PMC6419248_01
(a) Breast ultrasound shows left breast with cutaneous thickening, increasing echogenicity of subcutaneous tissue, superficial laminar collection, loss of fatty planes, and multiple anfractuous collections. (b) Percutaneous biopsy under ultrasound vision shows puncture needle (linear echogenic image) in collection area. (c) Ultrasound control shows no significant changes with respect to inflammatory changes. There is an anfractuous collection in the union of both outer quadrants of the left breast. (d) Digital mammography (localized and magnified plate) shows a diffuse dense breast with focal areas of higher density, related to areas of collections with no evident microcalcifications.
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Breast ultrasound revealed inflammatory changes characterized by cutaneous thickening, increasing echogenicity of subcutaneous tissue, superficial laminar collection, and loss of fatty planes due to multiple anfractuous collections (Figure 1(a)). A new ultrasound was performed showing no abscess formation and she underwent an ultrasound-guided core biopsy (Figure 1(b)). DCIS involvement, but both studies revealed no microcalcifications or other suspicious images for malignancy (Figure 1(c) and (d)). During the next months, she presented clinical worsening with several inflammatory collections growing in the outer quadrants, and she underwent incisional surgery and drainage of the collections.
Core biopsy of the breast. Note the multifocal distribution of the lesions; there are multiple foci of granulomatous lobular mastitis (blue arrows) and areas with ductal carcinoma in situ (red arrows) (hematoxylin-eosin 4x, original magnification).
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The diagnosis of GLM with coryneform bacteria associated with DCIS was established (Figures 2 and 3).
Core biopsy of the breast. (a) Granulomatous lobular mastitis (hematoxylin-eosin 10x, original magnification). (b) Coryneform bacteria in granulomatous lobular mastitis (Gram stain 40x, original magnification). (c) and (d) Solid ductal carcinoma in situ (hematoxylin-eosin 10x and 40x, respectively, original magnification).
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The diagnosis of GLM with coryneform bacteria associated with DCIS was established (Figures 2 and 3).
Surgical biopsy of the breast. (a) Skin (S) and breast tissue (BT). There are two areas with ductal carcinoma in situ (red arrows) and an area of granulomatous lobular mastitis (blue arrow) (hematoxylin-eosin 4x, original magnification). (b) Ductal carcinoma in situ (red arrows) coalescent with granulomatous lobular mastitis (blue arrow) (hematoxylin-eosin 10x, original magnification).
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With this information, the patient underwent a total mastectomy; we found, in both external quadrants, a wide region with DCIS, distant to more than 1 cm from all the surgical edges, also in coexistence with GLM (Figure 4).