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A Rare Case of Systemic Sarcoidosis Affecting the Breast FREE TO VIEW

Alexia Noutsios, DO; Josebelo Chong, MD; Daniel Shade, MD
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West Penn Allegheny Health System, Pittsburgh, PA

Chest. 2013;144(4_MeetingAbstracts):446A. doi:10.1378/chest.1703961
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SESSION TITLE: Interstitial Lung Disease Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoidosis is a chronic multi-system granulomatous disease of unknown etiology. In descending order of frequency, it affects the lungs, lymph nodes, spleen, liver, skin, eyes, muscles, bones, central nervous system and salivary glands. Although breast involvement is rare, it is being reported with increasing frequency. We are reporting the case of a patient with known systemic sarcoidosis who developed a suspicious breast mass.

CASE PRESENTATION: A 51 year-old African American female with systemic sarcoidosis presented with right-sided breast pain. She had no previous history of breast disease and had a previously normal mammogram. A repeat mammogram showed a new 3x6 mm spiculated mass with associated axillary lymphadenopathy. A core biopsy was performed; histologic specimens demonstrated multiple non-caseating granulomas consistent with a clinical diagnosis of sarcoidosis. No further intervention was recommended.

DISCUSSION: Sarcoidosis of the breast occurs in less than 1% of cases with systemic disease. It is most often found incidentally as a breast mass on physical examination or routine mammography. Unfortunately, it cannot be definitively distinguished from malignancy by radiologic studies. On mammography, it may have spiculated borders, with axillary lymphadenopathy suggestive of metastases. Affected lymph nodes and other organs can also exhibit intense uptake on F-2-deoxy-2-fluoro-d-glucose positron emission tomography (FDG-PET). Our review of the published literature yielded 58 cases of breast sarcoidosis prior to our patient. We noted that the detection of sarcoidosis of the breast has increased significantly since the initial studies on breast cancer screening that were introduced in the 1980s, with 48 of these cases being reported in the last three decades alone. With widespread adoption of breast cancer screening and improvement in radiologic techniques, we expect the incidence to increase. Fortunately, there is no increased risk of breast cancer with sarcoid lesions.

CONCLUSIONS: Sarcoidosis of the breast is a very rare entity that can easily mimic malignancy. Clinicians need to be aware of its existence and consider it in the differential diagnosis of breast lesions. The increasing incidence of the disease likely correlates more with increased screening for breast cancer, rather than an increased prevalence of the disease itself.

Reference #1: Ojeda, et al. Sarcoidosis of the breast: implications for the general surgeon. American Surgeon 2000;66(12):1144-48.

Reference #2: Mona, et al. Quiz case. Breast sarcoidosis presenting as a metastatic breast cancer. European Journal of Radiology 2005;54(1):2-5.

Reference #3: Lower, et al. Breast disease in sarcoidosis. Sarcoidosis Vasculitis and Diffuse Lung Diseases 2001;18(3):301-6.

DISCLOSURE: The following authors have nothing to disclose: Alexia Noutsios, Josebelo Chong, Daniel Shade

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