Sclerosing lymphocytic lobulitis in the male breast

Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players

Mastitis frequently affects women of childbearing age. Of all the pathological breast conditions requiring specific management, autoimmune mastitis is in the third position after infection and breast cancer. The aim of this literature review was to make a comprehensive description of autoimmune diseases targeting the mammary gland. Four main histological patterns of autoimmune mastitis are described: (i) lymphocytic infiltrates; (ii) ductal ectasia; (iii) granulomatous mastitis; and (iv) vasculitis. Our literature search found that all types of autoimmune disease may target the mammary gland: organ-specific diseases (diabetes, thyroiditis); connective tissue diseases (such as systemic erythematosus lupus or Sjögren’s syndrome); vasculitides (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, giant cell arteritis, polyarteritis nodosa, Behçet’s disease); granulomatous diseases (sarcoidosis, Crohn’s disease); and IgG4-related disease. Cases of breast-specific autoimmune diseases have also been reported, including idiopathic granulomatous mastitis. These breast-limited inflammatory diseases are sometimes the first symptom of a systemic autoimmune disease. Although autoimmune mastitis is rare, it is probably underdiagnosed or misdiagnosed. Early diagnosis may allow us to detect systemic diseases at an earlier stage, which could help to initiate a prompt, appropriate therapeutic strategy. In case of suspected autoimmune mastitis, we hereby propose a diagnostic pathway and discuss the potential pathophysiological pathways leading to autoimmune breast damage.

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

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.

Breast carcinoma in diabetic mastopathy

Diabetic mastopathy, or diabetic fibrous breast disease is a well-characterised benign, fibro-inflammatory condition affecting women with insulin dependent diabetes. To date the relationship between this condition and breast carcinoma has been poorly reported. We describe a case of breast carcinoma arising within a diabetic fibrous breast lesion, in a renal transplant recipient.

Diabetic Mastopathy: Adjunctive Use of Ultrasound and Utility of Core Biopsy in Diagnosis

Diabetic mastopathy is uncommon but occurs in long-term insulin-dependent diabetic patients who develop hard palpable breast masses which mimic breast cancer and are occult mammographically. Ultrasound evaluation is useful to analyze the masses. There is a spectrum of ultrasound findings from marked acoustic shadowing to a vague hypoechoic area without shadowing. Ultrasound-guided core biopsy (CB) is recommended for a definitive diagnosis since fine needle aspiration biopsy (FNAB) yields insufficient material for diagnosis secondary to extensive fibrosis. Four of the 11 patients in our series had FNAB, which was reported as insufficient material for diagnosis. However, 10 of 11 patients with diabetic mastopathy were successfully diagnosed by ultrasound-guided CB, helping to avoid an unnecessary surgical excisional biopsy.

"Diabetic mastopathy" in the male breast--a special type of gynecomastia. A comparative study of lymphocytic mastitis and gynecomastia

Focal B-lymphocytic mastitis and focal fibrosis of the breast in young women have rarely been reported as a complication of longstanding insulin-dependent diabetes mellitus type I. We present two cases of "diabetic mastopathy" in male diabetics suffering from gynecomastia. Furthermore, these two cases were examined in comparison to a selected group of 6 patients showing gynecomastia with a marked inflammatory reaction, as well as to 24 non-selected cases of common gynecomastia. The lesion is interpreted as a diabetes-induced autoimmune reaction of the breast and may be regarded as a lympho-epithelial lesion. Its histopathological characteristics are a marked chronic periductal and perivascular mastitis with a predominance of B-lymphocytes, a focal homogenous fibrosis and so called "epithelioid stromal fibroblasts" within the fibrotic matrix. Our findings support the existance of "diabetic mastopathy" in the male and point out to the potentially misleading pattern of this benign tumor-like lesion simulating gynecomastia.