General
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• Idiopathic systemic granulomatous disorder of noncaseating, epithelioid granulomas with multinucleated giant cells
• Usually involves lungs with fibrosis; also lymph nodes, skin, liver, spleen, phalanges, bones, parotid gland
• Rare in breast; either begins in breast or part of known disease

Clinical features
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• Abnormal breast examinations or mammograms present in 2% of sarcoidosis patients, granulomas in 1% (Sarcoidosis Vasc Diffuse Lung Dis 2001;18:301)
• Occasionally begins in breast and remains localized for long periods
• May mimic metastatic breast cancer (Clin Breast Cancer 2007;7:804)

Case reports
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• 41 year old woman with unusual presentation of sarcoidosis of the breast (Br J Radiol 2008;81:e231)
• 51 year old woman with sarcoidosis of the breast (Eur Rev Med Pharmacol Sci 2006;10:47)

Clinical images
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Mammogram, courtesy of Dr. Mark R. Wick

Breast skin, courtesy of Dr. Mark R. Wick

Micro description
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• Noncaseating, epithelioid granulomas with multinucleated giant cells
• No/rare necrosis

Micro images
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Courtesy of Dr. Mark R. Wick

Parenchyma, courtesy of Dr. Mark R. Wick

Breast skin, courtesy of Dr. Mark R. Wick

Stromal granulomas sparing lobules

DCIS (arrow) with sarcoid-like granuloma

Infiltrating lobular carcinoma and sarcoid-like granuloma

   

Non-necrotizing granulomatous inflammation

   

Lymph node

Cytology description
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• Epithelioid cells and lymphocytes

Differential diagnosis
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• Foreign material
• Fungi
• Granulomatous mastitis
• Mycobacteria

Additional references
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• Arch Pathol Lab Med 1984;108:673, Hum Pathol 1985;16:851, Hum Pathol 1985;16:185, Wikipedia - Sarcoidosis

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