alexa Can Lupus Mastitis be Treated Surgically? | OMICS International
ISSN: 2161-0533
Orthopedic & Muscular System: Current Research
Like us on:
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Can Lupus Mastitis be Treated Surgically?

Taner Dandinoglu1*, Ozgür Dandin2, Yasam Kemal Akpak3, Tuncer Ergin4 and Murat Karadeniz5

1Department of Physical Medicine and Rehabilitation, Bursa Military Hospital, Bursa, Turkey

2Department of General Surgery, Bursa Military Hospital, Bursa, Turkey

3Department of Obstetrics and Gynecology, Mevki Military Hospital, Ankara, Turkey

4Department of Radiology, Bursa Military Hospital, Bursa, Turkey

5Department of Physical Medicine and Rehabilitation, Çorlu Military Hospital, Tekirdag, Turkey

*Corresponding Author:
Taner Dandinoglu
Department of Physical Medicine and Rehabilitation
Bursa Military Hospital, Bursa, Turkey
Tel: +90 533 691 40 66
Email: [email protected]

Received Date: March 10, 2014; Accepted Date: March 21, 2014; Published Date: March 27, 2014

Citation: Taner Dandinoglu, Ozgür Dandin, Yasam Kemal Akpak, Tuncer Ergin, Murat Karadeniz (2014) Can Lupus Mastitis be Treated Surgically?. Orthop Muscul Syst 3: 148. doi: 10.4172/2161-0533.1000148

Copyright: © 2014 Dandinoglu T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Orthopedic & Muscular System: Current Research

Abstract

Lupus mastitis is a rare chronic inflammatory reaction of the sub-cutaneous fatty tissue of the breast and may
appear in 2-3% of patients with systemic lupus erythematosis. Surgical intervention is not needed for the treatment
of lupus mastitis, and if necessary the least invasive procedure should be chosen. In this case, despite the use of
hydroxychloroquine and oral steroids, patient with malignancy risk and ongoing complaints went to excision. Surgery
appears to be effective in patients with ongoing complaints despite the adequate medical treatment.

Introduction

Lupus mastitis (LM) is an uncommon and rare clinical presentation of systemic lupus erythematosus (SLE) which is described as benign inflammation of the deep subcutaneous adipose tissue of the breast. While a vast majority of patients present with systemic or discoid lupus (DL), LM can be the initial finding [1]. When the breast is affected, the term LM is used. The etiology is not clearly known. Skin manifestations of LM are as follows: epidermal atrophy, hyperkeratosis, lipoatrophy, erythema, hypertrichosis, ulceration and if left untreated - even fistulization, atrophy with scarring and retraction may develop. LM has a chronic course with aggravation and remission. Clinically close follow-up is required as flare ups can emerge in a different area. Antibodies can present, but are not required for the diagnosis [1,2]. Breast lupus panniculitis are usually solid and can mimic malignancies [3]. If skin changes are evident, it may be difficult to distinguish LP from inflammatory breast cancer [4]. While hydroxychloroquine is the first line treatment option for LM, systemic steroids and cyclophosphamide may also be used [5]. Deep localisation of the lesions mostly require tissue biopsy to determine whether a neoplasm exists or not. In patients diagnosed with SLE or DL, aggressive surgical interventions can trigger exacerbation [6]. In this paper, we report a case of surgically treated lupus mastitis which has ongoing complaints despite medical treatment for nearly two years.

Case

A 46-year-old woman presented to an outpatient clinic with redness, retraction and discharge from her left nipple (Figure 1). Medical history revealed that she has been using hydroxychloroquine at 400 mg/day for 1 year and 10 mg/kg/day prednisone for nearly 2 years (due to suspicion of aggravation, 1 mg/kg/day prednisone for the last 3 months). Despite this medical treatment regimen, the patient continued to have the same complaints.

orthopedic-muscular-system-redness-retraction-nipple

Figure 1: A 46-year-old woman with redness, retraction and discharge from left nipple

Antinuclear antibody titers were low. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and other routine lab tests were in normal range. Leucopenia, anemia and thrombocytopenia were not observed. A breast ultrasound revealed increased echogenicity of the sub-cutaneous adipose tissue and parenchyma due to edema, thickening of the skin and a sub-cutaneous fistula extending through the skin in the lower outer quadrant of the left breast.

The suspicious mass was completely excised due to malignancy risk and complaints refractory to guideline medical treatment. No complications were seen post operatively, and wound healing was also normal (Figure 2). Histopathological examination of the excised tissue revealed lymphocytic lobular panniculitis containing plasma cells and fat necrosis (Figure 3). In addition to hydroxychloroquine at 200 mg/day, the patient has been using prednisone 10 mg/day post operatively. A follow-up program including 6 consecutive monthly breast ultrasounds was planned. In the 10 months since the patient's intervention, she has had no further symptoms of panniculitis in her breast.

orthopedic-muscular-system-patient-breast-intervention

Figure 2: Patient’s left breast after intervention

orthopedic-muscular-system-lupus-mastitis-histopathologic

Figure 3: 46-year-old woman with lupus mastitis. Photomicrographs of histopathologic specimen of excised tissue show lymphocytic panniculitis

Discussion

Panniculitis is an inflammatory condition of sub-cutaneous fat tissue which is associated with several conditions including SLE and other connective tissue diseases. When associated with SLE or DL and presenting with breast involvement it is called LM. It occurs in 2% to 3% of SLE patients [2]. Typical lesions are deep subcutaneous nodules described as a firm, irregular, well-circumscribed palpable mass which is suspicious for a breast neoplasm [6,7]. Mammographic image of LM typically shows a dense, irregular, heterogeneous breast tissue [8]. A breast ultrasound can show skin thickening and a heterogeneous mass which is usually hyperechoic and may extend into the sub-cutaneous fat [9]. Histological examination reveals panniculitis with a marked lymphocytic infiltrate of the fat lobules which mimics a breast tumor [10].

Antimalarial drugs are the primary medical treatment option for LM, corticosteroids may also be used in combination or alone. Surgical interventions take place when lesions mimic a neoplasm. Although the patient with LM is under risk of malignancy, surgery should only be considered in patients whith ongoing complaints despite appropriate medical treatment, because of the possibility of triggering the risk of additional exacerbations [6].

In this report, despite the use of hydroxychloroquine and oral steroids for nearly 2 years, the patient with ongoing complaints and suspected malignancy went to excision for a clear diagnosis and management of the disease. Histopathologic specimen of excised tissue shows lymphocytic panniculitis, which is congruent with LM.

In this case, although it has been reported that trauma can initiate or exacerbate the disease, surgery appears to be effective in patients with an increased risk for malignancy and ongoing complaints despite appropriate medical treatment. In conclusion, we aimed to emphasize and note that surgery may be reasonable and more appropriate under certain conditions for carefully selected LM patients. Additional experimentations and studies are needed to determine certain decisions.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Article Usage

  • Total views: 12755
  • [From(publication date):
    March-2014 - Dec 18, 2017]
  • Breakdown by view type
  • HTML page views : 8969
  • PDF downloads : 3786
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version