Lupus Mastitis: A rare breast cancer differential diagnosis
A 35-year-old woman with Systemic Lupus Erythematosus (SLE) presented to
the emergency department with a painful right breast mass with one month
of progressive growth. On physical examination, the patient had a
swollen hardened breast with a poorly-defined 5cm mass on the upper
outer quadrant and periareolar inflammatory signs (Figure 1) .
Breast ultrasound revealed a lobulated and vascularized mass in the
upper outer quadrant, with liquid areas, suggesting a possible abscess,
but not excluding a malignant lesion. The patient was treated with
NSAIDs and a course of antibiotics, with subsequent revaluation 10 days
later. Due to the apparent progression of the inflammatory signs (Figure
2), the mass was drained and biopsied. Histopathology analysis revealed
a fibroinflammatory process with lobulitis, ductitis and vasculitis
phenomena highly suggestive of breast involvement by SLE –Lupus Mastitis . No signs of malignancy were identified. The
patient was referred to the rheumatology department and the dose of
corticosteroids was increased, resulting in a significant improvement of
the condition (Figure 3 and 4).
In case of a breast lesion suggestive of malignancy, patients with SLE
should be investigated for lupus mastitis. The diagnosis of this
condition is histological and the treatment is directed to the
underlying disease.
ACKNOWLEDGEMENTS
Published with written consent of the patient.