Non-sclerosing (T-cell) and sclerosing (B-cell) lymphocytic lobulitis in diagnostic breast biopsies: Clinical, imaging, and pathologic features.

Lymphocytic lobulitis (LL) is characterized by prominent lymphocytic infiltrates centered on lobules. Sclerosing lymphocytic lobulitis (SCLL) associated with diabetes mellitus (DM) or autoimmune disease (AI) was the first type to be described. Subsequently, non-sclerosing LL (NSCLL) was reported as an incidental finding in prophylactic mastectomies due to high risk germline mutations or a family history of breast cancer. The two types of LL were distinguished by stromal features and a predominant population of B-cells in the former and T-cells in the latter. In this study, 8 cases of NSCLL detected clinically or by screening were compared to 44 cases of SCLL. One case of NSCLL presented as a palpable mass, 2 as masses on screening, and 5 as MRI enhancement. In contrast, 80% of SCLL cases presented as palpable masses. Half the cases of NSCLL were associated with a BRCA1 or 2 mutation compared to 1 case of SCLL (2%). Three additional cases of NSCLL were associated with a strong family and/or personal history of breast cancer. Almost half (52%) of SCLL cases were associated with DM or AI, but only 25% of NSCLL. Immunoperoxidase studies confirmed a predominance of T-cells in NSCLL and B-cells in SCLL associated with DM or AI. It is important for pathologists to be aware of this new observation that NSCLL can be detected as a palpable mass or an imaging finding in diagnostic biopsies, as its presence can be indicative of a significant risk for breast cancer.

Diabetic Mastopathy With an Associated History of Elevated Thyroid Peroxidase (TPO) and Antimitochondrial Antibodies (AMA).

Diabetic mastopathy is an uncommon, benign breast lesion that is typically seen in patients with type 1 diabetes mellitus (T1DM). The main differential diagnosis for diabetic mastopathy is breast carcinoma, which appears similarly on clinical examination and diagnostic imaging. Although the etiology of diabetic mastopathy is poorly understood, it has been associated with several autoimmune conditions, such as Hashimoto's thyroiditis, systemic lupus erythematosus, and Sjogren's syndrome. Here, we report a case of diabetic mastopathy in a T1DM patient with an associated history of elevated thyroid peroxidase (TPO) and antimitochondrial antibody (AMA) levels, giving further support to the theory of autoimmune etiopathogenesis.

Benign breast disease with malignant imaging features: a case report.

BACKGROUND: Diabetic mastopathy is a rare breast condition that occurs in women with poorly controlled diabetes and is characterized by hardening of the breast tissue. The purpose of this case report is to provide an overview of the clinical characteristics and therapeutic principles of this rare disease to support front-line physicians in their crucial activity of case identification. CASE PRESENTATION: A 64-year-old Asian female patient with a history of type II diabetes mellitus was referred to our clinic for an evaluation of a newly discovered breast mass. The patient had been diagnosed with diabetes more than 20 years prior and was being managed with oral hypoglycemic agents. Her past medical history was otherwise unremarkable. Physical examination of the breast revealed a palpable, mobile, and firm mass measuring 6 × 4 cm in the upper quadrant of the right breast. Ultrasound images showed an uneven hypoechoic nodule, BI-RADS 4B. Mammography showed the compact and flaky nature of the two breasts and the heterogeneity of the substantive density increases. The patient's clinical manifestations and imaging findings suggest the possibility of breast cancer. The patient opted for surgical excision of the mass. Through surgery, the mass was completely excised with negative margins. Pathological examination of the mass revealed a proliferation of fibroblastic cells, with an increased nuclear/cytoplasmic ratio, consistent with a diagnosis of diabetic mastopathy. CONCLUSIONS: This case report serves to highlight the importance of recognizing diabetic mastopathy as a possible differential diagnosis of a breast mass in patients with diabetes mellitus. In our patient, early diagnosis and treatment with lumpectomy resulted in a favorable outcome, emphasizing the importance of prompt medical and surgical management. In addition, more research is needed to mine the diagnostic marker of diabetic mastopathy and provide data related to its prognosis.

Diabetic Fibrous Mastopathy: Imaging Features With Histopathologic Correlation.

Diabetic fibrous mastopathy (DFM) is a rare benign fibrotic disease of the breast that develops in patients with longstanding and often uncontrolled diabetes mellitus. Clinically, patients may present with an irregular, firm, palpable mass, which may be solitary or multiple, occurring in one or both breasts. Diabetic fibrous mastopathy occurs most often in premenopausal women with heterogeneously or extremely dense breasts; mammography may show focal asymmetry or, less often, a noncalcified mass with indistinct or obscured margins, but there are usually no discrete findings. On US, DFM may have marked hypoechogenicity and posterior shadowing secondary to extensive fibrosis. Diabetic fibrous mastopathy features on contrast-enhanced MRI are also nonspecific, with gradual persistent nonmass enhancement reported. Because the clinical presentation and US features of DFM overlap with those of breast cancer, histopathologic correlation is needed to confirm diagnosis and exclude malignancy. These findings include collagenous stroma often with keloidal features and chronic perilobular and perivascular inflammation. Histopathologic findings of lymphocytic lobulitis and perivascular inflammation are common to other autoimmune conditions.

Benign Breast Disease: Periareolar Mastitis, Granulomatous Lobular Mastitis, and Lymphocytic or Diabetic Mastopathy.

Periareolar mastitis, granulomatous lobular mastitis, and lymphocytic or diabetic mastopathy are benign inflammatory breast conditions that require specialized knowledge of the pathophysiology to reduce the morbidity from surgical management.

Mastopatía diabética. Revisión sistemática con 93 pacientes / Diabetic mastopathy. A systematic review of 93 patients

Introducción La mastopatía diabética (MD) es una afectación benigna de la mama que aparece en pacientes diabéticas con mal control glucémico de larga evolución. La enfermedad se caracteriza por la aparición de nódulos fibrosos que pueden simular tanto clínica como radiológicamente un cáncer de mama. Su diagnóstico debe realizarse con biopsia con aguja gruesa (BAG) y el tratamiento debe evitar resecciones quirúrgicas. El objetivo de este trabajo es caracterizar con más exactitud esta enfermedad y sus características aportando claridad en su diagnóstico diferencial. Material y métodos Se ha realizado una revisión sistemática de los artículos publicados en los últimos 5 años en las principales bases de datos médicas usando para ello los términos «Mastopatía diabética» y «Diabetic mastopathy». Se incluyeron todo tipo de artículos científicos que aportasen datos sobre la MD, excluyendo aquellos que incluyeran otras enfermedades inflamatorias de la mama. Se seleccionaron finalmente 28 artículos. Para el análisis estadístico se dividió a las pacientes en 2 grupos, diabetes mellitus (DM) tipo 1 (DM1) y DM tipo 2 (DM2), y se compararon la media y la proporción de las diferentes variables analizadas utilizando para ello la prueba t de Student. Se utilizó el programa STATA para realizar el análisis estadístico. Resultados Se analizaron 28 artículos, con un total de 93 pacientes incluidas. En los artículos analizados todos los pacientes eran mujeres. La mayoría de las pacientes presentaron DM1 y el tiempo medio de evolución de la diabetes fue de 20 años. La lesión asociada a la DM que se observó con mayor frecuencia fue la retinopatía diabética (34%). La lesión palpable fue la forma de manifestación más frecuente (53%). Respecto al diagnóstico el hallazgo mamográfico más habitual, fue la hiperdensidad asimétrica y en la ecografía la lesión hipoecoica de bordes irregulares y sombra acústica posterior. El tratamiento más habitual fue conservador. Conclusión ... (AU)

Introduction Diabetic mastopathy is a benign disease of the breast that develops in patients with long-standing diabetes and poor glycemic control. The disease is characterised by fibrous nodules that can be confused with breast cancer both clinically and radiologically. Diagnosis should be made with core needle biopsy (CNB) and treatment should avoid surgical resections. The main objective of this study was to characterise this rare disease in order to improve its differential diagnosis and treatment. Material and methods A systematic review was conducted, including articles published in the last 5 years in the main medical databases using the terms “Mastopatía diabética” and “Diabetic mastopathy”. We included all types of scientific articles providing data on diabetic mastopathy. We excluded articles including other inflammatory breast diseases. Finally 28 articles were selected. For the statistical analysis, patients were divided in 2groups: DM1 patients and DM2 patients. The mean and proportion of the different variables were analysed with the Student t-test. The statistical analysis was performed with the STATA programme. Results We analysed 28 articles, with 93 patients. None of the included articles reported male patients. Most patients had type 1 diabetes and diabetic mastopathy developed at a mean of 20 years after diabetes onset. The most frequent complication of diabetes was diabetic retinopathy (34%). The most common manifestation was a palpable nodule (53%). Regarding diagnosis, the most common mammographic finding was asymmetric hyperdensity and the most common ultrasound finding was a hypoechoic lesion with irregular edges and posterior acoustic shadow. The most frequent treatment was conservative. Conclusion... (AU)

Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature.

BACKGROUND: Diabetic mastopathy is a rare benign disease in clinical practice that mainly occurs in young and middle-aged women with type 1 diabetes. It has also been reported that this disease can be found in patients with type 2 diabetes and other autoimmune diseases, such as Hashimoto's thyroiditis, as well as in men. The pathogenesis of diabetic mastopathy is not yet clear, and it is easily confused with breast cancer due to their similar clinical manifestations and imaging features. CASE SUMMARY: A 69-year-old female patient was admitted because of painless breast masses, with a history of type 2 diabetes. The imaging and physical examination suggested a high risk of breast cancer. Further histopathological analysis showed dense lymphocytes infiltrating around the lobules of the breast, and extensive fibrosis of the surrounding stroma. Finally, diabetic mastopathy was diagnosed. CONCLUSION: The diagnosis of diabetic mastopathy in elderly patients with painless breast masses is difficult to distinguish from breast cancer, and its imaging manifestations are not specific.

Diabetic Mastopathy. Review of Diagnostic Methods and Therapeutic Options.

Diabetic mastopathy is a rare breast condition that may occur in insulin-treated men and women of any age. The etiology is still unclear; however, the autoimmunological background of the disease is highly suspected. The changes in diabetic mastopathy may mimic breast cancer; therefore, its diagnostic process is demanding, and treatment options are not clear and limited. Lesions in DM are usually multiple; therefore, surgical removal is not fully effective. A well-done anamnesis with core-needle biopsy is essential and definitive in most cases. In this review, we summarize up-to-date knowledge of diagnostic methods and therapeutic options for diabetic mastopathy treatment and present three cases of diabetic mastopathy-type lesions in ultrasound and radiological examinations.

Diabetic Mastopathy: Reporting an Unusual Scenario of a Rare Disease.

Diabetic mastopathy is a rare, benign breast disease that presents with fibrous breast lumps usually induced by the hyperglycemic state in diabetic patients and often associated with type 1 or 2 diabetes mellitus. Clinical and radiographic appearances are usually confusing and pathologic confirmation is essential for diagnosis mainly to rule out malignancy. However, a specialized breast pathologist often utilizes patient's history of diabetes as a guide to solve this diagnostic dilemma. We report a challenging scenario in which a case of diabetic fibrous mastopathy was pathologically identified with no previous given history of diabetes. This benign breast entity should be included in the differential diagnosis of breast lumps even without history of diabetes that may be overlooked before surgery.

Diabetic Mastopathy in a Patient with High Risk of Breast Carcinoma: A Management Dilemma.

Diabetic mastopathy is a rare benign breast condition. It is strongly associated with type I diabetes mellitus and commonly presents similar to malignancy. Here, we report a case of a 29-year-old Saudi female with a long history of type I diabetes mellitus (DM) who presented with a painless hard breast mass and had a strong family history of breast cancer. Further evaluation with ultrasound (US) imaging revealed a highly suspicious, ill-defined hypoechoic lesion. Mammographic examination revealed that both breasts were of normal shape with bilateral dense glandular parenchyma. US-guided true-cut biopsy was carried out, which showed acellular fibro-sclerotic tissues with normal-looking lobules and ducts surrounding by a dense lymphocytic infiltrate. Subsequently, a diagnosis of diabetic mastopathy was established. Results were discussed with the patient, and an agreement was reached to proceed with an excisional biopsy for further reassurance and exclusion of malignancy. Local surgical excision of the lesion was performed and histopathological examination revealed extensive fibrosis of the specimen with no cellular atypia. Awareness of such a condition, with its clinical, radiographical, and histopathological characteristics, is essential in order to alleviate the patient's anxiety and avoid unnecessary surgical interventions.

Clinical, mammographic, and ultrasonographic characteristics of diabetic mastopathy: A case series.

PURPOSE: Diabetic mastopathy (DMP) is a rare benign breast lesion that mimics breast cancer on ultrasound. Our aims were to identify patient characteristics and imaging features of the disease. METHODS: We conducted retrospective searches of our database for DMP lesions that were pathologically confirmed between January 2004 and November 2015. Mammographic and ultrasound features were reviewed by two experienced radiologists. RESULTS: Twelve women were identified with 16 lesions. Most patients (83%) had type 2 diabetes mellitus (DM) and over half were insulin-dependent (58.3%), with a mean time of 16.9 years between the diagnosis of DM and that of DMP. There were negative findings on mammography for 46.7% of the lesions, including larger-sized lesions. Ultrasound revealed various features, including irregular shape (81.3%), indistinct margins (100%), parallel orientation to the chest wall (93.8%), marked hypoechogenicity (87.5%), and posterior shadowing (62.5%). CONCLUSIONS: DMP was more common in patients with longstanding DM; in particular, type 2 DM and insulin-dependent patients. DMP lesions were usually occult on mammography, despite the relatively large size of DMP, which may help distinguish DMP from invasive cancer. Ultrasound detected several features that are also present in invasive cancer, making tissue sampling necessary to distinguish these.

Diagnostic and therapeutic management of diabetic mastopathy: a case report.

Sclerosing lymphocytic lobulitis (SLL) is a benign breast lesion, better known as diabetic mastopathy (DMP), since it tipically occurs in diabetic patients. This very uncommon condition is strongly associated with type I diabetes mellitus. We report a case of a 61-year-old woman, with type II insulin-dependent diabetes mellitus, who presented mammography and ultrasonography images suspicious for breast carcinoma. As histopathology surprisingly demonstrated SLL and breast MRI showed benign characteristics, unnecessary surgery was avoided. The aim of this report is to underline that DMP is an uncommon clinicopathological entity which can clinically and radiologically mimic breast cancer but also that breast carcinoma may be hidden within these dense fibrotic lesions. In the light of cases reported in literature, breast MRI can be considered an essential tool in the diagnostic and therapeutic management of DMP.

Diabetic mastopathy: case report and summary of literature.

Diabetic mastopathy is an uncommon, benign breast condition seen in type 1 and less frequently type 2 diabetic patients. It is characterized by a dense fibrous stromal proliferation of breast tissue, clinically mimicking cancerous masses, thus leading to worrisome investigations. Clinicians and pathologists must distinguish this benign condition from malignant causes because surgery may worsen the case as these lesions tend to recur more extensively at the site of resection. We present the case of a young woman with type 1 diabetes with typical diabetic mastopathy and summarize the literature to increase awareness of this troublesome but benign disorder.

Diabetic mastopathy.

Diabetic mastopathy is an uncommon condition found in patients with long-standing diabetic mellitus (DM). Although benign in nature, it can sometimes not be distinguishable from breast carcinoma, and may lead to unnecessary anxiety or intervention. Clinicopathologic features of 10 patients were reviewed in detail. Only three of the 10 patients had type I DM. All patients had over a 10-year history of DM, and presented with unilateral, solitary, palpable breast mass, ranging in size from 1.5 to 5 cm. Radiologic and pathologic features of each patient were described. None of the patients in our series developed malignancy during the follow-up period. Diabetic mastopathy is a benign condition and not unique to type I DM. Surgeons should be aware of this distinct fibroinflammatory breast condition and its association with long-standing DM.

Diabetic mastopathy.

Diabetic mastopathy is the occurrence of lymphocytic mastitis and stromal fibrosis in men as well as women having long-standing diabetes. Clinical and radiological appearance can raise a suspicion of malignancy and result in unnecessary biopsy. As these lesions are known to recur; failure to recognise them can have devastating results. A case of diabetic mastopathy is therefore presented for the knowledge and benefit of all so that unnecessary surgery can be avoided.

A Case of Diabetic Mastopathy

Diabetic mastopathy is an unusual fibroinflammatory breast lesion that is characteristically presented in premenopausal women with long-standing diabetes with multiple microvascular complications. This patient was a 49-year-old postmenopausal woman with diabetic nephropathy, neuropathy, and retinopathy. Although palpable mass was detected on the left breast, an ultrasonography could not distinguish it from breast cancer. Excisional biopsy was conducted. Histological findings indicated diabetic mastopathy with keloid-like fibrosis, perivascular lymphocytic infiltration, and lymphocytic lobulitis without evidence of malignancy. After excision, there has been no recurrence until now.

Imágenes en mastopatia diabética / Mr imaging of diabetic mastopathy

Objective: To retrospectively analyze the clinical records and imaging data of patients with diabetic mastopathy according to pathological findings of samples obtained by histological puncture with ultrasound guidance. Methods: Between 2002 and 2007, six patients were diagnosed with diabetic mastopathy, and their medical records and MR images were assessed. All patients underwent both mammography and ultrasound examination. One of them was additionally submitted to MRI. Results: The patients' mean age was 36.6 years. Mammograms showed asymmetric tissue densifications without micro calcifications, while ultrasound examination evidenced ill-defined solid nodular or pseudonodular areas greater than 2 cm, with posterior sonic attenuation. Magnetic resonance imaging revealed a nodular area with poorly defined contours with enhancement similar to normal breast tissue. By performing eco-guided biopsy, it was possible to establish the differential histological diagnosis of breast carcinoma and to confirm diabetic mastopathy. Conclusion: Diabetic mastopathy presents mammographic and ultrasound imaging features indistinguishable from breast cancer. Since MRI does not reveal pathological stromal enhancement it can be helpful for a differential diagnosis. The echo-guided biopsy allows the diagnosis of this condition.

Objetivo: Analizar retrospectivamente las historias clínicas e imágenes de pacientes conmastopatía diabética, según hallazgos en anatomía patológica de muestras obtenidas por punción histológica con guía ecográfica. Material y Métodos: Entre los años 2002 y 2007, se diagnosticaron 6 pacientes con mastopatía diabética, evaluándose sus historias clínicas e imágenes. A todas las pacientes se le efectuó mamografía y ecografía; a una paciente se realizó además resonancia magnética. Resultados: La edad promedio de las pacientes fue de 36,6 años. Las mamografías mostraron densificaciones tisulares asimétricas sin microcalcificaciones; las ecografías evidenciaron áreas sólidas nodulares o seudonodulares mal definidas, mayores a 2 cm, con atenuación sónica posterior y la resonancia magnética: un área nodular de contornos mal delimitados con realce similar al tejido mamario normal. La punción biopsia ecoguiada pudo establecer el diagnóstico histológico diferencial con carcinoma mamario y confirmar mastopatía diabética. Conclusión: La mastopatía diabética presenta características imaginológicas en mamografía y ecografía que pueden ser similares al carcinoma. La resonancia magnética, al no presentar realce patológico estromal, puede colaborar en el diagnostico diferencial. La biopsia eco-guiada permite el diagnóstico de esta patología.

Mastopatia diabética: um inusitado diagnóstico diferencial: relato de caso / Diabetic mastopathy: an unusual differential diagnosis: a case report

A mastopatia diabética acomete mulheres na pré-menopausa com diabetes mellitus tipo 1 de longa data. Seu diagnóstico é feito associando achados clínicos (espessamento ou nódulo mamário endurecidos, uni ou bilateral), radiológicos (aumento da densidade mamária), ultra-sonográficos (acentuada sombra acústica posterior) e histopatológicos (fibrose e infiltrado linfocítico perivascular e periductal). Pode simular carcinoma. Neste artigo relata-se um caso de paciente com mastopatia diabética.

Diabetic mastopathy affects premenopausal women with longstanding type 1 diabetes mellitus. The diagnosis is based on clinical findings (uni or bilateral hardened, palpable mass) associated with radiological (increase in breast density), sonographic (marked posterior acoustic shadowing), and histopathological (fibrosis and perivascular and periductal lymphocytic infiltration) findings. This disease may clinically simulate a breast carcinoma. The case of a patient with diabetic mastopathy is reported.