Lupus Mastitis Research Articles

A Rare Case of Concurrent Lupus Mastitis and Sarcoidosis in a 62-Year-Old Female.

Systemic lupus erythematosus (SLE) and sarcoidosis are two of the most well-recognized, chronically diagnosed conditions in the United States, with a plethora of known multisystem manifestations. With regard to breast pathology, lupus mastitis is a relatively uncommon manifestation of SLE, commonly involving both the mammary gland and subcutaneous soft tissues of the breast. Sarcoidosis in the breast is a similarly, exceedingly rare manifestation of this multi-system disorder, classically presenting with non-caseating granulomas. Both present with non-specific mammographic and sonographic features. We present a 62-year-old female with known diagnosis of discoid lupus and Graves' disease who presented initially with an abnormal screening mammogram, ultimately undergoing mammographic work-up and subsequent biopsy demonstrating lupus mastitis, including vasculitis, panniculitis, and fibrosis with chronic inflammation. The patient was also found to have small non-caseating granulomas, some in a perivascular distribution, classically seen in sarcoidosis. Given the rarity of both manifestations, our case explores the coexistence of these autoimmune processes and this atypical presentation.

Lupus mastitis and antiphospholipid syndrome treated with anticoagulation and immunosuppression: a case report

BackgroundSystemic lupus erythematosus is an autoimmune disease that can have cutaneous and systemic manifestations. Lupus panniculitis, also known as lupus mastitis, is a subset of chronic cutaneous lupus erythematosus that involves inflammation of the subcutaneous fat. The pathogenesis of lupus mastitis is not fully understood. Diagnosis involves a combination of skin manifestations, imaging, and pathologic confirmation. Treatment typically includes steroids and antimalarials, with more severe disease requiring additional immunosuppressive medications. This report highlights a case of lupus mastitis treated with rituximab and a possible relationship between this disease process and thrombotic disease.Case presentationA 48-year-old African American female with systemic lupus erythematosus and antiphospholipid syndrome presented with new breast lesion. Mammography revealed calcifications and increased density with coarse trabecular pattern. Breast biopsy showed features of cutaneous lupus and occlusive vasculopathy. The patient was diagnosed with lupus mastitis and treated with anticoagulation, rituximab, mycophenolate mofetil, and quinacrine with resolution of her symptoms.ConclusionThis patient experienced improvement in her breast symptoms with combination therapy including rituximab. There are only two other cases reported in literature of patients with lupus mastitis responding to rituximab, highlighting the possible role of B cell depleting therapy for those who have contraindications to standard treatments for lupus mastitis. While the pathophysiology of lupus mastitis is thought to be immune driven, some literature suggests that associated thrombosis commonly seen may be due to a physiologic overlap similar to antiphospholipid syndrome. The possible relationship between antiphospholipid syndrome and lupus mastitis and the use of antiplatelet and anticoagulation therapy is discussed and may warrant further investigation.

Lupus mastitis: Suspicious breast lesion as a rare presentation of lupus

Lupus mastitis: Suspicious breast lesion as a rare presentation of lupus

Lupus Mastitis in a Young Female Mimicking a Breast Carcinoma; a Rare Entity Through a Case Report and Review of the Literature.

Lupus mastitis (LM) is a rare presentation of lupus panniculitis (LP) that usually affects women of childbearing age and may mimic malignancy. The condition is recurrent and progresses along with the underlying disease. Breast pathology that may be associated with LM includes fat necrosis, calcification, fibrosis, scarring, and breast atrophy. Therefore, LM should be considered in the differential diagnosis of a suspicious breast mass on mammography or ultrasound, particularly if the patient has a background of systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). Traumatic procedures such as surgery or biopsy may worsen the condition and it is advisable to avoid biopsy if the diagnosis can be established through accurate patient history, with identification of typical clinical and radiological features. Thus, awareness of the radiologic and clinical features of LM is essential to avoid unnecessary interventional procedures that carry the potential for disease exacerbation. The authors present here the imaging findings of LM in a 37-year old female with SLE, which presented as bilateral palpable breast lumps.

Lupus mastitis: A rare breast cancer differential diagnosis.

Lupus mastitis is an uncommon SLE breast manifestation. Clinically, it can present itself as a malignant‐like mass. Therefore, a tissue biopsy is warranted to confirm the diagnosis. The treatment of this condition is pharmacological and directed to the underlying disease. The rarity of this entity demands a high degree of suspicion.

Lupus mastitis in men

To analyze the pathophysiological aspects of lupus mastitis (LM), clinical presentation, epidemiology, radiological and histological findings, and treatment, to disseminate it to the academic community and draw attention to this pathology as one of the differential diagnoses in the management of breast lesions in males, especially in the case of breast cancer in men. A literature review was done by searching scientific studies in the PubMed / Medline, Scopus, Scielo, Embase, Web of Science, and Google Scholar databases. Relevant scientifically validated studies related to lupus mastitis in men were selected. The analysis, review and selection of articles carried out in pairs, blindly and separately, based on the reading of the title and abstract, with a third reviewer in case of disagreement. The LM should be suspect in patients known to have lupus erythematosus who present painful breast nodules associated with skin changes. However, LM can be the initial manifestation of lupus and mimic, both clinically and imaging, malignant neoplasms. The histopathological diagnostic criteria are well-established, finding mainly hyaline fat necrosis and lymphoplasmacytic infiltrate. Treatment must be drug-based as invasive procedures can exacerbate the injury. Due to physiological and anatomical aspects, this condition can appear and evolve differently in men. The knowledge of this pathology is necessary to carry out the correct approach since the non-identification of the disease and its erroneous management can lead to complications and irreversible sequelae to the patient.

Lupus mastitis

Lupus mastitis Systemic lupus erythematosus (SLE) infrequently presents itself as lupus panniculitis. In lupus panniculitis the subcutaneous fat tissue is involved in the inflammatory process. Lupus mastitis is again a rare variant of lupus panniculitis, probably caused by an immune-mediated inflammatory process. In literature on the topic we can find 30 cases of lupus mastitis in men and women. Lupus mastitis may present like a breast lesion suspected to be malignant, clinically and radiologically. In the differential diagnosis we consider inflammatory breast cancer, subcutaneous panniculitis-like T-cell lymphoma (SPTL) and diabetes mastopathy. With a medical history of SLE and signs of inflammation of the skin above the lesion however, a diagnosis of lupus mastopathy is more presumable. Medical treatment seems more indicated in lupus mastitis, because delayed healing after surgical procedures is often reported. Even though methylprednisolone and chloroquine give clinical improvement, they need to be repeated often because of a high risk of relapse.

Lupus mastitis with predominant kappa-restricted plasma cell infiltration: report of a rare case

Lupus mastitis (LM) is a rare complication of systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). The clinical presentations of LM may mimic breast malignancy, and biopsy or excision is usually performed. Histologically, LM is featured by lymphoplasmacytic inflammation involving breast ducts, lobules, blood vessels and adipose tissue. Characteristic hyaline fat necrosis can be noted in most cases. Here, we reported a case of LM in an elderly female patient who presented with bilateral breast lesions. Histologically, the breast lesions showed prominent hyaline fat necrosis and predominantly plasmacytic inflammation involving breast ducts, vessels and fat lobules. Fibrinoid necrosis of vessels was also noted. The infiltrated plasma cells were Kappa light chain-restricted, but did not show the immunophenotypes for a plasma cell neoplasm. In addition, the patient developed Kappa-restricted plasma cell myeloma 2 years later. The patient was followed up for 8 years, and her breast lesion did not show recurrence. The patient’s unique clinicopathological presentations indicated a potential correlation between her LM and subsequently developed myeloma. It also indicated that the immunophenotypical characterization of infiltrated plasma cells in LM patients with predominant plasma cell infiltration may be important to rule out potential plasma cell neoplasms.

The evolving imaging features of lupus mastitis.

The evolving imaging features of lupus mastitis.

Interchanging Autoimmunity - Lupus Mastitis Coexisting with Systemic Polyarteritis Nodosa.

Lupus mastitis is an uncommon presentation of lupus erythematosus profundus (LE profundus), characterized by inflammation of the subcutaneous fat. LE profundus occurring as initial manifestation of LE is rare. We report a case where the patient presented with lupus mastitis and years later, she developed disseminated discoid LE (DLE) and polyarteritis nodosa (PAN). PAN and DLE are connective tissue diseases with different etiologies, clinical, immunological, and histopathological features. One connective tissue disease evolving into another is rare, and the reasons remain unexplained. This woman had histopathologically proven DLE and lupus mastitis with a negative antinuclear antibody profile. She satisfied the American College of Rheumatology criteria for PAN.

Lupus: The Great Pretender, Breast Manifestations of SLE

Lupus mastitis is an infrequent sequela of the autoimmune disease Systemic Lupus Erythematosus (SLE) which can be confounding to both clinicians and diagnosticians due to its similar appearance to an infectious or even neoplastic process. This case demonstrates a patient who presented with a painful and edematous breast that was initially concerning for mastitis or underlying abscess on the initial clinical examination. After a trial of antibiotics, the patient’s symptoms minimally approved with subsequent work up using mammogram and ultrasound concerning for a possible malignancy. Ultrasound guided needle and core biopsies eventually led to the diagnosis of lupus mastitis. This report discusses the clinical, radiological and histological presentation of lupus mastitis. This is importation for clinicians so they can have a better understanding of this unique presentation of SLE and can prevent unnecessary invasive procedures which may further increase inflammation involved with lupus mastitis. While SLE has a multitude of clinical presentations this case report demonstrates another unique way that SLE can be encountered.

PReS-FINAL-2286: Mastitis in an adolescent patient with juvenile systemic lupus erythematous

Mastitis is an inflammatory disease of the breast, acute or chronic that occurs primarily in young women and frequently lactating. In 2-3% it may occur in patients with systemic lupus erythematous (SLE). The authors describe in an adolescent with JSLE this rare disease called lupus mastitis, which is a subset of lupus panniculitis limited to the breast.

Serial MR Findings and Comprehensive Review of Bilateral Lupus Mastitis with an Additional Case Report

Lupus Mastitis (LM) is a rare presentation of lupus panniculitis involving the breast. Because it often presents as a tender palpable mass, a workup for malignancy usually ensues. It is well documented that surgery may worsen the condition; therefore, it is important to consider LM in the differential of a palpable breast mass in patients with systemic lupus erythematosus (SLE). Currently, management of LM remains primarily medical. We discuss the multi-disciplinary work-up of LM, and further describe its appearance on serial Magnetic Resonance (MR) exams.

Can Lupus Mastitis be Treated Surgically?

Lupus mastitis is a rare chronic inflammatory reaction of the sub-cutaneous fatty tissue of the breast and may appear in 2-3% of patients with systemic lupus erythematosis. Surgical intervention is not needed for the treatment of lupus mastitis, and if necessary the least invasive procedure should be chosen. In this case, despite the use of hydroxychloroquine and oral steroids, patient with malignancy risk and ongoing complaints went to excision. Surgery appears to be effective in patients with ongoing complaints despite the adequate medical treatment.

Lupus mastitis: a review

Lupus mastitis (LM) is a rare benign inflammatory condition characterized by inflammation of the deep subcutaneous adipose tissues of the breast. It can be seen in patients with a known history of systemic lupus erythematous or discoid lupus or rarely can be the initial presentation of these diseases. Histologically, the most common findings are the presence of a dense lymphoplasmacytic infiltration of lobules and hyaline fat necrosis. Radiologic characteristics of LM can mimic a malignant lesion. However, because histologic features of this lesion have been well defined, correlation with clinical history is important to arrive at an accurate diagnosis and, therefore, deliver appropriate patient management. Herein, we present a review of LM with emphasis on clinicopathologic findings and differential diagnosis.

Report of Lupus Mastitis

INTRODUCTION: Lupus Mastitis is an unusual presentation, about 2% to 3% of lupus erythematosus deep or lupus panniculitis, a rare variant of lupus erythematosus characterized by inflammation of the subcutaneous tissue. REPORT: Woman, 27 years old, referred to the outpatient mastology by bilateral breast pain, more pronounced at right. For four years she has been feeling pain like stabbing, intermittent, without irradiation, compounded with the mobilization of the upper and relief with rest and worsened in the last year. Medical history: no personal history of breast pathologies. Diagnosis of lupus erythematosus two years ago. At 12 years old presented sudden dyspnea with strong intensity, accompanied by widespread muscle pain, episodic, recurrent, with periods of spontaneous remission without regular medical monitoring. At 23 years old, she had a worsening of health and new symptoms such as abdominal pain, joint pain, muscle pain, mammary pain, diarrhea, vomiting, night sweats, nodules in the body, mouth and nose ulcers, leading to hospitalizations. During the hospitalization realized several tests, including: abdominal ultrasound revealed increased echogenicity of the skin, a transesophageal echocardiogram showed pulmonary hypertension, right chamber overload, patent foramen ovale and minimal pericardial effusion as confirmed by cardiac catheterization. Research results for autoimmune diseases. showed: ANA speckled pattern 1/1. 280; + Anti-Ro and anti-Scl 70 +. For investigation of breast tenderness and bilateral thickening, performs breast ultrasound reveals multiple nodules, mainly in the upper quadrants bilaterally, complemented by mammography wich showed coarse calcifications in form of serpent and nodular, dispersed bilaterally. Classified as BIRADS II. Start treatment with hydroxychloroquine, prednisone and diclofenac, have discharged with complete improvement of dyspnea. The following regular treatment with a rheumatologist. The physical examination of the breasts wich showed large-volume breasts, pendulous, with streaks bilateral bulging of the medial upper quadrant of the right breast that exacerbates the dynamic inspection. Palpation: Right breast: an area extremely dense, irregular, painful, in measuring 5x5cm mainly in medial upper quadrant Left breast: diffuse dense areas, especially in the upper outer quadrant.. Regional lymph nodes, no palpable. DISCUSSION: Coarse calcifications showed in the patient s mammogram, are probably due to the final stage of fat necrosis. The histological diagnosis can be difficult because fibrosis and calcification are the main findings. A biopsy may aggravate the situation. Thus it is possible to base the diagnosis on radiological findings and previous diagnosis of lupus. Treatment of Lupus mastitis not different from the treatment of lupus erythematosus, and the glucocorticoid and hydroxychloroquine the main drug.

Lupus Mastitis Without Systemic Disease: Unusual Imaging Findings Including MRI

Lupus Mastitis Without Systemic Disease: Unusual Imaging Findings Including MRI

Lupus Mastitis in Systemic Lupus Erythematosus: A Rare Condition Requiring a Minimally Invasive Diagnostic Approach

Breast involvement is a rare event in SLE patients. The most frequent presentation is lupus panniculitis with skin erythema, tenderness, and parenchymal nodules. However, when breast masses are detected in SLE patients without significant superficial inflammation, it is mandatory to rule out breast carcinoma. Here, we report the case of a 47-year-old woman with an 18-year-long history of SLE, who presented with a suspicious breast mass. Since surgical trauma has been reported to be able to exacerbate breast inflammation in lupus mastitis, an ultrasound-guided minimally invasive Mammotome biopsy was performed to obtain tissue samples for histological and immunohistochemical examinations. Histology was consistent with lupus mastitis. The patient was already on mycophenolate mofetil and hydroxychloroquine. At the latest follow-up visit 6 years later, no progression of the breast lesion was observed.

Mastitis showing bizarre calcifications in a systemic lupus erythematosus patient

We report a case of mastitis showing bizarre calcifications in a systemic lupus erythematosus (SLE) patient. A 34-year-old woman had suffered from SLE for 12 years. Initial mammogram showed global asymmetry and extensive linear branching casting calcifications with ductal distribution in the left breast; the image had the appearance of a ductogram. Sonogram showed multiple calcifications without formation of a mass in the left breast. At 5-year follow-up, mammogram revealed large, coarsely conglomerated calcifications in the left breast. The clinical and radiological diagnosis of lupus mastitis was made.

Lupus Mastitis

Lupus mastitis is an uncommon presentation of lupus erythematosus profundus or lupus panniculitis, a rare variant of lupus erythematosus characterized by inflammation of the subcutaneous fat. Lupus mastitis can present as single or multiple subcutaneous or deep breast masses, often clinically mimicking malignancy. Although lupus mastitis is rare, with less than 25 cases reported, the histologic features are distinct. Awareness of the entity and familiarity with the histologic features allow for accurate diagnosis and appropriate patient management. It most commonly affects women with a mean age at diagnosis of 40 years and an age range of 18 to 70 years. Typical histologic findings in lupus mastitis include a lymphocytic lobular panniculitis with plasma cells and hyaline fat necrosis. The lymphocytic infiltrate can be nodular, diffuse, periductal, and/or perilobular and germinal centers can frequently be identified. Lymphocytic vasculitis is also common. Immunohistochemistry shows a mixed T and B-cell population, with predominantly CD3+ CD4+ T cells intermixed with CD20-positive B cells and polyclonal plasma cells. Most commonly, lupus mastitis is seen in patients with a previous diagnosis of systemic or discoid lupus; however, it can also be the initial presentation of lupus in some patients. We report on 2 cases of lupus mastitis where the clinical impression was to rule out malignancy and review the literature to highlight the key clinicopathologic features.