Zusammenfassung
Die Wegener'sche Granulomatose ist eine Multisystem-Erkrankung, die durch eine nekrotisierende granulomatöse Entzündung und Vaskulitis der kleinen Gefäße, die alle Organsysteme befallen kann, gekennzeichnet ist. Die häufigsten Lokalisationen sind der obere und der untere Respirationstrakt, sowie die Nieren. Der Befall der Brust ist ungewöhnlich und äußerst selten. Wir berichten über eine 32-jährige Patientin, die sich mit pulmonalen Läsionen und tastbaren Tumoren in der linken Brust präsentierte. Die Mammographie zeigte multiple, scharf begrenzte Knoten ohne Mikrokalzifikationen. Die Echographie ergab multiple solide Läsionen mit herabgesetzter Echogenität, wobei manche davon zentrale Nekrosen aufwiesen. Die Computertomographie zeigte multiple Knoten. Die Histologie der biopsierten Läsionen der linken Mamma zeigten nekrotisierendes granulomatöses Material, das mit der Diagnose einer Wegener'schen Granulomatose kompatibel war. In der Literatur fanden wir 20 Berichte über Fälle mit Brustbefall bei Morbus Wegener. Die entsprechende ultrasonographische und computertomographische Bildgebung wurde allerdings bis jetzt noch nie berichtet.
Summary
Wegener's granulomatosis is a multisystem disorder characterized by necrotizing granulomatous inflammation and vasculitis of small vessels and can affect any organ system. The most common sites of involvement are upper and lower respiratory tracts, and kidneys. Breast involvement is unusual and very rare. We report a case of breast Wegener's granulomatosis in a 32-year-old woman who presented with pulmonary lesions and palpable masses in the left breast. Mammography showed multiple, sharply delineated nodules without microcalcifications. Ultrasonography revealed multiple hypoechoic solid lesions, some of them with anechoic areas of necrosis. Computed tomography showed multiple nodules. Histopathology of excision biopsy specimens of breast lesions revealed necrotizing granulomatous material consistent with Wegener's granulomatosis. Twenty reports of breast involvement in this rare disease were found in the literature; however, the respective ultrasonographic and computed tomography findings have not hitherto been described.
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References
Leavitt RY, Fauci AS, Bloch DA (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum 33: 1101
Duna GF, Galperin C, Hoffman GS (1995) Wegener's granulomatosis. Rheum Dis Clin N Am 21: 949–986
Lie JT (1997) Wegener's granulomatosis: histological documentation of common and uncommon manifestations in 216 patients. VASA 26: 261–270
Travis WD (1994) Common and uncommon manifestations of Wegener's granulomatosis. Cardiovasc Pathol 3: 217–225
Trüeb RM, Pericin M, Kohler E, Barandun J, Burg G (1997) Necrotizing granulomatosis of the breast. Br J Dermatol 137: 799–803
Göbel U, Kettritz R, Kettriz U (1995) Wegener's granulomatosis masquerading as breast cancer. Arch Intern Med 155: 205–207
Stappaerts I, Colpaert C, Verbraecken J, Van March E, Vermeire P (1999) Granulomatous mastitis as presenting sign of Wegener's granulomatosis. Acta Clin Belg 54: 207–210
Elsner B, Harper FB (1969) Disseminated Wegener's granulomatosis with breast involvement. Arch Path 87: 544–547
Chowdhury MM, Natarajan S (2000) Panniculitis of the breast preceding presentation of Wegener's granulomatosis by 7 years. Int J Dermatol 39: 312–320
Goulart RA, Mark EJ, Rosen S (1995) Tumefactions as an extravascular manifestation of Wegener's granulomatosis. Am J Surg Pathol 19: 145–153
Oimoni M, Suehiro I, Mizuno N, Baba S, Okada S, Kanazawa Y (1980) Wegener's granulomatosis with intracerebral and mammary manifestation. Arch Intern Med 140: 853–854
Wilson ME (1993) Wegener's granulomatosis: another cause of breast masses. Am J Med 95: 116
Shafiei K, Luther E, Archie M, Gulick J, Fowler M (2003) Wegener Granulomatosis: case report and brief literature review. J Am Board Fam Pract 16: 555–559
Jennings CR, Jones NS, Dugar RJ, Powell J, Lowe J (1998) Wegener's granulomatosis – a review of diagnosis and treatment in 53 subjects. Rhinology 36: 188–191
Langford CA (2003) Wegener's granulomatosis: current and upcoming therapies. Arthritis Res Therap 5: 180–191
Langford CA, Talar-Williams C, Sneller MC (2000) Use of methotrexate and glucocorticoids in the treatment of Wegener's granulomatosis. Long-term renal outcome in patients with glomerulonephritis. Arthritis Reum 43: 1836–1840
Jayne D (2001) Update on the European Vasculitis Study Group trials. Curr Opin Rheumatol 13: 48–55
Kleinert J, Lorenz M, Koestler W, et al (2004) Refractory Wegener's granulomatosis responds to tumor necrosis factor blockade. Wien Klin Wochensch 116: 334–338
Stegman CA, Cohen Tervaert JW, de Jong PE, et al (1996) Trimethoprim-sulfamethoxazole (co-trimoxazole) for the prevention of relapses of Wegener's granulomatosis. N Engl J Med 335: 16–20
Symmers WSC (1984) Tuberculosis of the breast. BMJ 289: 48–49
Ishimaru K, Isomoto I, Okimoto T, Itoyanagi A, Uetani M (2002) Sarcoidosis of the breast. Eur Radiol 12: S105–S108
Jorgensen MB, Nielsen DM (1992) Diagnosis and treatment of granulomatous mastitis. Am J Med 93: 97–101
Trüeb RM, Scheidegger EP, Pericin M, Singh A, Hoffman U, Sauvant G, Burg G (1999) Periarteritis nodosa presenting as a breast lesion: report of a case and review of the literature. Br J Dermatol 141: 1117–1121
Soleto MJ, Marcos L (2002) Behçet's disease involving the breast. Eur Radiol 12: S98–S100
Jordan JM, Rowe WT, Allen WB (1987) Wegener's granulomatosis involving the breast: report of three cases and review of the literature. Am J Med 83: 159–164
Deininger HK (1985) Wegener's granulomatosis of the breast. Radiology 154: 59–60
Wilson ME (1987) Wegener's granulomatosis presenting as breast abscess [letter]. Am J Med 83: 1168
Deininger HK (1984) Nachweis der Wegenerschen Granulomatose im Mammogramm. Fortschr Rontgenstr 141: 198–203
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Neralić-Meniga, I., Ivanovi-Herceg, Z., Mažuranić, I. et al. Wegener's granulomatosis of the breast. Wien Klin Wochenschr 118, 120–123 (2006). https://doi.org/10.1007/s00508-006-0536-y
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DOI: https://doi.org/10.1007/s00508-006-0536-y