Presentation: Clinical and Histological Characterization of Vasculitis Involving the Breast (2007)

2022 Clinical and Histological Characterization of Vasculitis Involving the Breast

Background: Vasculitis of the breast (VB) may be an isolated finding or the initial manifestation of systemic vasculitis. Because this entity has been rarely reported, there are no clearly established clinical or histologic prognostic guidelines that help predict development of systemic disease in patients presenting with isolated vasculitis of the breast (IVB).
Purpose: To characterize clinical and histopathologic patterns of VB.
Methods: Analysis of all reports of VB including data from patients in our center. Breast histology led to the initial diagnosis of vasculitis. Patients with a prior diagnosis of systemic vasculitis were excluded. Clinical, laboratory, histologic features, course of illness, and treatment were analyzed. Histopathologic assessment was based on size of affected vessels, and pattern of inflammation [necrotizing (NV) or granulomatous vasculitis (GV)].
Results: A total of 31 cases of VB (30F/1M) were identified from the literature (n=29) and our pathology database (n=2). All patients presented with either unilateral (n=17) or bilateral (n=14) breast masses. Breast manifestations were the only expression of disease in 14 patients, while 17 cases presented with other symptoms. Non-specific symptoms, such as fever, malaise, weight loss, myalgias and arthralgias, were present in 55% (17/31) of patients. Median follow-up was 14 months (range 1-96). Based on degrees of certainty of presence or absence systemic disease, patients with VB were divided in 3 groups: IVB (n=17, group 1), VB with uncertain systemic involvement (n=7, group 2), and VB with definitive systemic involvement (n=7, group 3). No differences were found between groups in age, duration of symptoms prior to diagnosis, characteristics of breast lesions, length of follow-up, biopsy procedure and size of affected vessels. Constitutional symptoms occurred less often in group 1, but myalgias (6/14) and arthralgias (8/14) occurred only among patients in groups 2 and 3. Group 1 showed significantly lower ESR values and higher hemoglobin levels than groups 2 and 3. Breast histology in group 1 revealed 9/17 samples with GV and 8/17 with NV. In groups 2 and 3 NV was seen in 6/14 and GV in 8/14 cases. In group 1, 12/17 (71%) had excisional biopsies and 5/12 (29%) were diagnosed by needle-biopsy. Only 1/17 (6%) patients (with local relapse) in group 1 received systemic therapy, while 5/7 (71%) in group 2, and 6/7 (85%) in group 3 received corticosteroids.
Conclusions: Histologic patterns of VB did not correlate with the presence of multi-system disease. Musculoskeletal symptoms only occurred in patients with other systemic features and were absent in those with IVB. Patients with IVB had lower acute phase reactant abnormalities than patients with systemic disease. IVB usually does not require systemic therapy. Patients with IVB have lesions that may regress spontaneously. Surgical resection of breast lesions was adequate therapy for most patients with IVB.

  J. Hernandez-Rodriguez, R. J. Fasenmyer Center for Clinical Immunology and Hospital Clinic Barcelona Awards, 9; C.D. Tan, None; E.S. Molloy, None; C.L. Koening, None; A. Khasnis, None; E. Rodriguez, None; G.S. Hoffman, None.