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\begin{document}

\title{Lupus Mastitis: A rare breast cancer differential diagnosis}



\author[1]{Alice Pimentel}%
\author[1]{Ana Moreira}%
\author[1]{Sofia Silva}%
\author[1]{Rita Lages}%
\author[1]{Joana Noronha}%
\affil[1]{Centro Hospitalar do Baixo Vouga EPE}%


\vspace{-1em}



  
  \date{May 28, 2024}


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\begin{abstract}
Lupus mastitis is an uncommon entity which can easily mimic other breast
conditions. The rarity of this disease demands a high degree of
suspicion.%
\end{abstract}%



\sloppy


\textbf{Lupus Mastitis: A rare breast cancer differential diagnosis}

\emph{Alice Pimentel} *, \emph{Ana Moreira} , \emph{Sofia Silva}
,\emph{Rita Lages} , \emph{Joana Noronha}

\textbf{Dr. Alice Pimentel}

General Surgery Department, Centro Hospitalar do Baixo Vouga, Aveiro,
Portugal

Estrada exterior da Circunvala\selectlanguage{ngerman}ção, nº7912B 5ºDirTras, 4200-162 Porto,
Portugal

+351 962 979 885

\emph{Malicep@sapo.pt}

\textbf{Dr. Ana Moreira}

General Surgery Department, Centro Hospitalar do Baixo Vouga, Aveiro,
Portugal

Av. Artur Ravara, 3810-164 Aveiro, Portugal

\emph{Anamoreira1\_@hotmail.com}

\textbf{Dr. Sofia Silva}

General Surgery Department, Centro Hospitalar do Baixo Vouga, Aveiro,
Portugal

Av. Artur Ravara, 3810-164 Aveiro, Portugal

\emph{sofia\_ads@hotmail.com}

\textbf{Dr. Rita Lages}

General Surgery Department, Centro Hospitalar do Baixo Vouga, Aveiro,
Portugal

Av. Artur Ravara, 3810-164 Aveiro, Portugal

\emph{ritarlages@gmail.com}

\textbf{Dr. Joana Noronha}

General Surgery Department, Centro Hospitalar do Baixo Vouga, Aveiro,
Portugal

Av. Artur Ravara, 3810-164 Aveiro, Portugal

\emph{joananor@gmail.com}

\textbf{Keywords:} Breast, Lupus, Mastitis, Cancer.

\textbf{Key Clinical Message}

Lupus mastitis is an uncommon breast manifestation of SLE. The diagnosis
of this condition is histological and the treatment is pharmacological
and directed to the underlying disease. The rarity of this entity
demands a high degree of suspicion.

\textbf{Lupus Mastitis: A rare breast cancer differential diagnosis}

A 35-year-old woman with Systemic Lupus Erythematosus (SLE) presented to
the emergency department with a painful right breast mass with one month
of progressive growth. On physical examination, the patient had a
swollen hardened breast with a poorly-defined 5cm mass on the upper
outer quadrant and periareolar inflammatory signs \textbf{(Figure 1)} .
Breast ultrasound revealed a lobulated and vascularized mass in the
upper outer quadrant, with liquid areas, suggesting a possible abscess,
but not excluding a malignant lesion. The patient was treated with
NSAIDs and a course of antibiotics, with subsequent revaluation 10 days
later. Due to the apparent progression of the inflammatory signs (Figure
2), the mass was drained and biopsied. Histopathology analysis revealed
a fibroinflammatory process with lobulitis, ductitis and vasculitis
phenomena highly suggestive of breast involvement by SLE --\textbf{Lupus
Mastitis} . No signs of malignancy were identified. The patient was
referred to the rheumatology department and the dose of corticosteroids
was increased, resulting in a significant improvement of the condition
(Figure 3 and 4).

In case of a breast lesion suggestive of malignancy, patients with SLE
should be investigated for lupus mastitis. The diagnosis of this
condition is histological and the treatment is directed to the
underlying disease.

ACKNOWLEDGEMENTS

Published with written consent of the patient.

\textbf{CONFLICT OF INTEREST}

There are no conflicts of interest to declare.

\textbf{AUTHOR CONTRIBUTIONS}

AP wrote the draft of the manuscript and prepared the figures.~AM and SS
involved in writing. RL and JN contributed to the management of the
patient, revised the manuscript, and approved the final manuscript.

\textbf{INFORMED CONSENT}

Consent for publication was obtained from the patient.

\textbf{References}

{[}1{]} Tanaka Y, Manabe H, Shinzaki W, Hashimoto Y, Komoike Y. A case
of lupus mastitis in a patient with systemic lupus erythematosus. Breast
J. 2020 Apr;26(4):780-781. doi: 10.1111/tbj.13582. Epub 2019 Sep 20.
PMID: 31538694.

{[}2{]} Rosa M, Mohammadi A. Lupus mastitis: a review. Ann Diagn Pathol.
2013 Apr;17(2):230-3. doi: 10.1016/j.anndiagpath.2012.09.003. Epub 2012
Nov 26. PMID: 23190681.

\textbf{List of figure legends~}

\textbf{Figure 1:} Initial presentation

\textbf{Figure 2:} 10 days after presentation

\textbf{Figure 3:} 1 month after presentation

\textbf{Figure 4:} 2 months after presentation\selectlanguage{english}
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