Isolated panniculitis with vasculitis of the male breast suspicious for malignancy on CT and ultrasound: a case report and literature review

Abstract

IntroductionWe report a case of a 54-year-old male patient with a hard, painful nodule within his right breast which was misdiagnosed preoperatively as breast cancer.Case descriptionPreoperative work-up included physical examination, non-contrast chest computed tomography (CT), sonography, and sono-guided breast biopsy. Isolated breast panniculitis with vasculitis (BPWV), a rare disease, was diagnosed by histopathologic examination of tissue obtained from excisional biopsy.Discussion and EvaluationSubcutaneous panniculitis with or without vasculitis, a condition of nonsuppurative inflammatory process involving the subcutaneous fat layer of skin, is related to different causes. A palpable benign male breast lesion resembling a malignancy includes gynecomastia, panniculitis with or without vasculitis, fat necrosis, ruptured epidermal cyst, pseudoangiomatous stromal hyperplasia, subareolar abscess, intraductal papilloma, hematoma, and atypical fibroadenoma. To make an accurate preoperative diagnosis of a male breast mass, a physician has to carefully analyze various imaging findings. The cases of BPWV may present as an isolated breast lesion or as a component of a systemic disease. The diagnosis of the reported patient was compatible with an isolated BPWV because panniculitis and/or vasculitis were not present at other sites or organs at the time of diagnosis or during follow-up.ConclusionsExcisional biopsy and clinical data can provide the correct diagnosis and determined the appropriate treatment strategy of a male BPWV.

Lupus mastitis of the male breast

“…This is followed by a reparative phase where fibroblasts proliferate, and in the final stage, fibrosis gradually replaces fat necrosis with little or no calcification. 15 , 16 …”

“… 2 , 11 Findings on the mammogram and ultrasonography depend on pathological staging, and coarse calcifications become visible with disease progression. 11 , 15 …”

Nonsuppurative Nodular Panniculitis of the Breast

“…Benign MRI features include high signal intensity on T1-weighted images and low signal intensity on fat-suppressed images suggesting fat, local cutaneous involvement, and continuous rim enhancement on MRI kinetic analysis instead of a wash-out curve. [6][7][8]12 During the reparative and final stage, however, breast panniculitis might present with indistinct or spiculated margins and architectural distortion on ultrasonography, mammography, and MRI, which might be indistinguishable from breast malignancy especially when the inflammatory changes are associated with vasculitis. [6][7][8]12 With increasing use of CT for a variety of diagnostic pathways, breast incidentalomas are identified more frequently, even though benign and malignant lesions might not be safely distinguished from each other on standard chest CT imaging.…”

Breast panniculitis with liquefactive fat necrosis: A case report

“…After treated with systemic corticosteroids, the condition improved (15). Yuan reported a case of isolated breast panniculitis without evidence of systemic inflammation, who underwent resection without systemic corticosteroid or immunosuppressive therapy (16). The patient did not suffer a relapse.…”