Lupus Mastitis Without Systemic Disease: Unusual Imaging Findings Including MRI

Abstract

A 31-year-old black woman presented with a several month history of painless palpable thickening and erythema of her upper outer right breast. The patient's past medical history was significant for lupus panniculitis but did not reveal signs or symptoms of systemic lupus erythematosus (SLE). Based on her history, lupus mastitis was suspected as the cause of her current breast complaints and the patient was referred to our breast center for imaging. Digital mammography ( Fig. 1) revealed severe rightsided skin thickening and increased subjacent stromal density. Lymphadenopathy was present. No focal masses were identified and no calcifications were seen as is usually reported in association with lupus mastitis. A right breast ultrasound (Fig. 2) demonstrated skin thickening and subcutaneous hyperechogenicity without a focal mass. Contrast-enhanced magnetic resonance imaging (MRI) was then obtained (Fig. 3). Extensive skin thickening in the right upper outer breast was noted with moderate persistent and plateau enhancement (Type I ⁄ II kinetics) of the underlying subcutaneous tissues. A discrete mass was not seen. Bilateral axillary adenopathy was also noted, extending into the subpectoral region on the right. There were additional areas of subclinical, subcutaneous involvement evident in the upper inner quadrants of both breasts.Although the presumptive diagnosis was lupus mastitis, because the patient did not have systemic lupus and the imaging findings differed from that described in the literature for lupus mastitis, both a skin punch biopsy as well as a subcutaneous ultrasound guided core biopsy were performed. Pathology was consistent with lupus mastitis (Fig. 4). No neoplastic tissue was evident. Several months following core biopsy, the patient has had no adverse sequelae from the procedure and the site of biopsy has completely healed.Lupus panniculitis is a chronic inflammatory reaction of subcutaneous fat that occurs in a small percentage of patients with SLE. Inflammation affecting the subcutaneous fat of the breast is termed lupus Figure 1. MLO view of the right breast demonstrates severe skin thickening and subjacent stromal density with adenopathy. No masses or calcifications are seen.

A mimicker of inflammatory breast carcinoma: Lupus mastitis and evolving imaging features

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Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players

“…So far, 27 cases have been reported in the literature: Kinonen and coll. reviewed 22 cases and 6 additional cases have since been reported [38][39][40][41][42][43][44].…”