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Matsushima H, Kikuchi M, Miyabe R, Yamaguchi S, Kita H, Kobayashi J, Ando T, Atsuta K, Soga T, Shintani T. IgG4-related mastitis managed without excision or steroid therapy. Surg Case Rep 2024; 10:32. [PMID: 38302639 PMCID: PMC10834898 DOI: 10.1186/s40792-024-01826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
IgG4-related mastitis is an extremely rare IgG4-related sclerosing disease involving the breast that must be differentiated from breast cancer. There is currently no consensus regarding the optimal treatment strategies. Here, we report a case of IgG4-related mastitis followed up without excision or steroid therapy. Although the association between IgG4-related mastitis and breast cancer remains unclear, regular follow-up imaging and measurement of serum concentrations of disease activity markers may allow for follow-up without excision or steroid therapy.
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Affiliation(s)
- Hirokazu Matsushima
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Masayuki Kikuchi
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan.
| | - Rika Miyabe
- Tosen Clinic, 1-20, Gohukucho, Aoi-Ku, Shizuoka, Shizuoka, 420-0031, Japan
| | - Sota Yamaguchi
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Hidenori Kita
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Junko Kobayashi
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Takashi Ando
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Koji Atsuta
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Takayoshi Soga
- Department of Rheumatology, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
| | - Tsunehiro Shintani
- Department of Surgery, Japanese Red Cross Shizuoka Hospital, 8-2, Ottemachi, Aoi-Ku, Shizuoka, Shizuoka, 420-0853, Japan
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Turashvili G, Li X. Inflammatory Lesions of the Breast. Arch Pathol Lab Med 2023; 147:1133-1147. [PMID: 37196345 DOI: 10.5858/arpa.2022-0477-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/19/2023]
Abstract
CONTEXT.— Inflammatory lesions of the breast are rare but not infrequently pose problems both clinically and morphologically, particularly on needle core biopsies. These lesions range from acute inflammatory conditions to chronic lymphoplasmacytic and lymphohistiocytic to granulomatous inflammatory diseases. OBJECTIVE.— To provide a comprehensive overview of inflammatory lesions of the breast, with etiopathogenesis and clinical, radiologic, and pathologic features as well as differential diagnostic considerations, clinical management, and prognosis. DATA SOURCES.— The existing literature in the English language, including original research articles and review articles describing inflammatory lesions of the breast. CONCLUSIONS.— Inflammatory lesions of the breast are characterized by a wide variety of clinical, radiologic, and morphologic features. The histopathologic differential diagnosis often includes a neoplastic process requiring ancillary studies and correlation with clinical and radiologic findings. Although most specimens display nonspecific findings precluding a definitive pathologic diagnosis, pathologists have a unique opportunity to play a crucial role in identifying key histologic features suggestive of certain entities, such as cystic neutrophilic granulomatous mastitis, immunoglobulin (Ig) G4 mastitis, or squamous metaplasia of lactiferous ducts, in the right clinical and radiologic context, and thereby guiding optimal and timely clinical management. The information presented herein will be helpful to practicing anatomic pathologists and pathology trainees in becoming more familiar with specific morphologic features and overcoming differential diagnostic challenges related to pathology reporting of inflammatory lesions of the breast.
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Affiliation(s)
- Gulisa Turashvili
- From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
| | - Xiaoxian Li
- From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia
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Rybakova MG, Mylnikova AA, Vlasova MT. [IgG4-related disease of the breast]. Arkh Patol 2022; 84:51-55. [PMID: 35880600 DOI: 10.17116/patol20228404151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
IgG4-related disease is an immune-mediated disorder with tumor-like multiorgan involvement, elevated serum IgG4 level and specific histopathological appearance (lymphoplasmacytic infiltrate rich in IgG4+ plasma cells and storiform fibrosis). The article presents rare clinical and morphological observations of IgG4-related mastopathy in women with suspected tumor process. A strategy for the treatment of IgG4-related disease should be based on the results of pre-surgery histopathological examination, which may help to avoid unreasonable surgical intervention and choose glucocorticoids or rituximab as the first-line treatment.
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Affiliation(s)
- M G Rybakova
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - A A Mylnikova
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - M T Vlasova
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
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Asano Y, Kashiwagi S, Kawano Y, Tanaka S, Kuwae Y, Takashima T, Ohsawa M, Hirakawa K, Ohira M. IgG4-related mastitis requiring differentiation from breast cancer: a case report. J Surg Case Rep 2021; 2021:rjaa240. [PMID: 34858570 PMCID: PMC8634083 DOI: 10.1093/jscr/rjaa240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 01/13/2023] Open
Abstract
Immunoglobulin (Ig) G4-related disease (IgG4-RD) is a group of chronic relapsing inflammatory conditions. Although IgG4-RD can occur in various organs, it is rarely observed in mammary glands. Here, we report a case of IgG4-related mastitis (IgG4-RM) that needed to be differentiated from breast cancer. A 54-year-old woman was examined for a tumor in her left breast. Mammary ultrasonography revealed an irregular hypoechoic tumor measuring 45.0 × 43.0 × 32.0 mm in size. A core-needle biopsy of the left breast tissue revealed a high degree of mixed T and B lymphocytic and plasma cell infiltration, as well as interstitial fibrosis. IgG4-RD was diagnosed based on hematological examination that revealed an abnormal IgG4 value of 332 mg/dl. All the clinical diagnostic criteria for IgG4 were met, resulting in a definitive diagnosis of IgG4-RM.
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Affiliation(s)
- Yuka Asano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Yuko Kawano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Sayaka Tanaka
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Yuko Kuwae
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tsutomu Takashima
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kosei Hirakawa
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masaichi Ohira
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Erivwo P, Turashvili G. Pathology of IgG4-related sclerosing mastitis. J Clin Pathol 2020; 74:475-482. [PMID: 33328182 DOI: 10.1136/jclinpath-2020-207029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/15/2020] [Accepted: 12/06/2020] [Indexed: 01/11/2023]
Abstract
Immunoglobulin G4-related sclerosing mastitis (IgG4-RM) is a recently recognised member of the IgG4-related disease (IgG4-RD) family, a multisystem fibroinflammatory condition that can affect any organ system. IgG4-RM is rare and predominantly occurs in middle-aged women. It may present with painless palpable mass and/or lymphadenopathy thereby mimicking breast cancer. Although there is an abundance of literature describing the clinicopathological characteristics of IgG4-RD in a variety of organs, data on IgG4-RM are limited due to its rarity. This review describes the manifestation of the disease in the breast based on reported cases, emphasising the clinicopathological features, pathophysiology, differential diagnosis, treatment and prognosis.
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Affiliation(s)
- Polycarp Erivwo
- Department of Pathology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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