Giant cell arteritis (GCA) from the above article
Although giant cell arteritis is a systemic disease, on rare occasions the breast may be the primary organ of manifestation. In a review of the English medical literature up to 2008, Kadotani et al identified 20 reported cases, all of which were postmenopausal elderly women. Single or multiple lumps due to arteritis were present in 80% (16 of 20 patients), and redness and tenderness in the absence of lumps were present in 10%. Breast involvement was bilateral in 50% of the patients. Spontaneous breast pain and tenderness were presenting features in 85% of the patients. Systemic symptoms such as low-grade fever, arthralgia, myalgia, and those suggestive of polymyalgia rheumatica were present in 65% of the patients.
There have been no reports of mass lesions or other distinctive findings by mammography or ultrasonography. In a recent case report of a patient presenting with a lump in her breast and a negative mammogram, ultrasound of a stringlike thickening in the right axillary tail of the breast revealed a “halo sign” (hypoechoic circumferential wall thickening indicating edema), which, compared with biopsy, has been reported to have a sensitivity of 69% and a specificity of 82% for diagnosis of arteritis. In most cases reported in the medical literature, the diagnosis was made after excisional biopsy (a considerable amount of tissue is required to make the diagnosis of giant cell arteritis). In rare cases, the diagnosis was established before biopsy on the basis of systemic symptoms and ultrasound findings. Pathology shows fragmentation of the elastica in association with giant cell infiltration, intimal proliferation, and narrowing of the vascular lumina. Inflammatory cancer was suspected in four of seven cases reported by Kadotani et al.
Prednisone is the treatment of choice. It has been shown to improve both general symptoms and breast-specific manifestations of giant cell arteritis.
