Baylor University Medical Center Proceedings April 2017 - 197

Diagnosis of sarcoidosis from a biopsy of a dilated
mammary duct
Callan Mason, MD, Robert Yang, MD, Raynal Hamilton, MD, Metin Punar, MD, Zeeshan Shah, MD, Joseph Spigel, MD,
and Jean Wang, MD

Sarcoidosis is an immunologic disease of unknown
etiology that manifests
most frequently within the
lungs or associated lymph
nodes. Sarcoidosis involving the breast is seen in
<1% of cases and usually
is diagnosed in patients
with multisystem disease.
The clinical and imaging
presentations of sarcoidosis of the breast can be
variable. Though uncommon, sarcoidosis should
be considered in the differential diagnosis of a
breast lesion, and given
that imaging characteristics cannot distinguish
between sarcoidosis and Figure 1. Diagnostic right (a) cranial-caudal and (b) mediolateral-oblique views show a single dilated duct in the subareolar tissues
of the right breast with an associated asymmetric mammographic density at the 12 o'clock position 4 to 5 cm from the nipple.
malignancy, all breast
lesions in patients with sarcoidosis should be biopsied. Our case study
mammogram (Figure 1), with an associated asymmetry at the
12 o'clock position of the right breast 4 to 5 cm from the nipple.
demonstrates a diagnosis of sarcoidosis in an asymptomatic patient
Targeted ultrasound of the right breast also demonstrated the
presenting with a single dilated duct and associated filling defect within
dilated duct within the subareolar tissues, as well as an associthe right breast.

CASE DESCRIPTION
An asymptomatic 37-year-old black woman with no
signiﬁcant past medical history presented to Baylor University
Medical Center at Dallas for a bilateral diagnostic mammogram
due to concern for an underlying primary breast malignancy
after a recent chest computed tomography exam demonstrated
multiple pulmonary nodules and mediastinal and hilar adenopathy. The patient's physical exam was unremarkable, without a
palpable abnormality identiﬁed on a clinical breast exam. The
patient also denied breast problems such as nipple discharge
or skin changes. A single dilated duct was identiﬁed within
the subareolar tissues of the right breast on the diagnostic

Proc (Bayl Univ Med Cent) 2017;30(2):197-199

ated 1.2 cm ill-deﬁned hypoechoic lesion at the 11 to 12 o'clock
position (Figure 2). Percutaneous ultrasound-guided core needle
biopsy of the lesion was performed. Sections from the biopsy
sample demonstrated small nonnecrotizing epithelioid granulomas in interlobular and intralobular stroma of the mammary
parenchyma (Figure 3). Special stains were negative for acid-fact
bacilli and fungi. These morphological ﬁndings, together with
clinical ﬁndings, were consistent with a diagnosis of sarcoidosis.
From the Departments of Radiology (Mason, Yang, Hamilton, Shah, Spigel, Wang)
and Pathology (Punar), Baylor University Medical Center at Dallas, Texas.
Corresponding author: Callan Mason, MD, Department of Radiology, Baylor
University Medical Center at Dallas, 3500 Gaston Avenue, Dallas, TX 75246
(e-mail: callan.mason@bswhealth.org).

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