Figure 1
Figura 1
Two focal parenchymal condensations in the upper outer quadrant and subareolar region of the left breast (arrows).
Clinical History
A 5cm solitary, hard, painless lump in the left breast of a patient with long-standing diabetes mellitus type 1.
Imaging Findings
A patient, with long-standing diabetes mellitus type 1, was admitted because of a 5cm solitary, hard, painless lump in the left breast. Her reproductive history included two deliveries, last menstrual period 9 days previously and no previous breast diseases. Mammography and ultrasonography were performed. On the mammograms there were two separate focal parenchymal condensations in the upper outer quadrant and subareolar region of the left breast, of 2cm each (Fig. 1), which corresponded to the palpable mass. Ultrasonography of the left breast showed two hypoechoic masses with posterior acoustic shadowing (Fig. 2). Excisional surgical breast biopsy was performed, based on clinical and radiological signs of malignancy. The histological examination revealed a benign sclerosing lymphocytic lobulitis (Fig. 3).
Sixteen months later, a new mass developed in the right breast, with the same clinical presentation. Mammography showed a newly-formed focal parenchymal condensation in the upper quadrants of the right breast, while in the left breast there was scarring due to the previous surgery (Fig. 4). Histological diagnosis of the right breast mass was sclerosing lymphocytic lobulitis.
Sixteen months later, a new mass developed in the right breast, with the same clinical presentation. Mammography showed a newly-formed focal parenchymal condensation in the upper quadrants of the right breast, while in the left breast there was scarring due to the previous surgery (Fig. 4). Histological diagnosis of the right breast mass was sclerosing lymphocytic lobulitis.
Discussion
Diabetic mastopathy is a rare clinical, radiological and pathohistological syndrome in patients with long-standing diabetes mellitus type 1, usually associated with diabetic retinopathy and neuropathy (1). Clinical manifestations are indistinguishable from breast malignancy: unilateral or bilateral, rock-hard, mobile, irregular, painless palpable mass or masses. Mammography reveals indirect signs of malignancy (focal parenchymal condensation). On sonography there is intense acoustic shadowing with or without a hypoechoic mass (2). Diabetic mastopathy shows absence of a Doppler signal on ultrasound and non-specific stromal enhancement on MR imaging (3).
The pathological substrate of these imaging findings is sclerosing lymphocytic lobulitis: dense stromal fibrosis with epitheloid fibroblasts and lymphocytic perilobular/perivascular infiltrates. The cause of the disease is unknown, but the lymphocytic deposits suggest an autoimmune reaction, probably against abnormal components of the extracellular matrix, induced by hyperglycaemia.
The prevalence of the disease is in the broad spectrum from 0.06% or less to 13%, depending on the type of study (surgical, pathological or radiological) and the patients involved. The disease may be recurrent, with new lesions in the same or contralateral breast (4).
Since the benign nature of diabetic mastopathy is recognised only on histological examination, surgical breast biopsy is mandatory for diagnosis. Follow-up of the patients is necessary and core biopsy is suggested for recurrent lesions, avoiding multiple surgical breast biopsies.
The pathological substrate of these imaging findings is sclerosing lymphocytic lobulitis: dense stromal fibrosis with epitheloid fibroblasts and lymphocytic perilobular/perivascular infiltrates. The cause of the disease is unknown, but the lymphocytic deposits suggest an autoimmune reaction, probably against abnormal components of the extracellular matrix, induced by hyperglycaemia.
The prevalence of the disease is in the broad spectrum from 0.06% or less to 13%, depending on the type of study (surgical, pathological or radiological) and the patients involved. The disease may be recurrent, with new lesions in the same or contralateral breast (4).
Since the benign nature of diabetic mastopathy is recognised only on histological examination, surgical breast biopsy is mandatory for diagnosis. Follow-up of the patients is necessary and core biopsy is suggested for recurrent lesions, avoiding multiple surgical breast biopsies.
Differential Diagnosis List
Recurrent diabetic mastopathy
Final Diagnosis
Recurrent diabetic mastopathy
References
[1]
1. Kudva YC, Reynolds C, O'Brien T, Powell C, Oberg AL, Crotty TB.
"Diabetic mastopathy," or sclerosing lymphocytic lobulitis, is strongly associated with type 1 diabetes.
Diabetes Care 2002 Jan;25(1):121-6. (PMID: 11772912)
[2]
2. Feder JM, de Paredes ES, Hogge JP, Wilken JJ.
Unusual breast lesions: radiologic-pathologic correlation.
Radiographics 1999 Oct;19 Spec No:S11-26. (PMID: 10517440)
[3]
3. Sakuhara Y, Shinozaki T, Hozumi Y, Ogura S, Omoto K, Furuse M.
MR imaging of diabetic mastopathy.
AJR Am J Roentgenol 2002 Nov;179(5):1201-3. (PMID: 12388498)
[4]
4. Camuto PM, Zetrenne E, Ponn T.
Diabetic mastopathy: a report of 5 cases and a review of the literature.
Arch Surg 2000 Oct;135(10):1190-3. (PMID: 11030878)
Case information
| URL: | https://eurorad.org/case/2185 |
| DOI: | 10.1594/EURORAD/CASE.2185 |
| ISSN: | 1563-4086 |
Figure 2
Figura 2
Dense posterior acoustic shadowing.
Figure 3
Figura 3
Dense collagenous stroma around lobulus with lymphocytic infiltrate, without signs of malignancy.
Figure 4
Figura 4
Newly-formed focal condensation of parenchyma in the upper quadrants of the right breast (arrow) and postoperative scaring in the left breast.
Figura 1
Two focal parenchymal condensations in the upper outer quadrant and subareolar region of the left breast (arrows).
Figura 2
Dense posterior acoustic shadowing.
Figura 3
Dense collagenous stroma around lobulus with lymphocytic infiltrate, without signs of malignancy.
Figura 4
Newly-formed focal condensation of parenchyma in the upper quadrants of the right breast (arrow) and postoperative scaring in the left breast.