Sarcoidosis of the breast: a rare case report and a review

Sarcoidosis is an idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. Breast involvement is extremely rare, but, when present, it could be confused with a benign or, more important, a malignant neoplasm. We have reported a case of sarcoidosis of the breast in a 51 years old woman with systemic manifestations of sarcoidosis (arthralgias and uveitis) associated with a breast mass and with a clinical history of fibrocystic mastopathy. A chest X-ray and a Computed Tomography (CT), with raised serum levels of Angiotensin Converting Enzyme (ACE), were compatible with a diagnosis of sarcoidosis. The mammography and ultrasonogram showed a solitary little nodular lesion localized in the breast. A breast cancer in a patient with sarcoidosis? To answer this question, the patient performed breast surgery under general anaesthesia and bioptic microscopic examination showed a typical sarcoid granuloma.     

Nocardiosis presenting as an anterior mediastinal mass in a patient with sarcoidosis

We report a patient with tissue-proven sarcoidosis receiving adrenocorticosteroid medication, who developed an enlarging mediastinal mass. Transcutaneous needle biopsy of the mass yielded pus which grew Nocardia asteroides on culture. Pleural effusion, bronchoesophageal fistula and brain nocardia metastases occurred. All evidence of active infection cleared with sulfa therapy. An enlarging mass in a patient with sarcoidosis unresponsive to corticosteroid therapy should provoke studies for other causes of mediastinal disease, including opportunistic infections.     

Musculoskeletal sarcoidosis in an Ethiopian

We report a patient with osseous lesions of his fingers and thumbs that eventually were proved to be a manifestation of systemic sarcoidosis. This had been mis-diagnosed as tuberculosis and the patient had previously been treated without effect with two full courses of anti-tuberculosis chemotherapy. Eventually the clinical and radiological suspicions were confirmed by biopsy.     

Breast conserving surgery for male noninvasive intracystic papillary carcinoma: a case report

We report an exceedingly rare case of male breast cancer on two brothers. The patient has family history that his younger brother had breast cancer 5 years ago. The patient was 70-years old man who presented with chief complaint of an indolent tumor mass of the left breast. Mammography demonstrated a well defined mass with microcalcifications. Noninvasive intracystic papillary carcinoma was diagnosed by excisional biopsy. We performed breast conserving surgery (BCS) with sentinel lymph node biopsy for this patient. The histological diagnosis was same as above, with no metastasis of sentinel lymph node. Immunohistochemical study showed estrogen receptor (ER) and progesterone receptor (PgR) were positive respectively, and human epidermal growth factor receptor type 2 (HER2/c-erbB-2) was negative. After surgery, he underwent radiation therapy of 60 Gy for left chest wall include nipple and areolar area. We report the case of BCS for male breast cancer. The preservation of the nipple areolar complex in male patients may also have a positive psychological impact as is the case in women treated for breast cancer. Our patients report an outstanding cosmetic result. As for the man, breast conserving therapy should be enforced without overt nipple and areolar involvement like a woman.     

A case of granulomatous renal sarcoidosis with a dramatic response to corticosteroid and urokinase therapy

A case of renal granulomatous sarcoidosis that presented with chronic renal failure (CRF) is described. Renal biopsy specimens revealed typical features of sarcoidosis in light microscopy and immunofluorescence microscopy examinations. The absence of bilateral hilar lymphadenopathy (BHL) was a distinctly unusual feature of sarcoidosis although uveitis and rectal granuloma were observed during the clinical course. A dramatic response occurred on corticosteroid and urokinase therapy, characterized by a fall of serum creatinine levels.     

Concomitant sarcoidosis in a patient with tuberculosis: first report of association in Africa

Sarcoidosis occasionally develops in patients previously treated for tuberculosis. Less commonly, tuberculosis develops as an opportunistic infection in patients following corticosteroid treatment for sarcoidosis. Rarely do you find sarcoidosis and tuberculosis coexisting in the same patient. This report in an African, documents the co-existence of both diseases in a patient, highlighting this relationship and reviews the literature on the possible aetiologic relationship between tuberculosis and sarcoidosis.     

Lupus mastitis in systemic lupus erythematosus: a rare condition requiring a minimally invasive diagnostic approach

Breast involvement is a rare event in SLE patients. The most frequent presentation is lupus panniculitis with skin erythema, tenderness, and parenchymal nodules. However, when breast masses are detected in SLE patients without significant superficial inflammation, it is mandatory to rule out breast carcinoma. Here, we report the case of a 47-year-old woman with an 18-year-long history of SLE, who presented with a suspicious breast mass. Since surgical trauma has been reported to be able to exacerbate breast inflammation in lupus mastitis, an ultrasound-guided minimally invasive Mammotome biopsy was performed to obtain tissue samples for histological and immunohistochemical examinations. Histology was consistent with lupus mastitis. The patient was already on mycophenolate mofetil and hydroxychloroquine. At the latest follow-up visit 6 years later, no progression of the breast lesion was observed.     

乳腺癌保乳术及前哨淋巴结活检术18例报告

目的探讨早期乳腺癌行保乳术及前哨淋巴结活检术的应用效耀。方法回顾性总结早期乳腺癌行保乳术＋前哨淋巴结活检术治疗乳腺癌18例的临床资料，所有患者采用肿瘤局部扩大切除，术后辅以化疗（除1例小管癌外）、放疗和内分泌治疗。结果本组18例，保乳均获成功，成功率100％。保乳术后乳房外形满意，其中17例共活检到前哨淋巴结，平均每例为1．8枚，检出率94．4％，阳性符合率100％。结论临床早期乳腺癌采用保乳手术加综合治疗可以取得满意的临床疗效，且美容效果良好，可作为早期乳腺癌的首选治疗方法。前哨淋巴结活检可以准确预测乳腺癌患者腋窝淋巴结状态。     

64层螺旋CT在肺部结节病影像学诊断中的价值

目的 探讨在诊断肺部结节病患者时采用64层螺旋CT检查的临床价值,观察其影像学特征.方法 30例肺部结节病患者,均经活检检查确诊为肺部结节病,对其进行64层螺旋CT检查,将检查结果 与活检检查结果 进行对比,分析其诊断符合率,并观察肺部结节病的影像学特征.结果 以活检检查结果 作为诊断金标准,64层螺旋CT检查结果 符...     

Breast angiosarcoma one year after adenosquamous endometrial cancer �� diagnostic pitfalls

Angiosarcoma of the breast is a rare and very aggressive tumors originated from endothelial cells lining blood vessels. We report a case of a 55-year-old postmenopausal female with a primary breast angiosarcoma diagnosed just a one year after radical hysterectomy and radiation therapy due to endometrial cancer. The patient initially presented with postmenopausal bleeding. Cytology and biopsy of the endometrium were performed and endometrial adenosquamous carcinoma was diagnosed followed by radical hysterectomy and postoperative local radiatiotherapy (50 Gy). One year later patient presented with a great painful tumorous mass in the right breast. Physical examination revealed an oval tumor, located in upper and outer quadrant of the right breast, around 15 cm in diameter. Mammography and ultrasonography were performed. The angiosarcoma of the breast was confirmed by biopsy. The patient underwent radical mastectomy. Histopathology proved the diagnosis of angiosarcoma (high-grade, numerous mitoses over 10/10 HPF, necrosis, ??blood lakes??, infiltrative borders). Differential diagnosis of a breast angiosarcoma should be considered in all painful breast tumours no mather the time and the location of the previous radiation treatment even if benign characteristics of these masses have been detected by mammography and breast ultrasound.     

高频超声引导下乳腺肿块穿刺活检的体会

目的在超声引导下乳腺肿块穿刺活组织病理学检查鉴别诊断良、恶性肿瘤。方法对73例超声诊断乳腺实质性肿块的女性患者,采用日本生产自动活检枪及16G活检针,在超声引导下穿刺乳腺肿块,取出组织2～3条,送病理学检查。结果病理诊断乳腺良性病变31例（42.4%）,乳腺恶性肿瘤42例（57.6%）,其中浸润性导管癌25例,髓样癌13例,硬癌3例,炎性癌1例。结论高频超声引导下乳腺肿块术前穿刺活检,可确定良、恶性肿瘤,对制定手术方案提供了依据,替代术中快速活检,缩短了手术时间,提高了手术质量,是一种理想诊断方法。     

A case of ichthyosiform sarcoidosis with unusual localization

Sarcoidosis is a systemic granulomatous disease of unknown cause that commonly involves the lungs, lymph nodes, bones, liver, spleen, or skin. Cutaneous findings of sarcoidosis occur in 20% to 35% of patients with systemic disease. The recognition of cutaneous lesions is important, because it gives important clues to diagnosis and also allows for easy biopsy. We report a 71-year-old Turkish woman with erythematous lesions, which included widespread, erythematous macules of various sizes on the chest, abdomen, and back on both sides of her body. Fine white scales covered some of the lesions. Hepatomegaly and bilateral hilar lymphadenopathy were also observed. Biopsy specimens of the skin showed dermal, noncaseating, epitheloid granulomas. The diagnosis, based on correlation of the clinical presentation and histopathological findings, was ichthyosiform sarcoidosis with systemic involvement. The difference between our case and other cases of ichthyosiform sarcoidosis described in the literature is that ours involved only the trunk and not the extremities. We are presenting this case because it is an interesting and rare variant of ichthyosiform sarcoidosis.     

真空辅助乳腺微创旋切术在乳腺良性疾病应用进展

真空辅助乳腺活检系统(VABB)由美国食品与药品监督管理局于1995年批准应用于乳腺肿物的活检。该系统包括内外套针、旋切刀、传送装置、真空抽吸泵、控制器及相关软件等组成。VABB可在多种影像学引导下(乳腺超声、MRI、X线)对乳腺病灶切除活检。起初VABB系统主要应用于乳腺病灶的活检,如早期乳腺癌的诊断。由于VABB通过影像学引导下精确完整切除病灶,能够获得足够量的组织样本进行病理学检查,因此广泛应用于良性乳腺疾病的治疗,如良性乳腺肿瘤的切除、乳腺炎、乳腺整形手术等,成为乳腺微创手术的重要手段。     

Tru-cut biopsy of palpable breast lesions: a practical option for pre-operative diagnosis in developing countries

OBJECTIVES: To establish the role of Tru-cut needle biopsy in the pre-operative diagnosis of breast lesions in a developing country. DESIGN: Prospective cross sectional study. SUBJECTS: 112 consecutive patients with palpable breast lesions who had both Tru-cut and excision biopsy as a pre-operative diagnostic procedure. RESULTS: Four (3.6%) patients had specimens that were inadequate for histological diagnosis. Tru-cut biopsy diagnosed 42 of the remaining 108 as malignant and 66 as benign, but only 40 and 61 respectively were confirmed to be correctly so by excision biopsy. Tru-cut biopsy, therefore, achieved a sensitivity of 88.9% (95% CI 79.7 to 98.1) specificity of 96.8% (95% CI 92.5 to 100) and an over all diagnostic accuracy of 93.5% (95% CI 88.9 to 98.2). There was a false positive rate of 4.8%, a false negative rate of 7.6% and a positive predictive value of 95.2%. The pathologist was able to make a correct specific histological diagnosis in 76.2% of all the adequate Tru-cut samples. CONCLUSION: If Tru-cut biopsy is done instead of excision biopsy, it will sufficiently reduce waiting time and reduce cost (four fold). It is well tolerated by patients. We regard the procedure as a useful adjunct and indeed a practical option for accurate pre-operative diagnosis of palpable breast lesions.     

The use of infliximab in cutaneous sarcoidosis

Infliximab, a chimeric (humanized mouse) monoclonal antibody which specifically inhibits TNF-alpha, has recently shown efficacy in the treatment of refractory sarcoidosis. The manifestations of sarcoidosis are diverse; however, the long-term effects on the lungs are often the most life-threatening. We describe a patient with sarcoidosis who experienced the complete resolution of her cutaneous disease and stabilization of her pulmonary symptoms after initiation of infliximab.     

乳腺肿块324例诊治体会

目的总结乳腺肿块诊治经验。方法对2009年12月至2013年12月门诊诊治的324例乳腺肿块资料进行回顾性分析。结果经空芯针活检、切取活检、切除活检，确诊乳腺癌31例、肉瘤1例，肿块切除活检305例，明确诊断，脓肿切开引流9例，均门诊治愈。结论彩色多普勒检查、空芯针活检、切除活检是诊治乳腺肿块的最佳方法。     

肺结节病的误诊分析

目的 提高列肺结节病的认|只和诊断符合率：方法 对1990～2001年诊治的6例结节病患者的临床误诊资料进行分析。结果和结论 肺结节病临床表现不典型，胸部X线及CT常表现为肺门增大，以双侧肺门肿大为主，易误诊为肺结核或肿瘤。经纤维支气管镜括检或皮肤粘腆、淋巴结活检可确诊。肺结节病多见青中年成人，女性发病率高，临床症状不典型，在诊断上要结合临床表现、胸片以及纤维支气管镜、皮肤粘膜、淋巴结活检进行病理检查。     

Extrapulmonary location of sarcoidosis.

Two cases of sarcoidosis located outside the lungs are reported. In both cases the symptoms of the sicca syndrome were in the foreground. In the first case other clinical manifestations included mediastinal and retroperitoneal lymphadenopathy, and lacrimal gland impairment. In the other case the symptoms of the sicca syndrome were associated with polyneuropathy and maculopapular skin rash. The diagnosis of sarcoidosis was confirmed by histological examination of a biopsy specimen of lower lip mucosa in the first case, and biopsy of skin lesion in the second case. Abnormal results of laboratory tests included only raised erythrocyte sedimentation rate, in both cases and presence of circulating immune complexes in one case. Serological tests failed to demonstrate the presence of rheumatoid factor, antinuclear and anti-ds DNA antibodies. No decrease was observed also in the haemolytic activity of the complement, and cryoglobulins were absent. Regression of clinical signs was obtained in both cases after treatment with glucocorticosteroids.     

肺结节病30例临床分析

目的探讨结节病的临床特点和诊断方法。方法回顾分析我院自1997年来经组织病理学确诊的30例结节病患者的临床资料。结果女性多于男性,男∶女为1∶2.0,平均发病年龄42.1岁。其中0期1例,Ⅰ期12例,Ⅱ期15例,Ⅲ期2例。呼吸道症状以咳嗽胸闷气促最多,分别占46.7%(14/30)、40.0%(12/30)和36.7%(11/30)。全身症状主要为乏力消瘦33.3%(10/30)和发热23.3%(7/30)。血清血管紧张素转换酶阳性率为70.0%。胸部X线、CT检查显示:肺门、纵隔淋巴结肿大伴或不伴两肺病变。经气管镜支气管黏膜活检和肺组织活检阳性率分别为72.7%和66.7%,纵隔镜活检阳性率100%。结论结节病易误诊,误诊率43.3%。结节病临床表现无特异性,对有肺门纵隔淋巴结肿大的可疑病例,应尽可能作组织病理学检查明确诊断。     

活检枪在乳腺癌诊断中的应用

目的：探讨活检枪在乳腺癌的诊断中的效果。方法：以半自动活检枪行局部活检术对患者作出病理诊断。结果：活检枪诊断乳腺癌准确率高,且具有创伤小、痛苦少、费用低等优点。结论：以活检枪检测乳腺癌操作简单、安全、迅速,是肿瘤确诊的重要手段之一。