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Systemic diseases affecting the breast: Imaging, diagnosis, and management. Clin Imaging 2021; 77:76-85. [PMID: 33652268 DOI: 10.1016/j.clinimag.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions. This review aims to discuss the clinical presentations, imaging features, pathologic findings, and management of systemic conditions that may affect the breast.
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Vyas S, Rangarajan K, Das A, Hari S, Srivastava A, Mathur S. Case 283: Breast Filariasis. Radiology 2020; 297:487-491. [PMID: 33074785 DOI: 10.1148/radiol.2020190501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 44-year-old woman who was a resident of Bihar, which is a state in eastern India, presented to the surgical outpatient department of our hospital with a history of gradually increasing swelling of the right breast associated with redness, pain, and itching over the past month. She reported a general sense of malaise and experienced episodes of chills over the past 6 months; however, she had no documented fever. There was no history of breast trauma. No history suggestive of a possible hypercoagulable state could be elicited (she was a nonsmoker, had undergone uncomplicated normal vaginal delivery 15 years earlier, was not taking oral contraceptives, and had no history to suggest past deep venous thrombosis). General physical examination findings were unremarkable. On local examination, she was found to have diffuse enlargement of the right breast. The skin over the lateral part of the breast was erythematous and showed the presence of prominent superficial veins. On palpation, few ill-defined firm mobile masses were found in the upper outer quadrant with overlying skin induration. No skin ulceration or nipple discharge was present. Few firm and discrete lymph nodes were palpable in the right axilla. Laboratory investigations showed mild anemia (hemoglobin level, 10 g/dL; normal range, 12-15 g/dL), a total leukocyte count of 14 000 cells per microliter (14 cells × 109/L) (normal range, 4500-11 000 cells per microliter [4.5-11 cells × 109/L]), a normal differential leukocyte count (74% neutrophils [normal range, 40%-80%], 24% lymphocytes [normal range, 20%-40%], and 2% eosinophils [normal range, 1%-4%]), and an erythrocyte sedimentation rate of 31 mm per hour (normal range, 0-29 mm per hour). She underwent both mammography and US. Real-time US showed mobile structures on the series of US images obtained seconds apart. On the basis of the imaging findings, US-guided fine-needle aspiration cytology was performed to confirm the diagnosis, and appropriate treatment was instituted.
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Affiliation(s)
- Surabhi Vyas
- From the Departments of Radiodiagnosis (S.V., K.R., A.D., S.H.), Surgery (A.S.), and Pathology (S.M.), All India Institute of Medical Sciences, New Ansari Nagar, New Delhi 110029, India
| | - Krithika Rangarajan
- From the Departments of Radiodiagnosis (S.V., K.R., A.D., S.H.), Surgery (A.S.), and Pathology (S.M.), All India Institute of Medical Sciences, New Ansari Nagar, New Delhi 110029, India
| | - Abanti Das
- From the Departments of Radiodiagnosis (S.V., K.R., A.D., S.H.), Surgery (A.S.), and Pathology (S.M.), All India Institute of Medical Sciences, New Ansari Nagar, New Delhi 110029, India
| | - Smriti Hari
- From the Departments of Radiodiagnosis (S.V., K.R., A.D., S.H.), Surgery (A.S.), and Pathology (S.M.), All India Institute of Medical Sciences, New Ansari Nagar, New Delhi 110029, India
| | - Anurag Srivastava
- From the Departments of Radiodiagnosis (S.V., K.R., A.D., S.H.), Surgery (A.S.), and Pathology (S.M.), All India Institute of Medical Sciences, New Ansari Nagar, New Delhi 110029, India
| | - Sandeep Mathur
- From the Departments of Radiodiagnosis (S.V., K.R., A.D., S.H.), Surgery (A.S.), and Pathology (S.M.), All India Institute of Medical Sciences, New Ansari Nagar, New Delhi 110029, India
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Das S, Lal H, Dey M, Mohindra N. Bilateral breast filariasis mimicking inflammatory breast carcinoma. BMJ Case Rep 2017; 2017:bcr-2017-221845. [PMID: 29184008 DOI: 10.1136/bcr-2017-221845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Breast is an uncommon site to be affected in filariasis. However, such cases may be encountered in endemic areas. Here, we report a case of filariasis of breast in a 55-year-old woman who was clinically mistaken for inflammatory carcinoma of the breast. Sonomammography revealed classic signs pointing towards the diagnosis of filariasis of breast, which was confirmed with microscopic examination of fine-needle aspirate. Thus, imaging played a pivotal role in correctly diagnosing and further altering the line of management.
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Affiliation(s)
- Simi Das
- Department of Radiology, GD Hospital, Kolkata, India
| | - Hira Lal
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Mousam Dey
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Namita Mohindra
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Affiliation(s)
- Monica D Agarwal
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shambhavi Venkataraman
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Priscilla J Slanetz
- Breast Imaging Section, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
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Antinori S, Schifanella L, Million M, Galimberti L, Ferraris L, Mandia L, Trabucchi G, Cacioppo V, Monaco G, Tosoni A, Brouqui P, Gismondo MR, Giuliani G, Corbellino M. Imported Loa loa filariasis: three cases and a review of cases reported in non-endemic countries in the past 25 years. Int J Infect Dis 2012; 16:e649-62. [PMID: 22784545 DOI: 10.1016/j.ijid.2012.05.1023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/13/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to highlight the increasing chance of Western physicians encountering patients (both immigrants and expatriates/travelers) seeking help for loiasis. METHODS We describe three cases of imported loiasis observed at two hospitals in Italy and France, and present a review of all previously published cases in the medical literature in the last 25 years (1986-2011). The search was performed using PubMed and Scopus databases using the terms "Loa loa" AND "loiasis". RESULTS We reviewed 101 cases of imported loiasis of which 61 (60.4%) were reported from Europe and 31 (30.7%) from the USA. Seventy-five percent of infestations were acquired in three countries: Cameroon, Nigeria, and Gabon. Overall, peripheral blood microfilariae were detected in 61.4% of patients, eosinophilia in 82.1%, eye worm migration in 53.5%, and Calabar swellings in 41.6%. However, Calabar swellings and eosinophilia were more common among expatriates/travelers, whereas African immigrants were more likely to have microfilaremia. Eye worm migration was observed in a similar proportion in the two groups. Only 35 patients (including the three described here) underwent clinical follow-up for a median period of 10.5 months (range 1-84 months); clinical relapse occurred in three of these patients and persistence or reappearance of blood microfilaria in another two. CONCLUSIONS Due to increasing travel and the migration of people from the endemic countries of West Africa to Europe and the USA, we speculate on the possible emergence of loiasis. Western physicians should be aware of the typical (eye worm migration and Calabar swellings) as well as unusual clinical presentations.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical Sciences L Sacco, Section of Infectious Diseases and Immunopathology, Università degli Studi di Milano, Via GB Grassi, 74, 20157 Milan, Italy.
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Abstract
Although mammography is primarily used for the detection of breast cancer, it can occasionally reveal breast abnormalities related to extramammary disease. Cardiovascular diseases such as congestive heart failure and central venous obstruction may manifest as venous engorgement and breast edema at mammography. Pathologic arterial calcifications seen at mammography can indicate an underlying risk factor for accelerated atherosclerosis such as chronic renal failure. Connective tissue diseases including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis-polymyositis, and systemic scleroderma typically manifest with bilateral axillary lymphadenopathy, and stromal calcifications are also seen in the latter three disease processes. Some diseases such as neurofibromatosis type 1 and filariasis may manifest with pathognomonic findings at mammography, whereas other systemic diseases such as Wegener granulomatosis, sarcoidosis, and amyloidosis can manifest as nonspecific breast masses that are indistinguishable from breast cancer and usually require tissue biopsy for confirmation. Knowledge of the imaging characteristics of various systemic diseases affecting the breast will aid the radiologist in differentiating systemic disease from suspect breast lesions, thereby helping ensure appropriate follow-up. Furthermore, recognition of systemic diseases such as Cowden syndrome that are associated with an increased risk of breast cancer will allow the radiologist to recommend appropriate surveillance.
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Affiliation(s)
- Mailan M Cao
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Ravikumar R, Sen KK, Singh SN, Chawla N, Choudhary SR, Singh D. Filarial Dance in a Breast Lump. Med J Armed Forces India 2010; 66:193-5. [PMID: 27375337 DOI: 10.1016/s0377-1237(10)80151-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 01/05/2010] [Indexed: 11/30/2022] Open
Affiliation(s)
- R Ravikumar
- Senior Advisor (Radiodiagnosis & Interventional Radiology), INHS Asvini, Colaba, Mumbai-5
| | - K K Sen
- Professor & HOD (Radiodiagnosis), PSG Institute of Medical Sciences and Research, Coimbatore 641004, Tamil Nadu
| | - S N Singh
- Graded Specialist (Radiodiagnosis), INHS Asvini, Colaba, Mumbai-5
| | - N Chawla
- Senior Advisor (Pathology), INHS Asvini, Colaba, Mumbai-5
| | - S R Choudhary
- Resident (Radiodiagnosis), INHS Asvini, Colaba, Mumbai-5
| | - D Singh
- Resident (Pathology), INHS Asvini, Colaba, Mumbai-5
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Sabaté JM, Clotet M, Gómez A, De las Heras P, Torrubia S, Salinas T. Radiologic Evaluation of Uncommon Inflammatory and Reactive Breast Disorders. Radiographics 2005; 25:411-24. [DOI: 10.1148/rg.252045077] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
A 56-year-old woman who came in for screening mammography was found to have extensive unilateral calcification of her left breast which had developed since her previous screening mammogram. The calcification had a ductal and lobular appearance. Possible known etiologies are discussed, but these do not explain the appearance in this case, implying that the cause is idiopathic.
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Affiliation(s)
- Alissa M Connors
- Department of Radiology, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom.
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Affiliation(s)
- Paul D Friedman
- Department of Radiology, Saint Barnabas Medical Center, Old Short Hills Rd, Livingston, NJ 07039, USA
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