Baylor University Medical Center Proceedings April 2017 - 198

Figure 2. Sonographic images demonstrate (a) a dilated duct within the subareolar tissue and (b) an ill-defined hypoechoic lesion at the 11 to 12 o'clock
position of the right breast, corresponding to mammographic findings.

DISCUSSION
Sarcoidosis is an immunologic systemic disease of unknown etiology that can involve any organ and is most
frequently seen involving the lungs or lymph nodes. Extrapulmonary manifestations of sarcoidosis are identiﬁed in up
to 30% of patients, including the spleen, liver, skin, and heart
(1). Sarcoidosis of the breast accounts for <1% of cases (2,
3), with a review of the scientiﬁc literature showing only 35
histologically proven cases from 1921 to 1997 (3). Breast
involvement is seen most commonly in patients with a known
diagnosis of sarcoidosis who demonstrate multisystem ina

volvement. A breast lesion can rarely be the initial presentation of sarcoidosis, with 7 of the 35 reviewed patients having
a breast mass as the primary presentation without clinical
evidence of systemic sarcoidosis (3). The average age of presentation of mammary sarcoidosis is similar to the timeframe
of involvement of other anatomic structures, typically in the
third to fourth decades of life (4).
The clinical appearance and imaging characteristics of
breast sarcoidosis are variable. The clinical presentation can
include skin dimpling with a peau d'orange appearance, a
mobile nontender mass, or a tender lesion (3-5). Mammographic ﬁndings can range from a spiculated mass suspicious
for carcinoma to an ill-deﬁned or irregular lesion (3, 4). Microcalciﬁcations are not associated with sarcoidosis (6). The
ultrasound appearance can be variable, but typically demonstrates irregular hypoechoic masses (4). Magnetic resonance
imaging is also variable and can show a slow delayed persistent
postcontrast enhancement typical for a benign lesion or malignant characteristics with rapid postcontrast enhancement
with rapid washout (5-7).
It is suggested that sarcoidosis involves breast tissue by
epithelioid granulomas forming nodules among ducts and
lobules (4). Fat necrosis or caseous necrosis is not typically
found on pathology sampling (8, 9). While sarcoidosis of
the breast is extremely rare, it should be considered in the
diﬀerential diagnosis, as it can be seen even in patients without systemic manifestations of sarcoidosis (3). Although there
is no relationship between breast sarcoidosis and the risk of
breast cancer, as imaging ﬁndings and clinical characteristics
cannot distinguish between the two, it is recommended that
all suspicious breast lesions in patients with sarcoidosis are
biopsied to exclude underlying malignancy (10).
1.

Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H Jr,
Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ,
McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B,
Weinberger SE, Terrin ML, Knatterud GL, Cherniak R. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit
Care Med 2001;164(10 Pt 1):1885-1889.

Figure 3. Histological sections show confluent nonnecrotizing granulomas involving lobules and interlobular stroma.
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