A Case of Antineutrophil Cytoplasmic Antibody-negative Granulomatosis with Polyangiitis Presenting as Breast Mass

Min Gyo Kim; Jae Hyeong Huh; Yun Hong Cheon; Sang Yeong Cho; Gyung Hyuck Ko; Hyun Ok Kim; Ji Eun Kim; Hye Yeong Choi; Sang Il Lee

doi:10.4078/jrd.2014.21.4.219

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Kim, Huh, Cheon, Cho, Ko, Kim, Kim, Choi, and Lee: A Case of Antineutrophil Cytoplasmic Antibody-negative Granulomatosis with Polyangiitis Presenting as Breast Mass

Case Report

J Rheum Dis 2014;21(4):219-222.

Published online: 31 October 2014

DOI: https://doi.org/10.4078/jrd.2014.21.4.219

A Case of Antineutrophil Cytoplasmic Antibody-negative Granulomatosis with Polyangiitis Presenting as Breast Mass

Min Gyo Kim¹, Jae Hyeong Huh¹, Yun Hong Cheon¹, Sang Yeong Cho¹, Gyung Hyuck Ko^2,⁴, Hyun Ok Kim^1,⁴, Ji Eun Kim³, Hye Yeong Choi³, Sang Il Lee^1,⁴

¹Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

²Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea

³Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea

⁴Department of Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea

Corresponding to: Sang Il Lee, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University School of Medicine, 90, Chilam-dong, Jinju 660-702, Korea. E-mail: glodgu@gnu.ac.kr

Received 11 July 2013 Revised 25 September 2013 Accepted 11 October 2013

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Granulomatosis with polyangiitis (GPA) is a disease characterized by a granulomatous necrotizing vasculitis of the small vessels, along with the presence of antineutrophil cytoplasmic antibody (ANCA), serologically. GPA is a multisystem disease, in which the diagnosis is frequently based on respiratory and renal manifestations, with rare breast invasion. To date, several cases of breast invasion by GPA have been published, and most cases have been positive for ANCA. However, ANCA-negative forms of breast invasion by GPA are extremely rare and have not been reported in Korea thus far. Therefore, we report a case of ANCA-negative GPA in a 70-year-old woman, who was initially presented with a localized palpable mass in the left breast.

Keywords: Granulomatosis with polyangiitis, Antibodies, Antineutrophil cytoplasmic, Breast

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Figure 1.

(A) Breast ultrasonography shows the lesion which is the prominent superficial vessels with diffuse wall thickening (arrows) and increased echogenicity of subcutaneous fat, surrounding them (arrow heads). (B) Follow-up breast ultrasonography after treatment shows the lesion is replaced by normal vessel conditions and does not obtain increased echogenicity of subcutaneous fat anymore.

Figure 2.

Histopathologic specimen of the breast demonstrates granulomatous inflammation in the small artery, media (arrow) and fibrinoid necrosis with neutrophilic infiltration in small artery, intima (arrow heads) (Hematoxylin and eosin, original magnification ×200).

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