Sarcoidosis of the breast: Implications for the general surgeon

Sarcoidosis is a multisystemic disease that may involve the breast parenchy ma and can be confused with benign or malignant tumors. A recent case of sa rcoidosis of the breast treated in our institution prompted us to review th e world literature on the topic. From 1921 to 1997, 45 cases relating to sa rcoidosis of the breast were reported; 10 of these cases were excluded from our review because of the lack of histological proof of sarcoidosis. The d ata were organized according to clinical presentation, diagnostic studies, treatment plan, and follow-up care. The mean age at presentation was 47 yea rs (range 20-72 years) and all patients were female. Seven patients (20%) h ad a breast mass as primary presentation of sarcoidosis without any clinica l evidence of systemic sarcoidosis. Thirty-one patients (89%) presented wit h a self-detected mass and three patients (8%) demonstrated skin dimpling a nd peau d'orange appearance mimicking cancer. The size of the breast lesion s ranged from 0.25 to 5 cm in diameter. One patient presented with bilatera l breast lesions and one with more than one lesion in the same affected bre ast. A single breast mass was found in the rest of the patients. Of the sev en patients evaluated by mammography, only one revealed changes suspicious for malignancy. Fine-needle aspiration was used only in four cases; the res ults of two were compatible with sarcoidosis and two required an excisional biopsy as a result of inconclusive results. Seventeen cases reported excis ional biopsy as the diagnostic procedure. In 11 patients the type of biopsy was not stated. In two cases of radical mastectomies for breast adenocarci noma, sarcoidosis was an incidental finding, either in the remaining breast tissue or in the axillary nodes. One patient underwent a partial mastectom y revealing sarcoidosis as the definitive diagnosis. Ultrasound was used in two cases; one revealed a suspicious lesion and one was inconclusive. Alth ough sarcoidosis of the breast constitutes a rare entity it should be consi dered in the differential diagnosis of breast cancer even in patients witho ut clinical evidence of systemic sarcoidosis. These patients should undergo a biopsy to rule out malignancy because clinical findings, mammography, an d ultrasound results can be misleading or inconclusive.