Bilateral, tumorlike diabetic mastopathy-progression and regression of the disease during 5-year follow up

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.

Ultrasound as a Valuable Imaging Modality in Sclerosing Lymphocytic Lobulitis: Imaging Features Based on a Retrospective Cohort Analysis of 51 Cases

PURPOSE

Sclerosing lymphocytic lobulitis (SLL) is a rare benign breast condition usually associated with diabetes mellitus and whose imaging features have been assessed in few studies, limiting the adoption of diagnostic guidelines. We aimed to identify the main morphological features associated with SLL on imaging examinations (mainly ultrasound and mammography) and to retrospectively evaluate the role that each method played in the diagnostic workup (detection and indication for biopsy).

METHODS

A retrospective study was conducted in a high-volume single center, encompassing 51 consecutive patients (100% female; 26-78 y; 43.7 ± 15.5 y) with histopathologically proven SLL (59 lesions; 0.5-6.1 cm).

RESULTS

Most lesions (31/59; 53%) were found in asymptomatic individuals. Ultrasound detected 91.1% (51 out of 56 lesions assessed by this modality), of which 94.1% were non-circumscribed masses (BI-RADS® 4). Mammography detected 41.6% (15 out of 36 lesions assessed by this modality), with a predominance (80%) of non-calcified ones (masses, asymmetries and distortion). Two-year follow-up was achieved in 29 lesions (49%), showing complete remission (45%) or stability (41%) in most cases.

CONCLUSIONS

Most lesions in this retrospective sample have been detected by means of ultrasound and had their need for biopsy indicated by this modality. Female diabetic patients younger than 40 years presenting with a palpable lesion and a non-circumscribed mass on ultrasound could be submitted to core biopsy; histopathologic findings suggestive of SLL should be considered concordant in this scenario, with subsequent conservative treatment.

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.

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 and Literature Review

Diabetic mastopathy is a rare fibroinflammatory breast disease characterized by lymphocytic lobulitis, ductitis, and perivasculitis with stromal fibrosis. This lesion often presents as a discretely palpable uni- or bilateral mass in long-standing type I diabetes and other autoimmune diseases. We report a case of insulin-dependent diabetic mastopathy, which presented clinically as an indeterminate breast lump suspicious for malignancy. The patient is a 36-year-old woman who had type 1 insulin-dependent diabetes mellitus. Mammography and ultrasonography raised a suspicion of malignancy, and an excisional biopsy was performed. A previous biopsy had shown no evidence of malignancy. Histopathological examination now showed dense keloid-like stromal fibrosis with epithelioid-like and spindly myofibroblasts and a characteristic lymphocytic infiltration around blood vessels in and around lobules and ducts, features consistent with diabetic mastopathy. The literature is briefly reviewed.

Diagnostic utility of diffusion-weighted magnetic resonance imaging in diabetic mastopathy

We report the clinical findings in a 36-year-old woman with diabetic mastopathy. The lesion showed heterogeneous segmental enhancement on magnetic resonance imaging (MRI), resembling a malignant lesion, but diffusion-weighted imaging (DWI) showed no abnormalities and the apparent diffusion coefficient value did not decrease. This case emphasizes the utility of DWI for differentiating diabetic mastopathy from malignant breast lesions. The value of DWI lies in its ability to exclude the possibility of malignant breast lesions and thus to avoid unnecessary biopsy.

Regression of the fibrous disease of the breast in a non-diabetic woman after pregnancy and breastfeeding

Fibrous mastopathy, also known as diabetic mastopathy and lymphocytic mastopathy, may mimic breast cancer at the physical examination, mammography, and ultrasound. We report a case of a woman who presented a non-tender mass clinically suggestive of breast carcinoma; however, the fine-needle aspiration cytology indicated atypia and the core needle biopsy revealed lymphocytic mastopathy. The magnetic resonance imaging of the breast showed a lesion with benign features. It was not demonstrated diabetics mellitus and autoimmune diseases. The patient got pregnant, breastfed, and it was observed the progressive regression of the lesion, with complete disappearance of the solid mass. Three years and three months later, there was no palpable mass at the clinical examination and ultrasound. In conclusion, fibrous mastopathy shall be considered for all breast lesions, regardless of the diagnosis of diabetes mellitus. Once a definitive diagnosis of this pathology is reached, it is recommended clinical, imaging studies and fine-needle aspiration biopsy follow-up of the patient, avoiding unnecessary surgical procedures.

Gynecomastia

Gynecomastia is common and may be asymptomatic. In most cases, a thorough history and physical examination, along with limited laboratory investigations, can help to exclude breast malignancy and serious underlying endocrine or systemic disease. Careful clinical observation may be all that is required in many cases, because gynecomastia often resolves spontaneously. Because gynecomastia is usually caused by an imbalance of androgenic and estrogenic effects on the breast, medical therapy may include antiestrogens, androgens, or aromatase inhibitors. Surgery is useful in the management of patients with long-standing symptomatic gynecomastia or when medical therapy is not successful.

Dynamic contrast enhanced magnetic resonance imaging and magnetic resonance spectroscopy in diabetic mastopathy

Diabetic mastopathy is a rare, benign clinico-pathological entity strongly associated with type I diabetes. X-ray mammography and ultrasonography are inadequate to distinguish this lesion from malignancy, leading to unnecessary excision biopsies. Dynamic contrast enhanced MRI and MR spectroscopy, powerful tools in the investigation of breast disease, can help solve this problem.

Diabetic fibrous mastopathy: sonographic-pathologic correlation

Fibrous and inflammatory lesions of the breast in patients with early-onset, longstanding insulin-dependent diabetes mellitus (IDDM) can lead to misdiagnosis because the clinical, mammographic, and sonographic findings simulate breast cancer. We report a case of diabetic fibrous mastopathy with suspicious clinical, imaging, and cytologic findings.

Diabetic Fibrous Mastopathy: Dynamic Contrast-Enhanced Magnetic Resonance Imaging Findings

Diabetic fibrous mastopathy (DFM) is an uncommon lesion that may clinically mimic breast carcinoma. Routine mammographic and ultrasonographic features of this disease also mimic the those of malignant disease, making an accurate preoperative diagnosis difficult. Dynamic contrast-enhanced magnetic resonance imaging (MRI), however, reveals a homogeneous low-enhancement with a gradual and progressive course without a washout. A corresponding time intensity curve is related to benign lesions of low vascularity, and by being a potential criterion for making a differentiation between DFM and malignant processes, spares patients from excisional biopsy.

Diabetic sclerosing lymphocytic lobulitis of the breast

Diabetic sclerosing lymphocytic lobulitis of the breast (SLLB) as a complication of long standing diabetes is a benign disease without known tendency to malignant evolution. Clinically, it is characterized by solitary or multiple rock-hard discrete lesion(s) in one or both breasts, usually in a subareolar site, but may appear equally in any part of the breast. Mammographically and morphologically, this lesion simulates cancer. The lesion may recur after excision in the same site or in another location of the ipsilateral or the contralateral breast. Awareness of this entity, establishment of the diagnosis by open biopsy or by core needle biopsy may spare the need for repeated wide excisions and the resulting distortion of the breast architecture. The aim of this review is to arouse the awareness of the physicians and surgeons to this possibility when they find a similar lesion in the breast of a diabetic patient.

Diabetic mastopathy. A clinicopathologic review

Diabetic mastopathy, an uncommon form of lymphocytic mastitis and stromal fibrosis, typically occurs in longstanding type 1 diabetes. Nineteen cases meeting predetermined histopathologic criteria for diabetic mastopathy were correlated as to clinical history and disease recurrence. Physical examination revealed palpable discrete masses or diffuse nodularity, both predominantly in the subareolar region. One nonpalpable lesion was detected incidentally during reduction mammoplasty. All cases contained lymphocytic ductitis and lobulitis with varying degrees of keloidal fibrosis, vasculitis, epithelioid fibroblasts, and lymphoid nodule formation. Single mammary lesions were found in 11 patients with type 1 diabetes, 1 with type 2 diabetes, and 3 without diabetes. Four cases were bilateral (3 patients with type 1 and 1 patient with type 2 diabetes). Six of 19 cases recurred (3 ipsilateral, 2 contralateral, and 1 bilateral). We confirm the histopathologic constellation for diabetic mastopathy. However, we question the specificity of these features because of identical findings in patients with type 2 diabetes and nondiabetic patients. We found diabetic mastopathy in men and women, as a solitary mass or bilateral disease, and recurrence in either breast, sometimes multiple. Recognition of potential recurrence is important because it might spare patients with documented diabetic mastopathy from repeated breast biopsies.