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. 2017:37:169-172.
doi: 10.1016/j.ijscr.2017.06.012. Epub 2017 Jun 15.

Immunoglobulin-G4 related mastitis: A case report

Affiliations

Immunoglobulin-G4 related mastitis: A case report

Ee Syn Tan et al. Int J Surg Case Rep. 2017.

Abstract

Introduction: IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literature to date. Organs that are affected with IgG4-related disease (IgG4-RD) all share the same histopathological hallmarks consisting of dense lymphocytic infiltration, storiform fibrosis and obliterative phlebitis.

Presentation of case: This case report highlights a case of IgG4-RM found incidentally in a 52-year-old woman during a routine breast screen and it explores the current literature about IgG4-RM and IgG4-RD.

Discussion: IgG4-RM and IgG4-RD, in general, is a new entity in the field of medicine and its aetiology is not well understood. In the literature, IgG4-RM often presents as a painless palpable breast lump in isolation or with other systemic manifestations. IgG4-RM is considered benign and has excellent prognosis post-conservative treatment with steroid or surgical excision.

Conclusion: IgG4-RM is diagnosed exclusively on histological analysis. It is hard to distinguish IgG4-RD from malignant breast lesions purely on clinical examination and imaging studies. Increasing awareness of this condition among clinicians will assist them in managing patients better. Extensive whole body imaging is not recommended unless symptomatic.

Keywords: Autoimmune; Breast; Case report; Granulomatous disease; Immunoglobulin-G4; Sclerosing mastitis.

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Figures

Fig. 1
Fig. 1
Screening mammogram (a and b). (a) left breast – MLO. (b) left breast – CC. A new small circumscribed opacity is noted in the left breast at approximately 9 o’clock 10 cm from the nipple (arrows). Apart from a small normal appearing lymph node (marked A), no other new lesions were seen. [Reviewer Point 4]. (c) (Ultrasound) – A single targeted B-mode ultrasound image of the left breast with colour doppler assessment demonstrates a small solid avascular hypoechoic nodule with a tiny internal hyerechogenic foci. The lesion did not demonstrate any suspicious features, and correlates with the small circumscribed lesion noted on the mammography.
Fig. 2
Fig. 2
(a) This micrograph is taken at 400× magnification and is stained with haemotoxylin and eosin. It shows a sparsely cellular specimen with aggregates of lymphoid follicles and plasma cells. (b) [Reviewer Point 7]. Immunohistohemical staining for IgG4 demonstrates prominent IgG4-positive plasma cell infiltrates in the specimen. [Reviewer Point 7].

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