Fine Needle Aspiration Cytology of Granulomatous Lesions of The Breast
A Six-Year Retrospective Study
Keywords:
Granulomatous mastitis, mycobacterium tuberculosis, meliodosis, histiocytes, giant cells
Abstract
Background: Granulomatous lesions of the breast are uncommon and can mimic malignancy. Fine needle aspiration (FNA) is among the first investigations in such patients. Cytological diagnosis in the absence of granulomas may pose a diagnostic dilemma. The present study outlines the cytological features of such lesions. Methods: This was a 6-year (January 2011 and December 2016) retrospective study. Cases with a biopsy proven diagnoses of granulomatous mastitis having FNA of the corresponding lesion were included in the study. Clinical, radiological and microbiological details were retrieved from the medical records. The cytology slides were reviewed and correlated with clinical and histopathological findings. Result: Thirty-two cases were included in the study. The age range was 22 to 62 years. On cytology, 17 showed well-formed granulomas. One case each of Mycobacterium tuberculosis and Burkholderia pseudomallei were identified by culture. Among the 15 cases with no granulomas, scattered histiocytes and giant cells were seen. Most patients presented with breast lump and fever. Uncommon presentations included peau de orange, skin erythema, induration, nipple retraction and axillary lymphadenopathy. Most lesions were hypoechoic on mammography. Nine cases were clinically suspicious for malignancy while rest were diagnosed as abscess, fibroadenoma or mastitis. Conclusion: In the developing world, tuberculosis and meliodosis can present with granuloma formation. In the breast, these entities can have overlapping features with idiopathic granulomatous mastitis. In the absence of granulomas on cytology, these lesions may be mislabeled as breast abscess. In such cases, the presence of scattered histiocytes and giant cells may aid in diagnosing these lesions.References
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8. Tauro LF, Martis JS, George C, Kamath A, Lobo G, Hegde BR. Tuberculous mastitis presenting as breast abscess. Oman Med J. 2011 Jan;26(1):53-5.
9. Mickail N, Klein NC, Cunha BA, Schoch PA. Melioidosis breast abscesses. J Infect 2102;64(4):434-5.
10. Gupta RK. Fine needle aspiration cytology of granulomatous mastitis: a study of 18 cases. Acta Cytol. 2010 Mar-Apr;54(2):138-41.
11. Kishore B, Khare P, Gupta RJ, Bisht SP. Fine Needle Aspiration Cytology in the Diagnosis of Inflammatory Lesions of the Breast with emphasis on Tuberculous Mastitis. J Cytol 2007;24(3):155-6.
12. Tse GMK, Poon CSP, Law BKB, Pang LM, Chu WCW, Ma TKF. Fine needle aspiration cytology of granulomatous mastitis. J Clin Pathol 2003;56:519–21.
13. Gangopadhyay M, De A, Chakrabarti I, Ray S, Giri A, Das R. Idiopathic granulomatous mastitis-utility of fine needle aspiration cytology (FNAC) in preventing unnecessary surgery. J Turk Ger Gynecol Assoc 2010;11(3):127-30.
14. Ail DA, Bhayekar P, Joshi A, Pandya N, Nasare A, Lengare P, Narkhede KA. Clinical and cytological spectrum of granulomatous mastitis and utility of FNAC in Picking up tubercular mastitis: an eight-year study. J Clin Diagn Res. 2017 Mar;11(3):EC45-EC49.
With A Brief Review Of Literature. J Clin Diagn Res. 2010;4:2913-7.
2. Bakaris S, Yuksel M, Ciragil P, Guven MA, Ezberci F, Bulbuloglu E. Granulomatous mastitis including breast tuberculosis and idiopathic granulomatous mastitis. Can J Surg. 2006 Dec;49(6):427-30.
3. Gangopadhyay M, De A, Chakrabarti I, Ray S, Giri A, Das R. Idiopathic granulomatous mastitis-utility of fine needle aspiration cytology (FNAC) in preventing unnecessary surgery. J Turk Ger Gynecol Assoc 2010;11(3):127-30.
4. Helal TE, Shash LS, Saad El-Din SA, Saber SM. Idiopathic granulomatous mastitis: cytologic and histologic study of 65 Egyptian patients. Acta Cytol. 2016;60(5):438-44.
5. Boufettal H, Essodegui F, Noun M, Hermas S, Samouh N. Idiopathic granulomatous mastitis: a report of twenty cases. Diagn Interv Imaging. 2012 Jul;93(7-8):586-96.
6. Kiyak G, Dumlu EG, Kilinc I, Tokaç M, Akbaba S, Gurer A, Ozkardes AB, Kilic M. Management of idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment. BMC Surg. 2014 Sep 4;14:66.
7. Vidyavathi K, Udayakumar M, Suresh TN, Sreeramulu PN. Granulomatous Mastitis: A Cytological Dilemma. J Cytol Histol 2012; 3:137.
8. Tauro LF, Martis JS, George C, Kamath A, Lobo G, Hegde BR. Tuberculous mastitis presenting as breast abscess. Oman Med J. 2011 Jan;26(1):53-5.
9. Mickail N, Klein NC, Cunha BA, Schoch PA. Melioidosis breast abscesses. J Infect 2102;64(4):434-5.
10. Gupta RK. Fine needle aspiration cytology of granulomatous mastitis: a study of 18 cases. Acta Cytol. 2010 Mar-Apr;54(2):138-41.
11. Kishore B, Khare P, Gupta RJ, Bisht SP. Fine Needle Aspiration Cytology in the Diagnosis of Inflammatory Lesions of the Breast with emphasis on Tuberculous Mastitis. J Cytol 2007;24(3):155-6.
12. Tse GMK, Poon CSP, Law BKB, Pang LM, Chu WCW, Ma TKF. Fine needle aspiration cytology of granulomatous mastitis. J Clin Pathol 2003;56:519–21.
13. Gangopadhyay M, De A, Chakrabarti I, Ray S, Giri A, Das R. Idiopathic granulomatous mastitis-utility of fine needle aspiration cytology (FNAC) in preventing unnecessary surgery. J Turk Ger Gynecol Assoc 2010;11(3):127-30.
14. Ail DA, Bhayekar P, Joshi A, Pandya N, Nasare A, Lengare P, Narkhede KA. Clinical and cytological spectrum of granulomatous mastitis and utility of FNAC in Picking up tubercular mastitis: an eight-year study. J Clin Diagn Res. 2017 Mar;11(3):EC45-EC49.
Published
2020-03-11
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