Answer for BIR CoW 03 Dec 2023
Xanthogranulomatous mastitis
Findings
USG showed multiple ill-defined irregular heteroechoic lesions from 2- 6o' clock position and retroareolar region of left breast showing increased vascularity with enlarged left axillary nodes- BIRADS 5. MR mammogram: Multiple irregular T1 hypo/ STIR hyperintense lesions with spiculated margins and surrounding STIR hyperintensities seen from 2- 6 o' clock position and in the retroareolar region. These lesions appear mildly hyperintense in diffusion weighted images with low ADC values. These lesions show peripheral heterogenous enhancement with central non- enhancing areas in the larger lesions and type 2 curve in dynamic contrast images (rapid wash in with no washout). Patient was suggested biopsy in suspicion for malignancy and HPE came as xanthogranulomatous mastitis
Discussion
Xanthogranulomatous mastitis is an extremely rare condition that is characterised by the infiltration of the breast parenchyma by foamy histiocytes. There have been only 26 reported cases amongst 10 publications. The major concern of XGM is its diagnostic challenge to differentiate it from breast malignancy both clinically and radiologically. Most cases of XGM were asymptomatic with incidental findings on routine screening whilst a minority of cases presented with pain or a palpable lump. Radiologically there is a tendency for XGM masses to mimic malignancy warranting a pathological diagnosis either by core or excisional biopsy. The trigger for XGM is not completely known although some papers have suggested a traumatic aetiology in the form of implant rupture or prolonged cutaneous scratching The entity of cystic neutrophilic granulomatous mastitis should be considered as a differential diagnosis for this case. This entity is characterised by rounded clear spaces/vacuoles which are rimmed by neutrophils and epithelioid histiocytes. Upon review of the literature, surgical excision was the most predominant mode of management. However, conservative management with antibiotics can be attempted in smaller lesions
Findings
USG showed multiple ill-defined irregular heteroechoic lesions from 2- 6o' clock position and retroareolar region of left breast showing increased vascularity with enlarged left axillary nodes- BIRADS 5. MR mammogram: Multiple irregular T1 hypo/ STIR hyperintense lesions with spiculated margins and surrounding STIR hyperintensities seen from 2- 6 o' clock position and in the retroareolar region. These lesions appear mildly hyperintense in diffusion weighted images with low ADC values. These lesions show peripheral heterogenous enhancement with central non- enhancing areas in the larger lesions and type 2 curve in dynamic contrast images (rapid wash in with no washout). Patient was suggested biopsy in suspicion for malignancy and HPE came as xanthogranulomatous mastitis
Discussion
Xanthogranulomatous mastitis is an extremely rare condition that is characterised by the infiltration of the breast parenchyma by foamy histiocytes. There have been only 26 reported cases amongst 10 publications. The major concern of XGM is its diagnostic challenge to differentiate it from breast malignancy both clinically and radiologically. Most cases of XGM were asymptomatic with incidental findings on routine screening whilst a minority of cases presented with pain or a palpable lump. Radiologically there is a tendency for XGM masses to mimic malignancy warranting a pathological diagnosis either by core or excisional biopsy. The trigger for XGM is not completely known although some papers have suggested a traumatic aetiology in the form of implant rupture or prolonged cutaneous scratching The entity of cystic neutrophilic granulomatous mastitis should be considered as a differential diagnosis for this case. This entity is characterised by rounded clear spaces/vacuoles which are rimmed by neutrophils and epithelioid histiocytes. Upon review of the literature, surgical excision was the most predominant mode of management. However, conservative management with antibiotics can be attempted in smaller lesions
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!