title: Chronic granulomatous inflammation of the breast as a first clinical manifestation of primary sarcoidosis.
abstract: BACKGROUND
  Sarcoidosis is an idiopathic multisystemic disease that affects young to middle aged adults, with higher incidence in women. Although it may involve the breast parenchyma, primary sarcoidosis of the breast is very rare. It occurs in less than 1% of cases. In a differential diagnosis it may potentially be considered a malignancy.
  
  
  METHODS
  We report a case in which breast sarcoidosis was the first clinical manifestation of systemic disease in a 54-year-old woman who presented with wide erythematous skin changes associated with palpable induration. Considering the fact that physical examination and the results of mammography, ultrasound and magnetic resonance imaging were inconclusive and unable to rule out malignancy, biopsy was performed. Pathohistological diagnosis showed a non-necrotizing granulomatous inflammation without elements of breast cancer. Sarcoidosis was confirmed with elevated level of angiotensin-converting enzyme in the sera and characteristic chest multislice computed tomography findings. The bronchoalveolar lavage was infiltrated with lymphocytes.
  
  
  CONCLUSIONS
  Breast sarcoidosis has diverse and nonspecific imaging characteristics. Carcinoma must always be excluded by core needle biopsy. Achieving correct diagnosis is mandatory so that adequate corticosteroid therapy can be applied as early as possible. A multidisciplinary approach is of utmost importance in the diagnostic workup.
authors.affiliation: Department of Radiology, Clinical Hospital Center Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia.
authors.forename: Petra Valković
authors.initials: PV
authors.lastname: Zujić
authors.affiliation: Department of Surgery, Clinical Hospital Center Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia.
authors.forename: Damir
authors.initials: D
authors.lastname: Grebić
authors.affiliation: Student of General Medicine, Medical Faculty of Rijeka, School of Medicine, University of Rijeka, Rijeka, Croatia.
authors.forename: Lara
authors.initials: L
authors.lastname: Valenčić
keywords: Breast sarcoidosis; Core needle biopsy; Granulomatous disease