrent episodes of right breast swelling and abscess for 8 years. These were proven to be chronic granulomatous mastitis by tissue biopsies on 3 different occasions. Her condition improved on similar courses of antibiotics and high-dose prednisolone. However, she subsequently developed progressive loss of vision due to an orbital tumour. She then underwent a craniotomy and left orbital decompression with excision of the tumour, which proved to be a metastatic carcinoma. A trucut biopsy of the right breast was then done and showed features consistent with an infiltrating ductal carcinoma. This case illustrates the possibility that chronic granulomatous mastitis could be a precursor for malignancy and the difficulty in differentiating one from the other. The possible mechanisms of development and the implications for future management are also discussed.

Keywords: breast; carcinoma; disease progression; granulomatous mastitis; surgery.

Figure 1:

Breast tissue showing chronic granulomatous mastitis. (A) Vague granuloma formation (arrow) composed of epithelioid cells at the centre and lymphocytes at the periphery. No central necrosis or multinucleated giant cell is apparent (haematoxylin and eosin staining, 40× magnification). (B) The epithelioid cells (arrow) have abundant eosinophilic cytoplasm (haematoxylin and eosin staining, 400× magnification).

Figure 1:

Breast tissue showing chronic granulomatous mastitis. (A) Vague granuloma formation (arrow) composed of epithelioid cells at the centre and lymphocytes at the periphery. No central necrosis or multinucleated giant cell is apparent (haematoxylin and eosin staining, 40× magnification). (B) The epithelioid cells (arrow) have abundant eosinophilic cytoplasm (haematoxylin and eosin staining, 400× magnification).

Figure 2:

Gadolinium-enhanced T2-weighted magnetic resonance image showing a soft tissue lesion at the left orbital apex involving the intracallicular portion of the left optic nerve.

Figure 3:

Infiltrating ductal carcinoma in breast biopsies. (A) Infiltration of malignant cells arranged in cords (arrow) and groups (arrow head) (haematoxylin and eosin staining, 40× magnification). (B) The groups of malignant cells (arrow head) display hyperchromatic nuclei with moderate amount of cytoplasm (haematoxylin and eosin staining, 400× magnification).

Figure 3:

Infiltrating ductal carcinoma in breast biopsies. (A) Infiltration of malignant cells arranged in cords (arrow) and groups (arrow head) (haematoxylin and eosin staining, 40× magnification). (B) The groups of malignant cells (arrow head) display hyperchromatic nuclei with moderate amount of cytoplasm (haematoxylin and eosin staining, 400× magnification).