Diabetic Mastopathy Research Articles

Sclerosing Lymphocytic Lobulitis Mimicking a Tumor Relapse in a Young Woman with a History of Breast Cancer

Sclerosing lymphocytic lobulitis or diabetic mastopathy is a benign entity with non-specific imaging features which can mimic breast carcinoma. It is a condition commonly associated with long standing diabetes and has also been linked with various auto-immune diseases. We present the case of a 27-year-old woman with a history of carcinoma of the left breast and otherwise unremarkable medical history, who developed sclerosing lymphocytic lobulitis in the right breast during follow-up.

A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples.

Inflammatory and reactive lesions of the breast are relatively uncommon among benign breast lesions and can be the source of an abnormality on imaging. Such lesions can simulate a malignant process, based on both clinical and radiographic findings, and core biopsy is often performed to rule out malignancy. Furthermore, some inflammatory processes can mimic carcinoma or other malignancy microscopically, and vice versa. Diagnostic difficulty may arise due to the small and fragmented sample of a core biopsy. This review will focus on the pertinent clinical, radiographic, and histopathologic features of the more commonly encountered inflammatory lesions of the breast that can be characterized in a core biopsy sample. These include fat necrosis, mammary duct ectasia, granulomatous lobular mastitis, diabetic mastopathy, and abscess. The microscopic differential diagnoses for these lesions when seen in a core biopsy sample will be discussed.

Diabetic Mastopathy: A Rare Complication of Type 1 Diabetes

Diabetic mastopathy is a rare complication encountered in type I diabetes. This observation relates diagnostic, morphological, therapeutic and evolutionary characteristics of diabetic mastopathy. Our case consist of a young woman aged 30 years, type 1 diabetic for 20 years with chronic blood sugar imbalance (HBA1C 13%); at the stage of microvascular complications. During the last year, she has had a painless bilateral breast induration, while physical examination found very hard breasts without inflammatory signs or well-individualized nodule. The echo-mammography showed a heterogeneous appearance of the two breasts with a nodule in the upper inner quadrant of the left breast rated ACR4 at the BI-RADS classification. The surgical biopsy showed dense fibrous tissue with a chronic inflammatory infiltrate, predominately lymphocytic, related to diabetic mastopathy. Abstention and monitoring were recommended. Indeed, clinical and radiological signs of diabetic mastopathy are nonspecific and can leave a suspected breast cancer. The pathogenesis is not known. The duration of diabetes and hyperglycemia could be contributing factors. After histological diagnosis, in agreement with the clinic (old and complicated diabetes), surgical abstention is the rule.

Diabetes and the breast

Diabetes and the breast

Diabetic mastopathy: a diagnostic challenge in breast sonography.

Our purpose was to retrospectively evaluate the incidence and morphologic features of diabetic mastopathy in a group of patients with diabetes, searching for specific sonographic characteristics of diabetic mastopathy. One hundred twenty diabetic patients underwent breast clinical examination, mammography, and sonography. All detected breast lesions were confirmed histopathologically. Breast lesions were found in 11 of the 120 patients (9%), including two cases of invasive ductal carcinomas and nine cases of diabetic mastopathy. In seven of those nine cases (77%), diabetic mastopathy appeared as a hypoechoic solid mass with irregular margins, inhomogeneous echotexture, and marked posterior shadowing. In the other two cases (23%), it appeared as a mildly inhomogeneous, hypoechoic solid mass. Diabetic mastopathy is a diagnostic challenge and needs to be suspected in all patients with diabetes mellitus. Imaging features are nonspecific and highly susggestive on breast sonography in most cases. Core-needle biopsy confirmation remains mandatory for a definitive diagnosis.

Unusual breast lesion mimicking cancer: Diabetic mastopathy

Diabetic mastopathy represents an uncommon tumor-like proliferation of fibrous tissue of the breast that usually occurs in patients who suffered from type 1 diabetes mellitus for a long time. We report an uncommon case of diabetic mastopathy presenting in a type 2 non-insulin dependent diabetes mellitus 61-year-old postmenopausal woman. Physical examination revealed a hard, low movable mass in the upper outer quadrant of the right breast. Mammography and ultrasonography showed typical features of breast cancer. Ultrasound-guided fine-needle aspiration cytology (US-FNAC) was performed showing inflammatory infiltrate, suggesting excisional biopsy. Histological findings demonstrated typical diabetic mastopathy with fibrosis, histiocytic and limphocytic infiltration without evidence of malignancy.

A case of diabetic mastopathy in a man with type 2 diabetes mellitus

We report a rare case of diabetic mastopathy in man with type 2 diabetes. The patient was a 64-year-old man who had suffered from type 2 diabetes for 18 years. He had poor glycemic control, and also had retinopathy and nephropathy. Seven years ago, he had undergone a mastectomy on the left side because of a breast mass. However, pathogenesis of the resected mass was not known. He developed a hard and mobile mass (diameter 4 cm) under the nipple of his right breast and complained of slight pain. Mammography revealed a dense mass without calcification, and ultrasonography revealed a hypoechoic lesion with unclear boundaries, acoustic shadows, and Doppler color flow. When a core needle aspiration biopsy was performed to exclude breast cancer the mass was diagnosed as diabetic mastopathy. As far as we know, this was the second case of diabetic mastopathy involving a man to occur in Japan.

A Case of Diabetic Mastopathy Associated with Insulin Treatment of Short Duration after Menopause

A Case of Diabetic Mastopathy Associated with Insulin Treatment of Short Duration after Menopause

Mimickers of Breast Malignancy on Breast Sonography

The aim of this article is to review benign breast lesions that can mimic carcinoma on sonography. Cases of benign lesions mimicking carcinoma on sonography were collected among lesions that were initially assessed as suspicious on sonography according to the American College of Radiology Breast Imaging Reporting and Data System category. Sonographically guided core needle biopsy was performed, and the pathologic types were confirmed to be benign. Cases of benign lesions mimicking carcinoma on sonography were shown to include fat necrosis, diabetic mastopathy, fibrocystic changes, sclerosing adenosis, ruptured inflammatory cysts, inflammatory abscesses, granulomatous mastitis, fibroadenomas, fibroadenomatous mastopathy, and apocrine metaplasia. Benign breast lesions may present with malignant features on imaging. A clear understanding of the range of appearances of benign breast lesions that mimic malignancy is important in radiologic-pathologic correlation to ensure that benign results are accepted when concordant with imaging and clinical features but, when discordant, there is no delay in further evaluation up to and including excisional biopsy.

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.

Male Breast Disease: Pictorial Review with Radiologic-Pathologic Correlation

The male breast is susceptible to many of the same pathologic processes as the female breast. Many of these conditions have mammographic, ultrasonographic (US), and magnetic resonance imaging findings that allow differentiation between clearly benign conditions and those that require biopsy. Gynecomastia is the most common abnormality of the male breast and has characteristic imaging features that usually allow differentiation from malignancy. Mammography is the initial imaging modality for a clinically suspicious mass. A palpable mass that is occult or incompletely imaged at mammography mandates targeted US. Suspicious or indeterminate masses require biopsy, which can usually be performed with US guidance. Approximately 0.7% of breast cancers occur in men. Men with breast cancer often present at a more advanced stage than do women owing to a delay in diagnosis. Benign breast neoplasms that may occur in men include angiolipoma, schwannoma, intraductal papilloma, and lipoma. Benign nonneoplastic entities that may occur in the male breast include intramammary lymph node, sebaceous cyst, diabetic mastopathy, hematoma, fat necrosis, subareolar abscess, breast augmentation, venous malformation, secondary syphilis, and nodular fasciitis. Familiarity with the salient features of the classic benign male breast conditions will allow accurate imaging interpretation and avoid unnecessary and often invasive treatment. © RSNA, 2013.

Mastopatía diabética: lesión poco conocida que simula un cáncer de mama

Diabetic mastopathy is an uncommon complication that usually occurs in patients with longstanding diabetes mellitus. This entity often presents as a palpable hard and irregular mass that mimics breast carcinoma. Imaging features are nonspecific and a histological diagnosis is required to exclude malignancy. The pathological features of diabetic mastopathy show dense keloid-like fibrosis associated with lymphocytic ductulitis, lobulitis and vasculitis. We report the case of a woman with a longstanding history of insulin-dependent diabetes mellitus and a hard, painless and irregular mass in her breast. Mammography and ultrasound examination showed a suspicious lesion (BIRADS IV). Sonographically-guided core biopsy of the mass was performed and pathological features revealed fibrosis compatible with diabetic mastopathy.

Diabetic Mastopathy: An Uncommon Complication of Diabetes Mellitus

Introduction. Whilst most consequences of diabetes mellitus are well recognized, breast-related complications remain obscure. The term diabetic mastopathy (DMP) attempts to describe the breast-related consequences of diabetes. Methods. We report the clinicopathologic findings in a patient with DMP and review the literature on this uncommon entity. Results. A 33-year-old woman with type 1 diabetes had excision biopsy of a 2 cm breast lump. Histopathologic evaluation revealed classic features of DMP: parenchymal fibrosis; keloid-like hyalinization of interlobular stroma; adipose tissue entrapment; lobular compression; dense chronic inflammatory cell infiltration; and lymphoid follicle formation. Conclusion. Clinicians should be aware of DMP as a differential for breast disease in women with uncontrolled diabetes.

Diabetic Mastopathy; Case Report and Review of Literature

Two cases of Diabetic Mastopathy presented at our Breast unit over the period of 12 months between June 2003 and June 2004. Both cases were seen in patients with Type 1 Diabetes Mellitus. Triple Assessment (Physical examination, imaging and Fine needle aspiration cytology) did not give a definite diagnosis and hence an excision biopsy had to be performed to achieve the final diagnosis. Case number 1 had all the classical Histological features of Diabetic Mastopathy. These two cases demonstrate importance of core/excision biopsy of suspicious lesions in diabetics before counselling the patient and making final management plan.

Lymphocytary Mastopathy in the Absence of Diabetes: 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.

Two cases of diabetic mastopathy: MR imaging and pathological correlation

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, a clinicopathological correlation of 34 cases

Diabetic mastopathy (DM) is an unusual fibrous disease of the breast. We report 34 cases with clinicopathological correlation and follow-ups. Patients mean age was 57 years and 24 had histories of diabetes mellitus. The DM presented as a palpable breast mass in 85.3% of the cases clinically. Image findings were often as an irregular hypoechoic mass (44.4%) on ultrasound and negative or non-specific density (67.6%) on mammogram. Histologically, we found that the majority of DM occurred in the upper outer/central part of the breast (76%) and the size ranged from 0.5 to 3.7 cm. All cases showed lymphocytic lobulitis and vasculitis, keloidal fibrosis, lobular atrophy and varying degree of epithelioid fibroblasts. Examining the surrounding normal tissue of the excision specimens revealed that the margins of DM were often poorly circumscribed and irregularly demarcated from the sounding breast tissue. Vascular calcifications were identified in 10 of 24 excisional specimens, suggesting a hypothesis that vascular damage and scar/wounding healing process could contribute to the pathogenesis of DM. Twenty-one cases had repeated procedures for uncertain descriptive diagnosis. This is the largest study of diabetic mastopathy to date with clinical and imagining correlation. Recognition of this benign entity is important to better understanding the pathogenesis and to avoid unnecessary procedures.

Diabetic mastopathy: a case report

Diabetic mastopathy (DMP) is an uncommon collection of clinical, radiological, and histological features, classically described in premenopausal women with long-term insulin-dependent diabetes mellitus. This entity can mimic breast carcinoma, but, in the appropriate clinical and imaging setting, the diagnosis can be made by core biopsy, avoiding unnecessary surgeries. We report the case of a 34-year-old female, with a 12-year history of type 1 diabetes, who presented with bilateral breast lumps. Mammography, ultrasonography, and magnetic resonance imaging could not exclude the suspicion of malignancy, and a core biopsy was performed showing the typical histologic features of DMP. The literature is briefly reviewed.

A Comprehensive Review of Imaging and Management of Fibrous Lesions of the Breast

Fibroepithelial lesions of the breast are composed of both prominent stroma and glandular epithelium. They range in spectrum from fibroadenoma (a common benign neoplasm) to phyllodes tumor (an uncommon tumor that can recur and metastasize). Other benign fibrous breast lesions include focal fibrosis, pseudoangiomatous stromal hyperplasia, radial scar, and fibromatosis. Diabetic fibrous mastopathy is a reactive stromal proliferation found in patients with type 1 insulin- dependent diabetes. Our goal in this article is to review these various fibrous lesions of the breast, concentrating on their imaging appearances and management implications.

Autoantibody with Cross-Reactivity between Insulin and Ductal Cells May Cause Diabetic Mastopathy: A Case Study

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.