**3. Clinical manifestations**

In the breast, the clinical presentation is a breast mass that could be isolated or multiple and unilateral or bilateral. Most of the patients do not present infectious or inflammatory symptoms. Moreover the nodules are not painful. It is very important to be alert of the possible systemic symptoms that our patient may present. Sometimes breast sarcoidosis is the first diagnosis disease, but most times, the diagnosis is already done.

#### **4. Diagnosis**

The clinical impact of sarcoidosis is directly related to the extent of granulomatous inflammation and its effect on the function of vital organs.

**149**

**Figure 1.**

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

lead to premature death.

resembling a carcinoma.

the nodule [5] (**Figure 1**).

fungi and acid-fast bacilli.

microcalcification.

previous ones.

the breast.

diagnosis.

systems that most greatly affect the patient's activities and quality of life or that may

In the breast, the most common symptom is a breast mass. It could be only one or multiple tumors. Therefore it is very important to make a correct differential

First of all, the physical examination probably discloses a non-tender, firm, and mobile lesion, with no nipple abnormalities. The patient could or not present axillary lymph nodes. But in some cases the lesions were fixed or tender, clinically

Mammography, most of the time, is the first test and usually shows a nonspecific, ill-defined mass with low density, poorly outlined with no

We have the same problem with ultrasound examination that does not support an unequivocal diagnosis, but we are able to point out the irregularity of the contours, hypoechoic spiculation, and nonhomogeneous internal echostructure of

The next step is the high-field system MR but always complementary to the

Images can reveal the lesion to be a solitary signal-intensive inhomogeneous tumor with irregular contours, fast contrast enhancement, and an early "washout" phenomenon often observed in carcinomas or in inflammatory lesions of

After that, it is important not to forget that the imaging techniques do not offer a

Biopsy of the breast demonstrates chronic granulomatous inflammatory process,

Breast sarcoidosis is very uncommon; most of the times, a fine needle biopsy is

To rule out infection origin, we should perform microbiologic test as stains for

definitive diagnosis and we must correlate it with pathological diagnosis.

with epithelioid granulomas and non-necrotizing giant cells (**Figure 2**).

not enough, so an excisional biopsy is necessary.

*Ultrasound examination with two nonspecific hypoechoic masses.*

Then, we should perform some image techniques.

In each patient, the sites and the severity of granulomatous involvement throughout the body must be assessed to determine the impact of sarcoidosis on

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

*Sarcoidosis and Granulomatosis - Diagnosis and Management*

in sarcoidosis has also been described [1].

tion in the absence of ongoing infection.

**3. Clinical manifestations**

diagnosis is already done.

**4. Diagnosis**

mimic breast carcinoma [4].

difficult [3].

**2. Etiology**

nervous system, locomotor system, lacrimal and salivary glands, heart, and kidney

The descriptions of breast sarcoid vary in the literature from masses with illdefined margins or spiculated as seen in cancer, negative imaging, or other nonspecific appearances [3]. The most common presentation is a palpable breast mass. Because sarcoidosis can mimic breast cancer, it makes the differential diagnosis very

Since sarcoidosis was first described more than a century ago, the etiologic determinants causing this disease remain uncertain. Studies suggest that genetic, host immunologic, and environmental factors interact together to cause sarcoidosis. Immunologic characteristics of sarcoidosis include noncaseating granulomas, enhanced local expression of T helper-1 (and often Th17) cytokines and chemokines, dysfunctional regulatory T-cell responses, dysregulated Toll-like receptor signaling, and oligoclonal expansion of CD4+ T cells consistent with chronic antigenic stimulation. Multiple environmental agents have been suggested to cause sarcoidosis. Studies from several groups implicate mycobacterial or propionibacterial organisms in the etiology of sarcoidosis based on tissue analyses and immunologic responses in sarcoidosis patients. Despite these studies, there is no consensus on the nature of a microbial pathogenesis of sarcoidosis. Some groups postulate sarcoidosis is caused by an active viable replicating infection, while other groups contend there is no clinical, pathologic, or microbiologic evidence for such a pathogenic mechanism [2]. The authors posit a novel hypothesis that proposes that sarcoidosis is triggered by a hyperimmune Th1 response to pathogenic microbial and tissue antigens associated with the aberrant aggregation of serum amyloid A within granulomas, which promotes progressive chronic granulomatous inflamma-

In the breast, the clinical presentation is a breast mass that could be isolated or multiple and unilateral or bilateral. Most of the patients do not present infectious or inflammatory symptoms. Moreover the nodules are not painful. It is very important to be alert of the possible systemic symptoms that our patient may present. Sometimes breast sarcoidosis is the first diagnosis disease, but most times, the

The clinical impact of sarcoidosis is directly related to the extent of granuloma-

In each patient, the sites and the severity of granulomatous involvement throughout the body must be assessed to determine the impact of sarcoidosis on

tous inflammation and its effect on the function of vital organs.

Sarcoid involvement of the breast parenchyma has been extremely rare in patients with sarcoidosis, less than 1% of the overall diagnosed patients. It is more common in African American, Afro-Caribbean, Swedish, and Danish individuals. It typically presents in women in their third and fourth decade of life and can often

**148**

systems that most greatly affect the patient's activities and quality of life or that may lead to premature death.

In the breast, the most common symptom is a breast mass. It could be only one or multiple tumors. Therefore it is very important to make a correct differential diagnosis.

First of all, the physical examination probably discloses a non-tender, firm, and mobile lesion, with no nipple abnormalities. The patient could or not present axillary lymph nodes. But in some cases the lesions were fixed or tender, clinically resembling a carcinoma.

Then, we should perform some image techniques.

Mammography, most of the time, is the first test and usually shows a nonspecific, ill-defined mass with low density, poorly outlined with no microcalcification.

We have the same problem with ultrasound examination that does not support an unequivocal diagnosis, but we are able to point out the irregularity of the contours, hypoechoic spiculation, and nonhomogeneous internal echostructure of the nodule [5] (**Figure 1**).

The next step is the high-field system MR but always complementary to the previous ones.

Images can reveal the lesion to be a solitary signal-intensive inhomogeneous tumor with irregular contours, fast contrast enhancement, and an early "washout" phenomenon often observed in carcinomas or in inflammatory lesions of the breast.

After that, it is important not to forget that the imaging techniques do not offer a definitive diagnosis and we must correlate it with pathological diagnosis.

To rule out infection origin, we should perform microbiologic test as stains for fungi and acid-fast bacilli.

Biopsy of the breast demonstrates chronic granulomatous inflammatory process, with epithelioid granulomas and non-necrotizing giant cells (**Figure 2**).

Breast sarcoidosis is very uncommon; most of the times, a fine needle biopsy is not enough, so an excisional biopsy is necessary.

**Figure 1.** *Ultrasound examination with two nonspecific hypoechoic masses.*

**Figure 2.** *Chronic granulomatous inflammatory process, with epithelioid granulomas and non-necrotizing giant cells.*

The diagnosis is based on typical radiologic manifestations supported by histologic evidence of noncaseating granulomas in the absence of infection and exclusion of other types of granulomatous affections [6].
