Granulomatous mastitis (GM) is a chronic inflammatory breast disease. This pathology was first described by Kersler and Wolloch in 1972 [1]. It is an uncommon cause of a breast mass [2-5]. Awareness of this entity is crucial, because it can clinically and radiologically mimic breast carcinoma, fibroadenoma or fibrocystic changes [3]. It has several appearances radiologically also; biopsy still remains the only way for final diagnoses. Here we present a woman with a breast mass. Our aim is to show ultrasound, mammography and magnetic resonance imaging findings of GM by reviewing the literature.
A 50-year-old woman was presented to the department of general surgery with a lump in her right breast. She didn’t have pain but she felt like her breast had swollen. She had 2 children and she didn’t have a family history of breast carcinoma. On her physical examination there was the skin was thick due to the edema in the lower outer quadrant of the right breast. Here was also a hard mass in the same region with obscured margins. On her mammography (Selenia, HOLOGIC) there was an asymmetrically increased parenchymal density in the lower outer quadrant of the right breast (Figures 1(a) and (b)). Then ultrasound (US) imaging was performed with a high solution scanner (Siemens S2000, Germany) with 9.4 MHz and 18 MHz linear transducers (
GM is a rare inflammatory disease of the breast to represent between 0.025% and 3% [2-8]. It is characterized by granulomas and abscess formation [2-4]. Though it can be seen bilaterally, it is mostly unilaterally occurring in young woman < 50 years of age, who usually present during lactation or within 6 years of pregnancy [
useful in a dense parenchyma. Ultrasound will show heterogeneous breast mass with ill defined margins. The Doppler ultrasound examination is shown to reveal increased vascularity of the lesions and the surrounding tissue [2-5]. Ultrasound may also show abscess formation [2,3]. On MR, the most frequent finding is local or diffuse signal intensity changes that are hypointensity on T1W images and hyperintensity on T2W images without a significant mass effect. A nodular lesion may also be seen. On dynamic contrast imaging, mass-like enhancement, ring-like enhancement, and nodular enhancement may be seen [3,4]. In our patient, we saw both mass-like and ring-like enhancements. The time-intensity curves differ from lesion to lesion [3,4]. In our patient there was Type 2 enhancement pattern.
Finally, GM is a rare breast pathology that should be kept in mind in the differential diagnosis of breast masses. It can easily be misdiagnosed as inflammatory breast carcinoma due to both clinical and radiological findings. As it has a number of appearances of ultrasound, mammography and MR images, biopsy still remains the only method for definitive diagnosis.