**5.1 Malignant pathology**

First of all, the most important and the most frequent is malignant pathology of the breast. The American Cancer Society (ACS) estimates that 268,600 women will receive a diagnosis of invasive breast cancer and 62,930 people will receive a diagnosis of noninvasive cancer in one year. When we diagnose a breast mass, we suspect breast cancer. The initial test is mammography, ultrasound, and sometimes MRI. As we have previously objectified, there are no defined patterns in the imaging test for sarcoidosis in the breast, and we have the same problem with cancer. Therefore, we obtain a suspicious diagnosis that we need to confirm. After those techniques, we perform further tests like pathological test and immunohistochemistry to establish the definitive diagnosis, prognosis parameters, and correct therapy.

#### **5.2 Idiopathic granulomatous mastitis (IGM)**

Idiopathic granulomatous mastitis is a rare, chronic benign breast disease, which may mimic a breast abscess, malignancy, or other granulomatous pathologies. Most patients present in the third or fourth decade of life, and it typically is seen in women of childbearing potential from 6 months to 6 years postpartum. It is a diagnosis of exclusion and requires a high index of suspicion [7, 8].

Early misdiagnosis as bacterial mastitis is common, prompting multiple antibiotic regimens. When antibiotics fail, patients are worked up for inflammatory

**151**

*Sarcoid Involvement of the Mammary Gland DOI: http://dx.doi.org/10.5772/intechopen.92183*

sometimes an ophthalmology evaluation [8].

ate that they do not present systemic symptoms.

potential sarcoidosis or IGM.

roids, or surgical excision.

**5.3 Tuberculosis**

developed world.

treatment.

lymph nodes.

**6. Treatment**

**Conflict of interest**

The authors declare no conflict of interest.

**5.4 Sarcoidosis-like reaction**

breast cancer, given the nonhealing breast nodules. Mammography, ultrasonography, and fine needle aspiration often are unable to rule out carcinoma, warranting excisional biopsies of nodules. After that, we exclude malignancy and suspect a

granulomatous disorders, such as tuberculosis and sarcoidosis.

Idiopathic granulomatous mastitis is a diagnosis of exclusion, made after obtaining evidence of granulomatous inflammation on breast biopsy and ruling out other

Almost the totality of sarcoid patients (90%) has lung disease; when we suspect a sarcoidosis, a chest radiograph is needed to screen for hilar lymphadenopathy and

Many cases self-resolve, but more severe cases can persist for a long period before adequate symptomatic treatment is achieved by methotrexate, corticoste-

Breast tuberculosis (TB) is another disease characterized by the presence of granulomas. This pathology is rare but increasingly reported in Western Europe, accounting for 4.5% of all breast lesions in TB-endemic areas and 0.1% in the

The presenting features may mimic other breast pathologies including bacterial

The most frequent symptom is an isolated mass, with less evidence of inflammation or infection than in other types of infectious mastitis. To this, we must associ-

Diagnosis of breast TB is difficult, often necessitating multiple clinic consultations and tissue sampling procedures. This frequently results in delays in TB

A phenomenon known as autoimmune/inflammatory syndrome induced by adjuvants may underlie the association between silicone implants and sarcoidosislike reaction with foreign body granulomatous reaction, in which silicone serves as an immunologic adjuvant to enhance antigen-specific immune response. This leads

There are some case reports in the literature that describe this reaction, and it may take place in the breast skin, subcutaneous tissue, and also in axillary

The treatment of breast sarcoidosis is similar to systemic sarcoidosis, but most of the time, an excisional biopsy has to be done to confirm the diagnosis, and if the

sarcoidosis is isolated in the breast, then other treatments is not necessary.

to enhanced production and activation of both B and T cells [11].

abscess, idiopathic granulomatous mastitis, sarcoidosis, or carcinoma, making diagnosis challenging. Risk factors for the development of breast TB include immu-

nosuppression, lactation, multiparty, and previous exposure to TB [9, 10].

#### *Sarcoid Involvement of the Mammary Gland DOI: http://dx.doi.org/10.5772/intechopen.92183*

breast cancer, given the nonhealing breast nodules. Mammography, ultrasonography, and fine needle aspiration often are unable to rule out carcinoma, warranting excisional biopsies of nodules. After that, we exclude malignancy and suspect a potential sarcoidosis or IGM.

Idiopathic granulomatous mastitis is a diagnosis of exclusion, made after obtaining evidence of granulomatous inflammation on breast biopsy and ruling out other granulomatous disorders, such as tuberculosis and sarcoidosis.

Almost the totality of sarcoid patients (90%) has lung disease; when we suspect a sarcoidosis, a chest radiograph is needed to screen for hilar lymphadenopathy and sometimes an ophthalmology evaluation [8].

Many cases self-resolve, but more severe cases can persist for a long period before adequate symptomatic treatment is achieved by methotrexate, corticosteroids, or surgical excision.

#### **5.3 Tuberculosis**

*Sarcoidosis and Granulomatosis - Diagnosis and Management*

The diagnosis is based on typical radiologic manifestations supported by histologic evidence of noncaseating granulomas in the absence of infection and

*Chronic granulomatous inflammatory process, with epithelioid granulomas and non-necrotizing giant cells.*

There are some diseases that we should rule out when we are thinking about the

First of all, the most important and the most frequent is malignant pathology of the breast. The American Cancer Society (ACS) estimates that 268,600 women will receive a diagnosis of invasive breast cancer and 62,930 people will receive a diagnosis of noninvasive cancer in one year. When we diagnose a breast mass, we suspect breast cancer. The initial test is mammography, ultrasound, and sometimes MRI. As we have previously objectified, there are no defined patterns in the imaging test for sarcoidosis in the breast, and we have the same problem with cancer. Therefore, we obtain a suspicious diagnosis that we need to confirm. After those techniques, we perform further tests like pathological test and immunohistochemistry to establish the definitive diagnosis, prognosis parameters, and correct

Idiopathic granulomatous mastitis is a rare, chronic benign breast disease, which

Early misdiagnosis as bacterial mastitis is common, prompting multiple antibiotic regimens. When antibiotics fail, patients are worked up for inflammatory

may mimic a breast abscess, malignancy, or other granulomatous pathologies. Most patients present in the third or fourth decade of life, and it typically is seen in women of childbearing potential from 6 months to 6 years postpartum. It is a

diagnosis of exclusion and requires a high index of suspicion [7, 8].

diagnosis of sarcoidosis in the breast. Then, we break down each one of them.

exclusion of other types of granulomatous affections [6].

**5.2 Idiopathic granulomatous mastitis (IGM)**

**5. Differential diagnosis**

**5.1 Malignant pathology**

**150**

therapy.

**Figure 2.**

Breast tuberculosis (TB) is another disease characterized by the presence of granulomas. This pathology is rare but increasingly reported in Western Europe, accounting for 4.5% of all breast lesions in TB-endemic areas and 0.1% in the developed world.

The presenting features may mimic other breast pathologies including bacterial abscess, idiopathic granulomatous mastitis, sarcoidosis, or carcinoma, making diagnosis challenging. Risk factors for the development of breast TB include immunosuppression, lactation, multiparty, and previous exposure to TB [9, 10].

The most frequent symptom is an isolated mass, with less evidence of inflammation or infection than in other types of infectious mastitis. To this, we must associate that they do not present systemic symptoms.

Diagnosis of breast TB is difficult, often necessitating multiple clinic consultations and tissue sampling procedures. This frequently results in delays in TB treatment.

#### **5.4 Sarcoidosis-like reaction**

A phenomenon known as autoimmune/inflammatory syndrome induced by adjuvants may underlie the association between silicone implants and sarcoidosislike reaction with foreign body granulomatous reaction, in which silicone serves as an immunologic adjuvant to enhance antigen-specific immune response. This leads to enhanced production and activation of both B and T cells [11].

There are some case reports in the literature that describe this reaction, and it may take place in the breast skin, subcutaneous tissue, and also in axillary lymph nodes.

## **6. Treatment**

The treatment of breast sarcoidosis is similar to systemic sarcoidosis, but most of the time, an excisional biopsy has to be done to confirm the diagnosis, and if the sarcoidosis is isolated in the breast, then other treatments is not necessary.

#### **Conflict of interest**

The authors declare no conflict of interest.

*Sarcoidosis and Granulomatosis - Diagnosis and Management*
