Advertisement

Systemic vasculitis involving the breast: a case report and literature review

  • Jiaqi Ren
  • Jianying Liu
  • Jing Su
  • Jingfeng Zhang
  • Jinxia ZhaoEmail author
Case Based Review
  • 237 Downloads

Abstract

Systemic vasculitis involving the breast is a rare clinical condition and may mimic breast cancer or mastitis clinically or radiographically. Here, we report a case of polyarteritis nodosa (PAN) with breast involvement and perform a literature review of published cases of systemic vasculitis affecting the breast to better understand this disorder. We report a case of PAN affecting the right breast in a young woman. A retrospective review was performed by searching Medline, Embase, Web of Science, the Cochrane Library, and Scopus for cases of systemic vasculitis involving the breast written in English up to June 1st, 2018. A 27-year-old woman presented with a painful mass in the right breast was diagnosed as PAN by the biopsy. She was treated with prednisone and methotrexate for 6 months, at which time her condition had stabilized and inflammatory markers had normalized. A total of 66 cases were identified, with granulomatosis with polyangiitis (GPA), giant cell arteritis (GCA), and PAN as the main types. The typical manifestation was mass (79.2%, 53/67) in the breast, and all diagnoses were made by the pathology of the breast biopsy. Glucocorticoid and immunosuppressant were the main therapies, and 74.6% (50/67) patients achieved remission during follow-up. Our case and a literature review of 66 cases of systemic vasculitis involving the breast reveal the importance of tissue biopsy to obtain a definitive diagnosis, because the vasculitis subtype strongly influences prognosis.

Keywords

Systemic vasculitis Breast 

Notes

Acknowledgements

We thank Anne M. O’Rourke, PhD, from Liwen Bianji, Edanz Group China (http://www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Author contributions

JR has finished the search of the literatures, analysis of the data, and the writing of the whole manuscript. JL and JS are pathologists who made the diagnosis of the biopsy of the patient’ breast and skin tissues. JZ is the physician who treated this patient and made the search of the literatures. JZ is the corresponding author of the manuscript who guided the writing and made the corrections of the whole paper. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Funding

None.

Compliance with ethical standards

Conflict of interest

Jiaqi Ren, Jianying Liu, Jing Su, Jingfeng Zhang, and Jinxia Zhao declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All authors fulfilled the ICMJE authorship criteria.

Informed consent

Written informed consent was obtained from the patient prior to submission of this article for consideration as a case-based review.

References

  1. 1.
    Firestein GS, Kelley WN (2013) Kelley’s textbook of rheumatology, 9th edn. Elsevier/Saunders, PhiladelphiaGoogle Scholar
  2. 2.
    Lluch J, Montserrat Perez-Tapia L, Taco-Sanchez MDR, Narvaez J (2018) Breast involvement in granulomatosis with polyangiitis. Joint Bone Spine.  https://doi.org/10.1016/j.jbspin.2018.05.004 Google Scholar
  3. 3.
    Tabbarah A, Voltaggio L (2017) Giant cell arteritis of the breast. Arch Pathol Lab Med 141(9):1283–1287.  https://doi.org/10.5858/arpa.2016-0285-RS CrossRefGoogle Scholar
  4. 4.
    Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31(11):1409–1417.  https://doi.org/10.1007/s00296-011-1999-3 CrossRefGoogle Scholar
  5. 5.
    Lee MXW, Teng GG, Raju GC, Lim AYN (2015) Catastrophic subarachnoid hemorrhage in eosinophilic granulomatosis with polyangiitis without asthma. Int J Rheum Dis 20(12):2127–2131.  https://doi.org/10.1111/1756-185x.12594 CrossRefGoogle Scholar
  6. 6.
    Visentin MS, Salmaso R, Modesti V, Ometto F, Ruffatti A, Punzi L, Doria A (2012) Parotid, breast, and fascial involvement in a patient who fulfilled the ACR criteria for Churg–Strauss syndrome. Scand J Rheumatol 41(4):319–321.  https://doi.org/10.3109/03009742.2012.672593 CrossRefGoogle Scholar
  7. 7.
    Villalba-Nuno V, Sabate JM, Gomez A, Vidaller A, Catala I, Escobedo A, Torrubia S (2002) Churg–Strauss syndrome involving the breast: a rare cause of eosinophilic mastitis. Eur Radiol 12(3):646–649.  https://doi.org/10.1007/s003300100949 CrossRefGoogle Scholar
  8. 8.
    Soleto MJ, Marcos L (2002) Behcet’s disease involving the breast. Eur Radiol 12(Suppl 3):S98–S100.  https://doi.org/10.1007/s00330-002-1420-4 Google Scholar
  9. 9.
    Bergant AM, Widschwendter M, Sepp N (2000) Bilateral nipple ulcers in a breastfeeding woman: a manifestation of Behcet’s disease? BJOG 107(10):1320–1322CrossRefGoogle Scholar
  10. 10.
    Dündar SV, Sivri B, Gököz A (1988) Vasculitis of breast in Behçet’s disease—a case report. Angiology 39(10):921CrossRefGoogle Scholar
  11. 11.
    Devinck M, Vander Cruyssen B, Lambein K, De Keyser F, Praet M, Brusselle G (2011) Microscopic polyangiitis involving the breast. Acta Clin Belg 66(2):139–141.  https://doi.org/10.2143/ACB.66.2.2062535 Google Scholar
  12. 12.
    Iyoda M, Ito J, Nagai H, Sato K, Kuroki A, Shibata T, Kitazawa K, Sugisaki T (2005) Microscopic polyangiitis after silicone breast implantation. Clin Exp Nephrol 9(3):252–254.  https://doi.org/10.1007/s10157-005-0366-7 CrossRefGoogle Scholar
  13. 13.
    Khalil HH, Marsden J, Akbar N, Gordon P, Roberts J, Schulte KM (2009) Polyarteritis nodosa of the breast: presentation and management. Int J Surg 7(5):446–450.  https://doi.org/10.1016/j.ijsu.2009.06.005 CrossRefGoogle Scholar
  14. 14.
    Ng WF, Chow LT, Lam PW (1993) Localized polyarteritis nodosa of breast—report of two cases and a review of the literature. Histopathology 23(6):535–539CrossRefGoogle Scholar
  15. 15.
    Dhaon P, Bansal N, Das SK, Wakhlu A, Tandon V (2013) Cutaneous polyarteritis nodosa presenting with digital gangrene and breast ulcer. Int J Rheum Dis 16(6):774–776.  https://doi.org/10.1111/1756-185X.12187 CrossRefGoogle Scholar
  16. 16.
    Orbo A, Bostad L (1989) Vasculitis of the breast. Case report and literature review. APMIS 97(11):1003–1006CrossRefGoogle Scholar
  17. 17.
    Kadotani Y, Enoki Y, Itoi N, Kojima F, Kato G, Lee CJ (2010) Giant cell arteritis of the breast: a case report with a review of literatures. Breast Cancer 17(3):225–232.  https://doi.org/10.1007/s12282-009-0120-1 CrossRefGoogle Scholar
  18. 18.
    Levy A, Weinberger A, Mor C, Pinkhas J (1986) Localized polyarteritis nodosa: cases involving the lower extremities and the breast. Rheumatol Int 6(1):43–44CrossRefGoogle Scholar
  19. 19.
    Jordan JM, Rowe WT, Allen NB (1987) Wegener’s granulomatosis involving the breast: report of three cases and review of the literature. Am J Med 83(1):159–164.  https://doi.org/10.1016/0002-9343(87)90513-4 CrossRefGoogle Scholar
  20. 20.
    Neralic-Meniga I, Ivanovi-Herceg Z, Mazuranic I, Puljic I, Zekan M, Gorecan M, Kos M (2006) Wegener’s granulomatosis of the breast. Wien Klin Wochenschr 118(3–4):120–123.  https://doi.org/10.1007/s00508-006-0536-y CrossRefGoogle Scholar
  21. 21.
    Stappaerts I, Colpaert C, Verbraecken J, Van Marck E, Vermeire P (1999) Granulomatous mastitis as presenting sign of Wegener’s granulomatosis. Acta Clin Belg 54(4):207–210. doi: https://doi.org/10.1080/17843286.1999.11754233 CrossRefGoogle Scholar
  22. 22.
    Waugh TR (1950) Bilateral mammary arteritis; report of a case. Am J Pathol 26(5):851–861Google Scholar
  23. 23.
    Griffiths A, Patel A, Roth MZ (2017) Polyarteritis nodosum of the breast in a patient with history of bilateral augmentation mammoplasty. Aesthetic Plast Surg 41(3):560–562.  https://doi.org/10.1007/s00266-017-0825-z CrossRefGoogle Scholar
  24. 24.
    Yamen H, Andrew CJ, Homsi S (2015) Polyarteritis nodosa presenting as digital gangrene and breast lesion following exposure to silicone breast implants. Case Rep Rheumatol.  https://doi.org/10.1155/2015/765170 Google Scholar
  25. 25.
    Reddy SM, Pui JC, Gold LI, Mitnick HJ (2005) Postirradiation morphea and subcutaneous polyarteritis nodosa: case report and literature review. Semin Arthritis Rheum 34(5):728–734.  https://doi.org/10.1016/j.semarthrit.2004.11.004 CrossRefGoogle Scholar
  26. 26.
    Kafantari E, Sotiropoulou M, Sfikakis P, Dimitrakakis K, Zagouri F, Mandrekas K, Dimopoulos S, Dimopoulos MA, Papadimitriou CA (2008) Giant cell arteritis of the breast and breast cancer: paraneoplastic manifestation or concomitant disease? A case report. Onkologie 31(12):685–688.  https://doi.org/10.1159/000165055 Google Scholar
  27. 27.
    Hinze S, Hart YM, Adams RF (2011) Lumpy breasts and headache—a crucial ultrasound. Br J Radiol 84(1000):386–387.  https://doi.org/10.1259/bjr/23418860 CrossRefGoogle Scholar
  28. 28.
    Lee JY, Joo M (2017) Isolated breast vasculitis manifested as breast edema with suggestive sonographic findings: a case report with imaging findings. J Med Ultrason 44(2):191–195.  https://doi.org/10.1007/s10396-016-0753-6 CrossRefGoogle Scholar
  29. 29.
    Anim JT, van Herk EJ (2004) Giant cell arteritis of the breast. Med Princ Pract 13(4):234–236.  https://doi.org/10.1159/000078322 CrossRefGoogle Scholar
  30. 30.
    Kim KH, Yang WI, Choi IJ (1990) Giant cell arteritis of the breast—a case report. Yonsei Med J 31(1):80–84.  https://doi.org/10.3349/ymj.1990.31.1.80 CrossRefGoogle Scholar
  31. 31.
    Allende DS, Booth CN (2009) Wegener’s granulomatosis of the breast: a rare entity with daily clinical relevance. Ann Diagn Pathol 13(5):351–357.  https://doi.org/10.1016/j.anndiagpath.2009.04.005 CrossRefGoogle Scholar
  32. 32.
    Georgescu R, Podeanu MD, Colcer I, Grigorescu G, Coros MF, Moldovan C, Ilyes A, Barsan I, Moncea D, Stolnicu S (2015) Wegener’s granulomatosis of the breast with peculiar radiological aspect mimicking breast carcinoma. Breast J 21(5):550–552.  https://doi.org/10.1111/tbj.12458 CrossRefGoogle Scholar
  33. 33.
    Mengoli MC, Ragazzi M, Lococo F, Mengoli MA, Balli MC, Marchioni A, Rossi G (2017) Breast granulomatosis with polyangiitis mimicking breast cancer. Pathologica 109(4):405–407Google Scholar
  34. 34.
    Lee MXW, Teng GG, Raju GC, Lim AYN (2017) Catastrophic subarachnoid hemorrhage in eosinophilic granulomatosis with polyangiitis without asthma. Int J Rheum Dis 20(12):2127–2131.  https://doi.org/10.1111/1756-185x.12594 CrossRefGoogle Scholar
  35. 35.
    Zardawi IM, Barker BJ, Clark DA, Davies DJ (2004) ANCA-positive vasculitis of the breast. Pathology 36(4):370–373.  https://doi.org/10.1080/00313020410001721645 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  1. 1.Department of Rheumatology and ImmunologyPeking University Third HospitalBeijingChina
  2. 2.Department of Pathology, School of Basic Medical SciencesPeking UniversityBeijingChina

Personalised recommendations