Xanthogranulomatous Mastitis: Report of a Rare Case and Review of Literature

Abstract

Background: Xanthogranulomatous inflammation (XGI) is a rare form of chronic inflammation characterized by the presence of lipid- laden macrophages, multinucleated giant cells, and cholesterol crystals. It is an uncommon finding in the breast. Our literature search  revealed twenty-four documented cases in the English literature.
Case report: An 18-year-old female presented with a mass in the left upper lateral quadrant of the breast with ulceration for a 1-month  duration. The mass was initially small about 2cm in its widest diameter and continued to increase in size to 5 x 3 cm. The overlying skin is  smooth and not attached to the underlying structures. It is firm with mild tenderness and ill-defined margins. Two months later she  developed a left breast ulcer that measured 2 x 1 cm on the surface of the lump. It has a sloping edge with a necrotic floor. There was no  associated axillary lymphadenopathy. Fine needle aspiration cytology suggested an inflammatory process. Tissue biopsy histology shows  abundant foam cells, multinucleated giant cells of foreign body type as well as numerous lymphoplasma cells infiltrating the breast tissue  with geographic areas of necrosis in keeping with xanthogranulomatous mastitis.
Conclusion: Xanthogranulomatous mastitis is a very rare entity, it is self-limiting in most cases. The diagnosis of XGM can be made by  excluding other diseases that elicit inflammation in the breast. The lesion can mimic granular cell tumor, histiocytoid carcinoma, invasive  carcinoma NST, and lipid-rich breast cancer; therefore, clinicians should always consider these as differential diagnoses to avoid  unnecessary surgery.