Giant cell arteritis of the breast: a case report with a review of literatures

Abstract

Although giant cell arteritis (GCA), clinically designated as temporal arteritis, is recognized as a systemic disease, the breast may be the primary organ in which it is manifested. GCA of the breast is a rare disease that mainly occurs in postmenoposal elderly women. It manifests as nodules or pain in the breast, with or without tenderness, and is associated with significant constitutional symptoms that resemble those of polymyalgia rheumatica (PMR). These symptoms can be treated with or without prednisone therapy and can improve without the development of organ dysfunction. The clinical manifestations can often be recognized only by retrospective analysis after excisional biopsy. GCA of the breast occasionally mimics carcinoma, and its initial manifestations may be similar to those of other forms of vasculitis involving the breast, such as polyarteritis nodosa and Wegener granulomatosis. Biopsy is indispensable for establishing a definitive diagnosis. Thus far, the findings of imaging procedures, such as mammography and ultrasonography, for patients with mammary GCA have not been reported in detail, and no distinctive findings associated with this condition have been identified. Considering this and the fact that spontaneous remission may occur in some cases, mammary GCA probably often goes undiagnosed or may be misdiagnosed as an ordinary mammary disease. GCA of the breast should be considered as a potential diagnosis in the case of elderly women presenting with PMR-like symptoms and tenderness, lumps, or pain in the breast. We report a case of GCA affecting the breast and review previous reports on this condition in an attempt to summarize the features that distinguish this disease from other vascular diseases of the breast.

Breast manifestations of systemic diseases

“…In a review of the English medical literature up to 2008, Kadotani et al22 identified 20 reported cases, all of which were postmenopausal elderly women. Single or multiple lumps due to arteritis were present in 80% (16 of 20 patients), and redness and tenderness in the absence of lumps were present in 10%.…”

“…Breast involvement was bilateral in 50% of the patients. Spontaneous breast pain and tenderness were presenting features in 85% of the patients 22. Systemic symptoms such as low-grade fever, arthralgia, myalgia, and those suggestive of polymyalgia rheumatica were present in 65% of the patients.…”

“…In most cases reported in the medical literature, the diagnosis was made after excisional biopsy (a considerable amount of tissue is required to make the diagnosis of giant cell arteritis). In rare cases, the diagnosis was established before biopsy on the basis of systemic symptoms22 and ultrasound findings. 23 Pathology shows fragmentation of the elastica in association with giant cell infiltration, intimal proliferation, and narrowing of the vascular lumina.…”

Giant Cell Arteritis of the Breast

“…In the case of the development of artery stenosis other than this, interventions such as "stent," "bypass," or "angioplasty" can be applied (10). Most interestingly, even if no treatment applied, spontaneous remission can be seen in some patients (2). After the lesion area was removed in our patient, recurrence or other organ involvement was not seen.…”

“…Among these conditions, GCA may rarely be seen in the breast as the primary organ involvement (1,2). Concomitant sensitivity, redness, and palpable masses can be detected in the breast, and they can be confused with malignancy (2).…”