Diagnostic Dilemma Of A Rapidly Progressive Ulcer Of The Breast: A Case Report

摘要

Idiopathic granulomatous mastitis is a rare inflammatory breast disease of unknown etiology. It tends to occur in young females usually with a history of recent childbirth or oral contraceptive usage. The clinical presentation is varied and may mimic malignancy. It may be identified by presence of epithelioid histiocytes, lymphocytes, plasma cells, neutrophils and multinucleated Langhans-type giant cells usually without any caseation or necrosis. Introduction Idiopathic granulomatous mastitis was described as a specific entity in 1972 by Kessler and Wolloch. Despite many cases reported in the international literature, this pathology remains quite unknown.1 It is a rare inflammatory breast disease of unknown aetiology and tends to occur in young female patients with a history of recent childbirth or oral contraceptive usage.2 Histopathologically, it may be identified by presence of epithelioid histiocytes, lymphocytes, plasma cells, neutrophils and multinucleated Langhans-type giant cells usually without any caseation or necrosis.3,4 It usually presents with one or more of clinical features like galactorrhea, inflammation, breast mass, tumorous indurations and ulcerations of the skin.5 Case History A 20-year-old female presented to us with complaints of a large ulcer in the region of left breast with sloughed-off areola and skin. The lesion had started as a swelling in the left breast below the nipple-areola complex about 2 month back which was small initially and then rapidly increased in size followed by sloughing off the nipple-areola complex with eventual progression to sloughing -off of the entire breast tissue. The patient had had full term normal delivery 2 months before. On clinical examination there was a large ulcer of about 12cm x 10cm size in the left pectoral region replacing much of the bulk of the left breast with slough and necrotic tissues. The floor gave appearance of a fungating mass. Local temperature was slightly increased, tender to touch and the ulcer was not fixed to underlying structures. No axillary or other lymph nodes were palpable. Imaging studies of chest and abdomen were normal. A provisional diagnosis of locally advanced breast malignancy was made. Biopsy showed congestion with chronic inflammatory infiltrate consisting of lymphocytes, plasma cells, histiocytes and Langhans-type of giant cells. Keeping idiopathic granulomatous mastitis as provisional diagnosis, the patient was treated conservatively.