Granuloma after breast conserving surgery-a report of three cases

Abstract

Granulomatous mastitis is a rare breast disease that is categorized as a benign tumor with chronic inflammation. Since the cause of the chronic inflammation is usually unknown, it is sometimes called idiopathic granulomatous mastitis (IGM). Although imaging modalities, such as ultrasound, magnetic resonance imaging and mammography can detect tumors, they are sometimes unable to differentiate between benign and malignant tumors. In such cases, biopsy is needed to make a correct diagnosis. We experienced three cases of IGM after breast conserving surgery in breast cancer patients in whom we needed to rule out recurrence of breast cancer. In our cases, tumorectomy was performed in two cases for pathological diagnosis, since neither biopsy nor cytology was able to reveal a conclusive pathological diagnosis. Our management of these three cases might suggest the appropriate management of granulomatous tumors after breast conserving surgery in breast cancer survivors.

Keywords: Breast cancer; Breast conserving surgery; Granuloma; Ipsilateral recurrence.

Figure 1

Ultrasound of the right breast in case 1 revealed a mass-like lesion 16.6 × 10.0 × 4.9 mm (a), and PET-CT showed that the right breast mass had an SUV max of 2.7 (b).

Figure 2

Ultrasound examination in case 2 revealed a mass 19.4 × 18.8 × 10.7 mm in the left breast (a) and cytodiagnosis did not unclear that it showed local recurrence. (b-1: ×20 magnification, b-2: ×40 magnification).

Figure 3

Case 3 presented with erythematous changes in the skin of the right breast (a). Ultrasound evaluation revealed a mixed pattern mass lesion 26.3 × 34.8 × 25.0 mm in the right breast (b), and PET-CT showed a right breast mass with an SUV max of 4.0 (c).

Figure 4

Pathological evaluation of a vacuum-assisted core needle biopsy specimen in case 3 revealed xanthogranulomatous inflammation with micro-calcification a: ×2.5 magnification, b: ×20 magnification.