Lymphocytic mastopathy mimicking carcinoma in a non–insulin-dependent diabetic: a case report

INTRODUCTION: The diabetic mastopathy is a rare form of mastitis, characterized by fibrous lesions and inflammatory mammary stroma that simulates the infiltratingcarcinoma in the general Medicine and in the radiology. It is also known as fibrous mastopathy, diabetic mastopathy and sclerosing lymphocytic mastopathy. It occurs more frequently in association with type 1 diabetes of long standing, in patients with type 2 diabetes mellitus who have developed auto-immune diseases and in patients with no associated diseases. In this paper we report a case of a patient with histopathological diagnosis of lymphocytic mastopathy with no association with diabetes mellitus or other pathologies. CASE REPORT: Female patient, 28 years, complaining of pain and lump which appeared suddenly in the right breast. Physical examination revealed a hardened and irregular area with approximately 3, 0 x 2, 0 cm located at a “9 hours” periareolar region. A breast ultrasound was done and it showed BIRADS US 0, due to this a histopathological evaluation was recommended. A magnetic resonance imaging showed a nodular area between the external quadrants of the right breast, measuring about 3. 6 x 3. 2 cm with characteristics of a benign lesion. Then a core-biopsy was carried out and the histopathological diagnosis was fibrosis. Later, after a lumpectomy with an expansion of margins, the histopathological diagnosis was immunohistochemical lymphocytic mastopathy. At present, the patient hasn’t uttered any complaints and is happy with the aesthetic result of the surgery. DISCUSSION: The lymphocytary mastitis is a rare disorder, representing less than 1% of the benign breast lesions, and occurs in up to 13% of diabetic patients. In this case report, however, there is no association with diabetes or auto-immune diseases, thus we emphasize the peculiarity of the case. The histopathological description is characteristicand shows dense stroma fibrosis and periductal and perivascular lymphocytic infiltrate. The differential diagnosis of these lesions is infiltrative breast carcinoma.

We report a case of insulin-dependent diabetic fibrous mastopathy with special reference to the findings of computed tomography (CT). The patient was a 27-year-old woman with a history of insulin-dependent diabetes mellitus from childhood who presented with a right breast tumor. Physical examination showed a stony-hard, ill-defined but freely movable mass under the nipple of the right breast without nipple discharge. Mammography revealed a high-density mass shadow without microcalcifications or spicular formation. Ultrasonographic examination revealed an irregularly-shaped hypoechoic lesion with marked posterior acoustical shadowing. Contrast-enhanced CT revealed poor early phase contrast enhancement and slight delayed phase heterogeneous enhancement. Since core needle biopsy revealed fibrocystic disease, the lesion was suspicious for diabetic mastopathy. Incisional biopsy of the right breast lump was performed. On histopathological examination, the lesion showed fibrosis with dense lymphocytic infiltration around the lobules. Diabetic fibrous mastopathy was diagnosed. Physicians should be aware of the association of long-standing diabetes mellitus with the development of fibrous mastopathy. CT is considered a useful tool to differentiate diabetic mastopathy from breast cancer.

Diabetic mastopathy is a rare benign condition associated with long-standing diabetes mellitus and presents with breast lumps. This report describes two cases in which diffusion-weighted images (DWI) on magnetic resonance imaging were quite different from each other. In case 1, there were hyperintense lesions on DWI, and surgically removed specimens revealed ductitis with marked lymphocytic infiltration. In case 2, no abnormal intensity was depicted on DWI, and biopsy specimens showed dense stromal fibrosis with mild perivascular lymphocytic infiltration that corresponded to previous reports. Although it is reported that diabetic mastopathy is composed of dense fibrous tissue with low cellularity that results in no hyperintense lesion on DWI, in cases with marked lymphocytic infiltration, strong hyperintensity can be seen on DWI mimicking malignant breast tumors.

Diabetic mastopathy is an unusual lesion affecting the breast of patients with longstanding diabetes mellitus (DM). This lesion presents as large hard masses, leading to clinical suspicion of malignancy, and may result in unnecessary surgeries. It is characterized histopathologically by sclerosing lymphocytic mastitis. During 1-year period from January 2016 to December 2016, we came across three cases of sclerosing lymphocytic mastitis. All were females with longstanding DM and presented with palpable, nontender, hard breast masses. Clinical impression was malignancy. They underwent imaging studies, fine needle aspiration cytology, and core needle biopsies before excision biopsy. The specimens consisted of firm-to-hard fibrotic masses with a grayish-white cut surface. Histopathology showed characteristic keloid-like sclerosing fibrosis, dense perilobular and intralobular lymphocytic infiltrates. Clinicopathological correlation will resolve these cases in most instances and aid in preventing radical surgical procedures. Imaging studies however may not be helpful in all cases.

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 is an unusual fibroinflammatory breast lesion that characteristically presents in premenopausal women with long-standing type 1 diabetes mellitus with multiple microvascular complications. The pathogenesis of this condition is believed to involve an autoimmune reaction to the accumulation of abnormal matrix induced by hyperglycemia. Clinicopathologic features include the development of dense keloidlike breast masses that are often recurrent or bilateral or both. Clinical distinction from a malignancy can be difficult. However, the benign nature of this lesion is easily recognized on histologic examination, and it is not associated with an increased incidence of epithelial or stromal neoplasia. A constellation of histopathologic and clinical features is necessary to make the diagnosis of diabetic mastopathy. Unnecessary surgery can be avoided in the clinical follow-up of patients with multiple, bilateral, and recurrent lesions. Case series. Between December 1993 and December 1998, 5 premenopausal women with type 1 diabetes mellitus of 18 to 23 years' duration presented with nontender, palpable, firm-to-hard breast masses. To date, progression of the tumorlike proliferations has been bilateral and recurrent in 2 patients, bilateral in a third patient, and recurrent in a fourth. The fifth patient has developed neither bilateral nor recurrent lesions. Imaging studies did not in any patient demonstrate a focal lesion. All lesions were treated by either excisional (4 patients) or core (1 patient) biopsy. The resected specimens were examined histopathologically. Gross examination of the specimens showed firm masses with homogeneous tannish-white cut surfaces. They measured between 3.0 and 6.0 cm in maximum diameter. Microscopic examination showed keloidal fibrosis with ductitis, lobulitis, and vasculitis. The clinical profile in combination with these pathologic features is characteristic of diabetic mastopathy. Physicians should be aware of the association of long-standing diabetes mellitus with the development of benign fibroinflammatory breast lesions when managing these in premenopausal women. We outline the constellation of findings on clinical examination, medical history, imaging studies, and histopathologic examination that are required to make the diagnosis of diabetic mastopathy. Although these breast masses may be recurrent, they are not premalignant. In the appropriate setting, the diagnosis can be made by core biopsy, avoiding unnecessary surgeries in patients with multiple, bilateral, or recurrent lesions.

We report a case of diabetic mastopathy in a man with type 2 diabetes. The patient was a 62-year-old man who had been diagnosed with type 2 diabetes at the age of 46 years. He had been treated with oral hypoglycemic agents. He noticed a mass in his left breast in February 2007, when HbA(1)c was 7.6% with the treatment using oral hypoglycemic agents, including acarbose, glimepiride, buformine, and pioglitazone. Mammography of the breast showed increased density, and ultrasonography showed a regular-shaped hypoechoic mass. Core needle biopsy was performed, and diabetic mastopathy was confirmed pathologically. Diabetic mastopathy usually occurs in women with type 1 diabetes. This case, a man with type 2 diabetes, is very rare.

Lymphocytic mastopathy or diabetic mastopathy is a benign breast disease characterized by dense fibrosis, lobular atrophy, and aggregates of lymphocytes in a periductal and perilobular distribution. The condition usually affects women with a long history of diabetes mellitus (DM) and also those with autoimmune disorders. While the pathogenesis is unknown, a particular type of class II human leukocyte antigen has been associated with this disease. Herein, we report a case of diabetic mastopathy which clinically and radiologically mimicked primary breast neoplasms. The patient was a 74-year-old woman with a 31-year history of DM type II who presented with multiple firm lumps in bilateral breasts. Findings from mammography, ultrasonography, and magnetic resonance imaging of the breasts revealed an abnormal appearance which suspiciously resembled malignancy. An aspiration cytology specimen showed atypical accumulation of lymphoid cells, leading us to suspect lymphoma. Histology of an excisional biopsy showed the characteristic appearance of lymphocytic mastopathy, which predominantly consisted of B-lymphocytes. Autoantibodies in her serum reacted positively against her ductal epithelium as well as other diabetic and nondiabetic breast ductal cells. An antigen absorption test with insulin revealed attenuating intensity according to insulin concentration. These anti-insulin antibodies produced in the DM patient may cause ductitis because of antigen cross-reactivity.

Triple assessment of breast is based on clinical examination, histological and radiological study where in our study, the pattern of breast swelling in a premenopausal and postmenopausal woman was compared. A total of 150 female patients with palpable breast lump went through clinical examination, FNAC, USG breast while mammogram & core needle biopsy was done in selected patients. Histopathological examination of the specimen was done for all post-operative patients. Benign & malignant breast lesion accounted for 82(54.6%) & 68(45.3%) respectively. Based on the incidence of benign breast lump & malignant breast lump among pre menopausal women, it was 79% & 21% respectively while in post menopausal women it was 21.9% & 78.1%. The most common type of breast lump among the pre and post menopausal women was fibroadenoma 56.9% & Invasive ductal carcinoma 59.3% respectively. The most common benign breast lump & malignant breast lesion based on the histological pattern among the premenopausal women was fibroadenoma 72% & Invasive ductal carcinoma 50% while in postmenopausal women it was fibroadenosis 71.4% & Invasive Ductal Carcinoma 76%. Based on the hormonal status(ER/PR) of pre and postmenopausal women positivity was seen majorly in post menopausal women 82.3% compared to premenopausal women 17.7%. In our study, the malignant breast disease was more common in post menopausal, while benign breast disease was common in pre menopausal women. Triple assessment in evaluating a breast lump is per se a reliable & valid tool in the armamentarium of treating clinician with very high diagnostic accuracy.

Diabetic fibrous mastopathy (DFM) is a relatively rare condition that most often occurs in insulin-dependent diabetics with a characteristic hypoechoic appearance on ultrasound (US). DFM frequently poses a diagnostic challenge in radiology due to malignant imaging similarities, and core needle biopsy is often required. If DFM is in the differential, fine-needle aspiration should not be considered as it will likely be non-diagnostic due to insufficient sampling and excisional biopsy should be avoided as it may worsen the disease process. Therefore, high clinical suspicion of DFM is important for diagnostic intervention consideration. We report the case of a 57-year-old who presented with a firm breast lump which on mammography was seen as a new 5.8 by 5.3 cm global asymmetry. US was performed and a diffuse area of increased echogenicity without posterior shadowing was identified. Given the appearance and patient history, DFM was considered unlikely. However, core needle biopsy revealed diabetic lymphocytic mastopathy consistent with DFM. Even though DFM is uncommon and has been reported to have a specific US appearance, it should be included in the differential for a palpable breast lump in any diabetic patient regardless of glucose control or atypical imaging findings.

Diabetic Mastopathy (DMP) is an uncommon benign fibro-inflammatory condition that occurs in women with long-standing diabetes mellitus (DM), particularly type 1. It often mimics breast cancer (BC) in clinical and imaging presentations, leading to diagnostic challenges. A retrospective monocentric study was conducted, analyzing clinical, radiologic, and pathological data from 28 women diagnosed with DMP over 10 years at the European Institute of Oncology. Data on DM type, age at DMP diagnosis, associated autoimmune conditions, imaging features, and surgical outcomes were collected and compared with the existing literature. The majority (82%) of the patients had type 1 DM, with most diagnosed with DMP before age 40. Common complications included retinopathy (46%) and neuropathy (35%). Imaging often suggested malignancy, necessitating core needle biopsies for diagnosis. Surgical intervention occurred in 55% of cases, with a recurrence rate of 32%. One case of BC was observed. DMP remains challenging due to its resemblance to BC. Conservative management is typical, but the recurrence rate post-surgery highlights the importance of ongoing monitoring. Although DMP does not significantly increase BC risk, caution is advised, especially for immunocompromised patients. Further studies are needed to comprehensively understand DMP's relationship with BC.

This study was undertaken to determine the prevalence of diabetes mellitus (DM), insulin-dependent diabetes mellitus (IDDM), noninsulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) in different areas of Saudi Arabia. A household survey was conducted in 34 different areas of Saudi Arabia. Demographic data and medical history were taken and filled. Fasting and two-hour "post-glucose load" blood samples were collected from 23,493 Saudi males and females and blood glucose was estimated immediately. The diagnoses of DM and IGT were made based on the criteria of the World Health Organization (WHO). Diabetic patients were subgrouped as IDDM and NIDDM on the basis of age of onset and mode of treatment. In the overall group (two to 70 years), the prevalence of IDDM, NIDDM and IGT was 0.193%, 5.503% and 0.498% in the Saudi males and 0.237%, 4.556% and 0.900% in the Saudi females. When grouped on the basis of age, there were 8762 children (<14 years). Of these children, 15 (0.171%) had IDDM and 13 (0.148%) had maturity onset diabetes of the young (MODY). The prevalence of IGT in this group was 0.250%. In the 14-70-year age group, the prevalence of IDDM, NIDDM and IGT was 0.239%, 9.50% and 0.717% in the males and 0.248%, 6.820% and 1.347% in the females, respectively. A significant increase (P<0.001) was obvious in the age group >30 years, where the prevalence of NIDDM and IGT rose to 17.32% and 1.30% in the males and 12.18% and 2.2% in the females, respectively. IDDM showed a slight decrease in those over the age of 60 years. These results place Saudi Arabia among the countries that have a high prevalence for DM and a moderate risk for IGT. In light of these findings, it is clear that carefully planned programs are needed to achieve control and prevention of diabetes mellitus in Saudi Arabia.

BackgroundDiabetic 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 presentationA 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.ConclusionsThis 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.

Introduction: Diabetic mastopathy is a rare benign condition that can occur in patients with long standing Type I or II diabetes mellitus male or female of any age. Diabetic mastopathy is a fibroinflammatory condition that resembles carcinoma of breast. Here, we report a case of Type II Diabetic female patient with suspicious breast lump in right breast Case presentation: A 62 year old female presented with complaints of lump in right breast for 10 days. Clinically, hard lump of size 8x6 cm was palpable in upper outer quadrant. Trucut biopsy showed features of Diabetic mastopathy. Patient undergone wide local excision and biopsy confirmed the diagnosis. Post operative period was uneventful. Discussion: Diabetic mastopathy is an uncommon tumor-like proliferation of fibrous tissue of the breast, clinically and radiologically mimicking breast cancer. Histopathologically, it involves periductal, perilobular and perivascular lymphocytic infiltration. Primary excision with adequate normal tissue margins is the treatment of choice Conclusion: Diabetic mastopathy is a rare clinical entity, however due to increase in prevalence of Diabetes, diagnosis of Diabetic mastopathy should be considered in patients with breast lumps

Non-insulin-dependent diabetes mellitus (NIDDM) is being increasingly diagnosed as its importance as a risk factor for the development of cardiovascular disease continues to be recognised. Good metabolic control remains a major goal of drug therapy as it decreases the severity and incidence of diabetic complications. Many drugs have been known to interfere with glucose control, either in a beneficial or, more commonly, in a deleterious fashion. Unfortunately in many instances drug-induced effects have not been looked at specifically in NIDDM. Thiazide diuretics have been shown to cause a deterioration in glucose control not only in the general population but especially in patients who have impaired glucose tolerance. While the effect appears less with potassium supplementation and the lower dosage employed nowadays, thiazide diuretics are best avoided in diabetic patients. Loop diuretics have been reported to reduce glucose control to a lesser extent than thiazides. Although indapamide would appear not to interfere with blood sugar control in NIDDM, higher doses that cause potassium loss may cause a deterioration. β-Adrenoceptor antagonists have been reported to cause a rise in blood sugar and glycosylated haemoglobin in NIDDM. The effect may be more marked in patients on oral hypoglycaemic agents as opposed to diet alone and in those on concomitant thiazide diuretics. The greatest effect was seen with propranolol, and the least with cardioselective and the less lipophilic β-blockers. It is of interest that α-blockade with prazosin seems to antagonise β-adrenoceptor blocker-induced deterioration in glucose control. The calcium antagonists have differing effects which may be structure related. In some, but not all, studies use of the dihydropyridines such as nifedipine has been associated with a deterioration in glucose control in NIDDM. Long term studies are needed to assess definitively their effect on glucose control. Verapamil, on the other hand, has in 1 small study been found to have a beneficial effect on glucose control in NIDDM. Centrally acting α-agonists such as the antihypertensive drug clonidine have not been shown to result in a deterioration in glucose control when used in NIDDM, although there are isolated case reports. Long term therapy with the more specific agonist guanfacine was reported in 1 uncontrolled study to have a beneficial effect on glucose tolerance in NIDDM. Uncontrolled studies suggest that phenothiazines may aggravate diabetic control. The significance of a number of recent observations is not fully clear. The balance of endogenous opioid influences over pancreatic β-cell function in NIDDM patients favours the inhibitory effects of met-enkephalin, and the opiate antagonist naloxone partially restores the acute insulin response to glucose. Aspirin appears to have a dual effect in NIDDM — decreased insulin clearance and tissue sensitivity — with no resultant overall change in glucose levels. There are also a number of drugs that may improve glucose tolerance in NIDDM. A number of studies have reported a fall in glycosylated haemoglobin and 2-hour plasma glucose during treatment with the angiotensin converting enzyme (ACE) inhibitors captopril (post glucose load) and enalapril (postprandial), although the effect is relatively small and nonsignificant in some studies. There are also reports of a reduction in fasting plasma glucose and insulin levels during treatment with the lipid-lowering fibric acid derivatives (clofibrate, bezafibrate and fenofibrate) and possibly nicotinic acid derivatives, suggesting increased tissue sensitivity to insulin. The effect was not seen with gemfibrozil and other lipid-lowering agents. Mebendazole, through insulin secretion, and chloroquine, through reduced hepatic degradation of insulin, have been shown in 2 small studies to improve glucose tolerance in NIDDM. While induction of hepatic drug metabolising enzyme activity has been advanced as a means of improving glucose control, possibly through enhanced peripheral glucose utilisation, studies to date in NIDDM have produced contradictory results. A number of uncontrolled studies suggest that both monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants may improve glucose tolerance. Close monitoring of glucose and glycosylated haemoglobin is recommended where the abovementioned drugs are used in NIDDM. There is evidence that possible effects of new drugs in NIDDM are being recognised increasingly as a requirement in new drug development, particularly with cardiovascular agents.