Sarcoidosis of The Breasts - When Should It Be Considered? a Case Report

Abstract

Sarcoidosis is a systemic inflammatory disease of unknown aetiology. Given its complex clinical presentation, the disorder frequently causes diagnostic challenges. In most cases, the primary manifestation is in the lungs and mediastinum. Breast involvement as the primary manifestation of sarcoidosis is rare, accounting for less than 1% of cases. The authors present the case of a 44-year-old woman whose disease first manifested as multiple non-specific BIRADS 4 lesions in both breasts, accompanied by axillary lymphadenopathy, detected by ultrasound examination. The lesions were not visible on mammography. The course of the disease was clinically silent, with intermittent remissions, until the complete resolution of focal breast lesions on ultrasound after two years of follow-up. The paper presents an algorithm for the management of multifocal breast pathology with associated lymphadenopathy, which led to the prompt verification of sarcoidosis.

Keywords: breast diseases; granulomas; granulomatous mastitis; sarcoidosis; ultrasonography.

Fig. 1

Ultrasound findings in a 44-year-old female patient with breast sarcoidosis. A–D. Pre-biopsy examination, E–H. Examination performed a year later. B-mode ultrasound revealed a hypoechoic nodule with an irregular margin. Colour Doppler ultrasound showed small blood vessels surrounding the lesion. On shear wave elastography, the lesion appeared soft

Fig. 2

Microscopic examination of lymph node tissue showed an aggregation of epithelial cells with multinucleated giant cells, without signs of necrosis. Hematoxylin and eosin staining (10x magnification)

Fig. 3

Typical features of breast sarcoidosis (5x magnification)

Fig. 4

Axial CT scan showed small perivascular nodules in the middle and lower lobes of the right lung, consistent with sarcoid granulomas