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1
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Mariano L, Nicosia L, Scolari S, Pasi S, Netti S, Mazzarol G, Latronico A, Cassano E. Diabetic Mastopathy: A Monocentric Study to Explore This Uncommon Breast Disease. Diagnostics (Basel) 2024; 14:2749. [PMID: 39682657 DOI: 10.3390/diagnostics14232749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 11/25/2024] [Accepted: 12/02/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Luciano Mariano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Sofia Scolari
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Sara Pasi
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Sofia Netti
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Mazzarol
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antuono Latronico
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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Biancha-Vasco JM, Muñoz P AL, Gómez J, Rios-Serna LJ, Ruiz-Ordoñez I, Tobón GJ, Sua LF, Sánchez A, Cañas CA. Idiopathic gigantomastia exacerbated during pregnancy. Its relationship with autoimmunity: A case report. Int J Rheum Dis 2023; 26:2567-2571. [PMID: 37218579 DOI: 10.1111/1756-185x.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
Gigantomastia is a rare entity characterized by diffuse and excessive breast enlargement. It mainly occurs during puberty and pregnancy as a consequence of hormonal fluctuations. We report an unusual case of gigantomastia in a 29-year-old woman with a history of personal and familiar autoimmune phenomena. She had autoimmune thyroiditis and several positive autoantibodies, and developed 3 crises of the disease, 1 related to pregnancy (possibly hormone-mediated), and 2 unrelated to pregnancy in which an autoimmune role is raised based in clinical, histological and laboratory findings. Immunological aspects that may be involved in this presentation of the disease are discussed.
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Affiliation(s)
- Juan M Biancha-Vasco
- Autoinmunidad y Medicina Traslacional, Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Cali, Colombia
| | - Anyela L Muñoz P
- Autoinmunidad y Medicina Traslacional, Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Cali, Colombia
- Escuela de Bacteriología y Laboratorio Clínico, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Jessica Gómez
- Autoinmunidad y Medicina Traslacional, Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Cali, Colombia
| | - Lady J Rios-Serna
- Autoinmunidad y Medicina Traslacional, Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Cali, Colombia
| | - Ingrid Ruiz-Ordoñez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
| | - Gabriel J Tobón
- Department of Medical Microbiology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Luz Fernanda Sua
- Departamento de Patología y Medicina de Laboratorio, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Aura Sánchez
- Departamento de Patología y Medicina de Laboratorio, Fundación Valle del Lili, Cali, Colombia
| | - Carlos A Cañas
- Autoinmunidad y Medicina Traslacional, Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Cali, Colombia
- Fundación Valle del Lili, Unidad de Reumatología, Cali, Colombia
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3
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Patel PB, Carter GJ, Berg WA. Diabetic Fibrous Mastopathy: Imaging Features With Histopathologic Correlation. JOURNAL OF BREAST IMAGING 2023; 5:585-590. [PMID: 38416913 DOI: 10.1093/jbi/wbad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 03/01/2024]
Abstract
Diabetic fibrous mastopathy (DFM) is a rare benign fibrotic disease of the breast that develops in patients with longstanding and often uncontrolled diabetes mellitus. Clinically, patients may present with an irregular, firm, palpable mass, which may be solitary or multiple, occurring in one or both breasts. Diabetic fibrous mastopathy occurs most often in premenopausal women with heterogeneously or extremely dense breasts; mammography may show focal asymmetry or, less often, a noncalcified mass with indistinct or obscured margins, but there are usually no discrete findings. On US, DFM may have marked hypoechogenicity and posterior shadowing secondary to extensive fibrosis. Diabetic fibrous mastopathy features on contrast-enhanced MRI are also nonspecific, with gradual persistent nonmass enhancement reported. Because the clinical presentation and US features of DFM overlap with those of breast cancer, histopathologic correlation is needed to confirm diagnosis and exclude malignancy. These findings include collagenous stroma often with keloidal features and chronic perilobular and perivascular inflammation. Histopathologic findings of lymphocytic lobulitis and perivascular inflammation are common to other autoimmune conditions.
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Affiliation(s)
- Priya B Patel
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
| | - Gloria J Carter
- Magee-Womens Hospital, University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA
| | - Wendie A Berg
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Department of Radiology, Pittsburgh, PA, USA
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4
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Bahadure SD, Noman O, Jaiswal N, Bandre G, Akulwar A. Incidental Finding of Invasive Ductal Carcinoma on Mastectomy in the Case of Lymphocytic Mastitis: A Case Report. Cureus 2023; 15:e44545. [PMID: 37790038 PMCID: PMC10544750 DOI: 10.7759/cureus.44545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
A rare inflammatory breast disorder called lymphocytic mastitis is characterized by lymphocyte infiltrates in the mammary parenchyma. Due to their rarity, incidental observations of invasive ductal carcinoma in lymphocytic mastitis present diagnostic and management challenges. We present a case of a 52-year-old female with a history of painfully swollen breasts for three months who underwent a core needle biopsy, consistent with lymphocytic mastitis on histopathology. Due to persistent and worsening symptoms, a mastectomy was performed. During the examination, an incidental finding of infiltrating ductal carcinoma was identified in the mastectomy specimen. This unexpected discovery led to further investigations and altered the patient's treatment plan. The detection of invasive ductal carcinoma in the presence of lymphocytic mastitis highlights the importance of continuous surveillance and thorough examination. In the circumstances of lymphocytic mastitis, it is vital to take the likelihood of concurrent malignancy into account, especially when symptoms persist or reappear after appropriate management. This case report seeks to raise awareness among physicians of this exceptional association and drive further research that will explain its pathophysiology while enhancing management strategies.
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Affiliation(s)
- Sweta D Bahadure
- Department of Pathology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Obaid Noman
- Department of Pathology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Neha Jaiswal
- Department of Pathology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Gulshan Bandre
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anil Akulwar
- Department of Surgery, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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5
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Boumarah DN, AlSinan AS, AlMaher EM, Mashhour M, AlDuhileb M. Diabetic mastopathy: A rare clinicopathologic entity with considerable autoimmune potential. Int J Surg Case Rep 2022; 95:107151. [PMID: 35576751 PMCID: PMC9118609 DOI: 10.1016/j.ijscr.2022.107151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Diabetic mastopathy is a rare entity affecting diabetic patients. It has been previously linked to type 1 diabetes mellitus; however, due to the several accompanying conditions, a theory of autoimmune factors contributing to the origin of this condition has been on the rise. In this paper, we report a case of diabetic mastopathy associated with several autoimmune diseases to highlight the immunological potential of this condition. Case presentation A 25-year-old female, known to have type 1 diabetes mellitus, hypertension, hypothyroidism, adrenal insufficiency, dilated cardiomyopathy and end-stage renal disease, was referred to our clinic for a breast lump. Radiological investigations showed a dense mass with irregular borders in the retroareolar area of the left breast. A core biopsy was obtained which revealed keloid-like fibrosis along with lymphocytes infiltrated, suggestive of lymphocytic mastopathy. Clinical discussion Fibrous mastopathy has been merely attributed to a long-standing use of insulin therapy by diabetic patients; recent observations, however, proved the major contribution of immunity to etiopathogenesis. Even though human leukocyte antigen (HLA) association has not been supported in the literature, the histological changes of breast lymphocytic infiltrate are seen in patients who not only have T1DM, but also thyroiditis, systemic lupus erythematosus, Sjogren's syndrome, and Addison's disease. The frequent presence of several possible autoimmune conditions has promoted the theory of an autoimmune process affecting connective tissues, however, these claims are yet to be proven by future studies. Conclusion Recent observations have proved the major contribution of immunity to etiopathogenesis of diabetic mastopathy. We shed light on the role of the immune system in triggering the disease process by reporting a case of diabetic mastopathy with a cluster of autoimmune diseases. Future studies should explore the genetic background of the condition as it would potentially have several clinical implications. The discussed pathophysiologic explanations raise the possibility of autoimmunity as a key driver in pathogenesis and indicate the need to change the nomenclature of this condition.
Recent observations proved the major contribution of immunity to etiopathogenesis of fibrous mastopathy. Fibrous mastopathy has some clinical and diagnostic features that resemble malignancy. The benign nature of diabetic mastopathy permits following a conservative approach for management.
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Affiliation(s)
- Dhuha N Boumarah
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Ali S AlSinan
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Eman M AlMaher
- Department of Surgery, Security Forces Hospital, Dammam, Saudi Arabia
| | - Miral Mashhour
- Department of Pathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed AlDuhileb
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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6
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Diabetic Mastopathy. Review of Diagnostic Methods and Therapeutic Options. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010448. [PMID: 35010708 PMCID: PMC8745003 DOI: 10.3390/ijerph19010448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022]
Abstract
Diabetic mastopathy is a rare breast condition that may occur in insulin-treated men and women of any age. The etiology is still unclear; however, the autoimmunological background of the disease is highly suspected. The changes in diabetic mastopathy may mimic breast cancer; therefore, its diagnostic process is demanding, and treatment options are not clear and limited. Lesions in DM are usually multiple; therefore, surgical removal is not fully effective. A well-done anamnesis with core-needle biopsy is essential and definitive in most cases. In this review, we summarize up-to-date knowledge of diagnostic methods and therapeutic options for diabetic mastopathy treatment and present three cases of diabetic mastopathy-type lesions in ultrasound and radiological examinations.
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7
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Chen XX, Shao SJ, Wan H. Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature. World J Clin Cases 2021; 9:3458-3465. [PMID: 34002158 PMCID: PMC8107902 DOI: 10.12998/wjcc.v9.i14.3458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/15/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Xiao-Xiao Chen
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200001, China
| | - Shi-Jun Shao
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200001, China
| | - Hua Wan
- Department of Breast, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200001, China
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8
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Betts CB, Quackenbush A, Anderson W, Marshall NE, Schedin PJ. Mucosal Immunity and Liver Metabolism in the Complex Condition of Lactation Insufficiency. J Hum Lact 2020; 36:582-590. [PMID: 32795211 DOI: 10.1177/0890334420947656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lactation insufficiency is variously defined and includes the inability to produce milk, not producing enough milk to exclusively meet infant growth requirements, and pathological interruption of lactation (e.g., mastitis). Of women with intent-to-breastfeed, lactation insufficiency has been estimated to affect 38%-44% of newly postpartum women, likely contributing to the nearly 60% of infants that are not breastfed according to the World Health Organization's guidelines. To date, research and clinical practice aimed at improving feeding outcomes have focused on hospital lactation support and education, with laudable results. However, researchers' reports of recent rodent studies concerning fundamental lactation biology have suggested that the underlying pathologies of lactation insufficiency may be more nuanced than is currently appreciated. In this article, we identify mucosal biology of the breast and lactation-specific liver biology as two under-researched aspects of lactation physiology. Specifically, we argue that further scientific inquiry into reproductive state-dependent regulation of immunity in the human breast will reveal insights into novel immune based requirements for healthy lactation. Additionally, our synthesis of the literature supports the hypothesis that the liver is an essential player in lactation-highlighting the potential that pathologies of the liver may also be associated with lactation insufficiency. More research into these biologic underpinnings of lactation is anticipated to provide new avenues to understand and treat lactation insufficiency.
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Affiliation(s)
- Courtney B Betts
- 89020 Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, OR, USA
| | - Alexandra Quackenbush
- 89020 Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, OR, USA
| | - Weston Anderson
- 89020 Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, OR, USA
| | - Nicole E Marshall
- Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pepper J Schedin
- 89020 Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, OR, USA.,University of Colorado Cancer Center, Aurora, CO, USA.,Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
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Airola K, Moy L. Unknown Case #5 Diagnosis: Rheumatoid Arthritis-Associated Lymphocytic Mastopathy. JOURNAL OF BREAST IMAGING 2020; 2:168-169. [PMID: 38424881 DOI: 10.1093/jbi/wbz043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Indexed: 03/02/2024]
Affiliation(s)
- Krystal Airola
- NYU School of Medicine, Department of Radiology, New York, NY
| | - Linda Moy
- NYU School of Medicine, Department of Radiology, New York, NY
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10
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Intracyctic Papillary Carcinoma of the Breast: Report of a Rare Case and Literature Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.7259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Schaadt NS, Alfonso JCL, Schönmeyer R, Grote A, Forestier G, Wemmert C, Krönke N, Stoeckelhuber M, Kreipe HH, Hatzikirou H, Feuerhake F. Image analysis of immune cell patterns in the human mammary gland during the menstrual cycle refines lymphocytic lobulitis. Breast Cancer Res Treat 2017; 164:305-315. [PMID: 28444535 DOI: 10.1007/s10549-017-4239-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/07/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To improve microscopic evaluation of immune cells relevant in breast cancer oncoimmunology, we aim at distinguishing normal infiltration patterns from lymphocytic lobulitis by advanced image analysis. We consider potential immune cell variations due to the menstrual cycle and oral contraceptives in non-neoplastic mammary gland tissue. METHODS Lymphocyte and macrophage distributions were analyzed in the anatomical context of the resting mammary gland in immunohistochemically stained digital whole slide images obtained from 53 reduction mammoplasty specimens. Our image analysis workflow included automated regions of interest detection, immune cell recognition, and co-registration of regions of interest. RESULTS In normal lobular epithelium, seven CD8[Formula: see text] lymphocytes per 100 epithelial cells were present on average and about 70% of this T-lymphocyte population was lined up along the basal cell layer in close proximity to the epithelium. The density of CD8[Formula: see text] T-cell was 1.6 fold higher in the luteal than in the follicular phase in spontaneous menstrual cycles and 1.4 fold increased under the influence of oral contraceptives, and not co-localized with epithelial proliferation. CD4[Formula: see text] T-cells were infrequent. Abundant CD163[Formula: see text] macrophages were widely spread, including the interstitial compartment, with minor variation during the menstrual cycle. CONCLUSIONS Spatial patterns of different immune cell subtypes determine the range of normal, as opposed to inflammatory conditions of the breast tissue microenvironment. Advanced image analysis enables quantification of hormonal effects, refines lymphocytic lobulitis, and shows potential for comprehensive biopsy evaluation in oncoimmunology.
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Affiliation(s)
- Nadine S Schaadt
- Institute of Pathology, Neuropathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Juan Carlos López Alfonso
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | - Ralf Schönmeyer
- Definiens AG, Bernhard-Wicki-Straße 5, 80636, Munich, Germany
| | - Anne Grote
- Institute of Pathology, Neuropathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Germain Forestier
- MIPS, University of Haute Alsace, 12 rue des Freres Lumiere, 68093, Mulhouse, France
| | - Cédric Wemmert
- ICube, University of Strasbourg, 300 bvd Sebastien Brant, 67412, Illkirch, France
| | - Nicole Krönke
- Institute of Pathology, Neuropathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Mechthild Stoeckelhuber
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Neuropathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Haralampos Hatzikirou
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | - Friedrich Feuerhake
- Institute of Pathology, Neuropathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
- University Clinic of Freiburg, Institute for Neuropathology, Breisacher Str. 64, 76106, Freiburg, Germany.
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12
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Sharma A, Ali S, Devendra S. Breast lump in a patient with Type 1 Diabetes. LONDON JOURNAL OF PRIMARY CARE 2016; 8:42-45. [PMID: 28250832 PMCID: PMC5330332 DOI: 10.1080/17571472.2016.1163937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Jabbour G, El-Mabrok G, Al-Thani H, El-Menyar A, Al Hijji I, Napaki S. Primary Breast Lymphoma in a Woman: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:97-103. [PMID: 26893404 PMCID: PMC4763798 DOI: 10.12659/ajcr.896264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Patient: Female, 43 Final Diagnosis: Primary breast lymphoma Symptoms: — Medication: — Clinical Procedure: CT scan • PET • chemotherapy • radiotherapy Specialty: Oncology
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Affiliation(s)
- Gaby Jabbour
- Department of Surgery, General Surgery, Hamad General Hospital, Doha, Qatar
| | - Gamela El-Mabrok
- Department of Surgery, General Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, General Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | | | - Sarbar Napaki
- Department of Laboratory Medicine and Pathology, Hamad General Hospital, Doha, Qatar
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14
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Chen LY, Tsang JYS, Ni YB, Chan SK, Chan KF, Zhang S, Tse GM. Lymphocyte subsets contribute to the degree of lobulitis and ductitis in sclerosing lymphocytic lobulitis of the breast. J Clin Pathol 2015; 69:527-32. [PMID: 26582743 DOI: 10.1136/jclinpath-2015-203334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/28/2015] [Indexed: 11/03/2022]
Abstract
AIMS Sclerosing lymphocytic lobulitis (SLL) of the breast is characterised by lymphocytic lobulitis, ductitis, vasculitis and dense keloidal fibrosis with epithelioid fibroblasts. However, the subsets of the infiltrating lymphocytes and their contribution to disease progression have not been fully explored. METHODS CD20, CD3, CD4, CD8 and regulatory T (Treg) lymphocytes were evaluated in the epithelial and vascular areas in SLL. The relationship between the lymphocyte subset in different regions and the degree of inflammation was analysed. RESULTS Lymphocytic infiltration was mainly located in peri-lobular, peri-ductal and peri-vascular areas. No significant differences between CD20 and CD3 lymphocytes were found in peri-epithelial areas. However, there were more intra-ductal/lobular epithelial CD3 than CD20 lymphocytes (p<0.001). For T lymphocyte subsets, more CD4 than CD8 lymphocytes were found in the peri-lobular/vascular regions (p≤0.026); but an opposite trend was seen in the intra-ductal/lobular regions (p<0.001). In the peri-lobular/vascular regions, generally, different lymphocyte subsets correlated with each other. Interestingly, in the peri-ductal region, only CD4 lymphocytes showed significant correlations with all other subsets (p≤0.020). Regarding their relationship with the degree of inflammation, significant positive correlations were observed for all subsets in peri-vascular/lobular regions (p≤0.045). Only regulatory T cells, but not the others, at the peri-ductal region showed significant correlation with the degree of inflammation at all three regions (p≤0.014). CONCLUSIONS In addition to B lymphocyte subsets, T lymphocyte subsets could be involved differently in SLL. CD4 lymphocytes may have a pivotal role in recruiting other subsets to the inflamed site, and triggered the cascade of inflammatory changes resulting in fibrosis.
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Affiliation(s)
- Lin-Ying Chen
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Julia Y S Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Yun-Bi Ni
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Siu-Ki Chan
- Department of Pathology, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Kui-Fat Chan
- Department of Pathology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Sheng Zhang
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Kim J, Kim EK, Kim MJ, Moon HJ, Yoon JH. Diabetic mastopathy: imaging features and the role of image-guided biopsy in its diagnosis. Ultrasonography 2015; 35:140-7. [PMID: 26810194 PMCID: PMC4825211 DOI: 10.14366/usg.15052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The goal of this study was to evaluate the imaging features of diabetic mastopathy (DMP) and the role of image-guided biopsy in its diagnosis. METHODS Two experienced radiologists retrospectively reviewed the mammographic and sonographic images of 19 pathologically confirmed DMP patients. The techniques and results of the biopsies performed in each patient were also reviewed. RESULTS Mammograms showed negative findings in 78% of the patients. On ultrasonography (US), 13 lesions were seen as masses and six as non-mass lesions. The US features of the mass lesions were as follows: irregular shape (69%), oval shape (31%), indistinct margin (69%), angular margin (15%), microlobulated margin (8%), well-defined margin (8%), heterogeneous echogenicity (62%), hypoechoic echogenicity (38%), posterior shadowing (92%), parallel orientation (100%), the absence of calcifications (100%), and the absence of vascularity (100%). Based on the US findings, 17 lesions (89%) were classified as Breast Imaging Reporting and Data System category 4 and two (11%) as category 3. US-guided core biopsy was performed in 18 patients, and 10 (56%) were diagnosed with DMP on that basis. An additional vacuum-assisted biopsy was performed in seven patients and all were diagnosed with DMP. CONCLUSION The US features of DMP were generally suspicious for malignancy, whereas the mammographic findings were often negative or showed only focal asymmetry. Core biopsy is an adequate method for initial pathological diagnosis. However, since it yields non-diagnostic results in a considerable number of cases, the evaluation of correlations between imaging and pathology plays an important role in the diagnostic process.
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Affiliation(s)
- Jonghyeon Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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16
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Leroux-Stewart J, Rabasa-Lhoret R. Diabetic Mastopathy: Case Report and Summary of Literature. Can J Diabetes 2014; 38:305-6. [DOI: 10.1016/j.jcjd.2013.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/16/2014] [Indexed: 02/06/2023]
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17
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Bilir BE, Atile NS, Bilir B, Guldiken S, Tuncbilek N, Puyan FO, Sezer A, Coskun I. A metabolic syndrome case presenting with lymphocytic mastitis. ACTA ACUST UNITED AC 2014; 7:493-5. [PMID: 24715834 DOI: 10.1159/000345474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lymphocytic mastitis is a disease of premenopausal women, and its association with type 1 diabetes mellitus is the basis for its alternative name 'diabetic mastopathy'. It is a benign condition but must be considered in the differential diagnosis of breast cancer, especially in diabetic patients. CASE REPORT We present the case of an overweight 50-year-old dyslipidemic woman with metabolic syndrome presenting with lymphocytic mastitis. CONCLUSION Although lymphocytic mastitis is usually regarded as an autoimmune disease seen mostly in diabetic patients, it may also be seen in nondiabetic patients with metabolic syndrome who do not have an autoimmune disease.
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Affiliation(s)
- Betul Ekiz Bilir
- Department of Endocrinology and Metabolism, Medical Faculty, Trakya University, Edirne, Turkey
| | - Neslihan Soysal Atile
- Department of Endocrinology and Metabolism, Medical Faculty, Trakya University, Edirne, Turkey
| | - Bulent Bilir
- Internal Medicine Clinics, Edirne Public Hospital, Saricapasa, Trakya University, Edirne, Turkey
| | - Sibel Guldiken
- Department of Endocrinology and Metabolism, Medical Faculty, Trakya University, Edirne, Turkey
| | - Nermin Tuncbilek
- Department of Radiology, Medical Faculty, Trakya University, Edirne, Turkey
| | - Fulya Oz Puyan
- Department of Pathology, Medical Faculty, Trakya University, Edirne, Turkey
| | - Atakan Sezer
- Department of General Surgery, Medical Faculty, Trakya University, Edirne, Turkey
| | - Irfan Coskun
- Department of General Surgery, Medical Faculty, Trakya University, Edirne, Turkey
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18
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Park SH, Choi SJ, Jung HK. Sclerosing lymphocytic lobulitis manifesting as suspicious microcalcifications with Hashimoto's thyroiditis in a young woman. Breast J 2013; 19:539-41. [PMID: 23834442 DOI: 10.1111/tbj.12156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sclerosing lymphocytic lobulitis (SLL) is a rare inflammatory disorder, which is also known as fibrous mastopathy and lymphocytic mastitis. It is commonly associated with autoimmune disorders, particularly type 1 diabetes and thyroiditis. We report the case of a 28-year-old woman diagnosed as SLL with Hashimoto's thyroiditis, but without diabetes. She presented suspicious microcalcifications without palpable mass in routine mammograms in both breasts. She had been diagnosed as Hashimoto's thyroiditis several years before and had been followed up in endo-clinics.
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Affiliation(s)
- Sung Hee Park
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
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19
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Diabetic mastopathy: an uncommon complication of diabetes mellitus. Case Rep Surg 2013; 2013:198502. [PMID: 23936718 PMCID: PMC3713321 DOI: 10.1155/2013/198502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/17/2013] [Indexed: 01/16/2023] Open
Abstract
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.
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20
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Kesaraju P, Jaini R, Johnson JM, Altuntas CZ, Gruden JJ, Sakalar C, Tuohy VK. Experimental autoimmune breast failure: a model for lactation insufficiency, postnatal nutritional deprivation, and prophylactic breast cancer vaccination. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:775-84. [PMID: 22901749 DOI: 10.1016/j.ajpath.2012.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 05/20/2012] [Accepted: 05/30/2012] [Indexed: 01/31/2023]
Abstract
Mastitis is a substantial clinical problem in lactating women that may result in severe pain and abrupt termination of breastfeeding, thereby predisposing infants to long-term health risks. Many cases of mastitis involve no known infectious agent and may fundamentally be due to autoimmune-mediated inflammation of the breast. Herein, we develop a murine model of autoimmune mastitis and provide a detailed characterization of its resulting phenotype of breast failure and lactation insufficiency. To generate breast-specific autoimmunity, we immunized SWXJ mice with recombinant mouse α-lactalbumin, a lactation-dependent, breast-specific differentiation protein critical for production of lactose. Mice immunized with α-lactalbumin showed extensive T-cell-mediated inflammation in lactating normal breast parenchyma but none in nonlactating normal breast parenchyma. This targeted autoimmune attack resulted in breast failure characterized by lactation insufficiency and decreased ability to nurture offspring. Although immunization with α-lactalbumin had no effect on fertility and birth numbers, pups nursed by α-lactalbumin-immunized mice showed significantly disrupted growth often accompanied by kwashiorkor-like nutritional abnormalities, including alopecia, liver toxicity, and runting. This experimental model of autoimmune breast failure has useful applications for prophylactic breast cancer vaccination and for addressing inflammatory complications during breastfeeding. In addition, this model is suited for investigating nutritionally based "failure-to-thrive" issues, particularly regarding the long-term implications of postnatal nutritional deprivation.
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Affiliation(s)
- Pavani Kesaraju
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Ohio 44195, USA
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21
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Masood S. Characteristics of systemic diseases in the breast: clinical, imaging and pathologic features. ACTA ACUST UNITED AC 2012; 8:593-9. [PMID: 22934732 DOI: 10.2217/whe.12.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite tremendous efforts placed on advances in diagnosis and treatment of the spectrum of breast disease, the impact of systemic diseases on the breast has remained under recognized. Distinction between a variety of benign breast diseases versus those that are manifestations of a systemic disease is critically important for appropriate treatment planning and follow-up of patients. This article is designed to provide an overview of different systemic diseases that can present as a breast lesion. Attempts are made to highlight the significance of the distinction between benign breast disease versus benign conditions that present as the result of a systemic disease. Naturally, distinction between any benign condition versus breast carcinoma is a part of the evaluation process.
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Affiliation(s)
- Shahla Masood
- Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
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22
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Abstract
Some inflammatory and reactive lesions of the breast present problems clinically but are treated without resort to biopsy. In others, biopsy is required to make the correct diagnosis and to distinguish the process from malignancy. Still others represent incidental microscopic findings that may create diagnostic problems. This article reviews a number of inflammatory and reactive conditions that are likely to be encountered in routine surgical pathology practice, as well as those that have been recently described.
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Affiliation(s)
- Jennifer S Kaplan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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23
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Dorokhova O, Fineberg S, Koenigsberg T, Wang Y. Diabetic mastopathy, a clinicopathological correlation of 34 cases. Pathol Int 2012; 62:660-4. [PMID: 23005592 DOI: 10.1111/j.1440-1827.2012.02853.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Olena Dorokhova
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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24
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Kuper-Hommel MJJ, van Krieken JHJM. Molecular pathogenesis and histologic and clinical features of extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue type. Leuk Lymphoma 2012; 53:1032-45. [DOI: 10.3109/10428194.2011.631157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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25
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26
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Croce S, Chaney G, Bretz-Grenier MF, Wittersheim A, Casnedi S, Mathelin C. [Diabetic mastopathy: a recurrent benign breast disease]. ACTA ACUST UNITED AC 2011; 38:686-9. [PMID: 20971025 DOI: 10.1016/j.gyobfe.2010.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 11/16/2009] [Indexed: 01/16/2023]
Abstract
Diabetic mastopathy is an uncommon benign entity occurring in young women with type 1 diabetes. Its clinical and radiological signs are not specific and often mimic a breast carcinoma. However, the benign nature of this lesion is easily recognized on histological examination, visualizing dense keloid-like fibrosis, lymphocytic lobulitis and ductitis with lymphocytic perivascular inflammation, with or without epithelioid-like fibroblasts. Surgery can generally be avoided. The evolution of this entity is characterized by the risk of local growth, bilateralisation or recurrence after surgical treatment. We present a case in which the core biopsy allowed the diagnosis of a diabetic mastopathy and we discuss its clinical, diagnostic, pathological and therapeutic particularities.
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Affiliation(s)
- S Croce
- Département de pathologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
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27
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Neetu G, Pathmanathan R, Weng NK. Diabetic Mastopathy: A Case Report and Literature Review. Case Rep Oncol 2010; 3:245-251. [PMID: 20740205 PMCID: PMC2920008 DOI: 10.1159/000318641] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- G Neetu
- Department of Pathology, Monash University Sunway Campus, Bandar Sunway, Selangor, Malaysia
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28
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Pereira MADQF, Magalhães AVD, Motta LDCD, Santos AMDS, Segura MEDA, Pereira CF, Casulari LA. Fibrous mastopathy: Clinical, imaging, and histopathologic findings of 31 cases. J Obstet Gynaecol Res 2010; 36:326-35. [DOI: 10.1111/j.1447-0756.2009.01146.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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29
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Oya M, Hirahashi M, Ochi M, Hashimoto M, Ohshima K, Kikuchi M, Tsuneyoshi M. Spontaneous regression of primary breast lymphoma. Pathol Int 2009; 59:664-9. [DOI: 10.1111/j.1440-1827.2009.02424.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Akahori H, Kaneko M, Kiyohara K, Terahata S, Sugimoto T. A rare case of diabetic mastopathy in a Japanese man with type 2 diabetes mellitus. Intern Med 2009; 48:915-9. [PMID: 19483361 DOI: 10.2169/internalmedicine.48.1834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Hiroshi Akahori
- Department of Endocrinology and Metabolism, Tonami General Hospital, Toyama.
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31
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Oba M, Sasaki M, Ii T, Hoso M, Ajisaka H, Matsuki N, Miwa K. A case of lymphocytic mastopathy requiring differential diagnosis from primary breast lymphoma. Breast Cancer 2008; 16:141-6. [DOI: 10.1007/s12282-008-0064-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Accepted: 06/04/2008] [Indexed: 01/15/2023]
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32
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Thorncroft K, Forsyth L, Desmond S, Audisio RA. The Diagnosis and Management of Diabetic Mastopathy. Breast J 2007; 13:607-13. [DOI: 10.1111/j.1524-4741.2007.00489.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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33
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Cohen SM, Petryk M, Varma M, Kozuch PS, Ames ED, Grossbard ML. Non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue. Oncologist 2007; 11:1100-17. [PMID: 17110630 DOI: 10.1634/theoncologist.11-10-1100] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The concept of mucosa-associated lymphoid tissue (MALT) lymphomas was introduced by Isaacson and Wright [Cancer 1983; 52:1410-1416] in 1983. After more than 20 years of clinical research MALT lymphomas are now recognized as a distinct subtype of non-Hodgkin's lymphoma (NHL) with unique pathogenic, histological, and clinical features. Although this subtype of NHL occurs frequently, optimal management remains elusive. This manuscript reviews features of the clinical presentation, diagnosis, pathology, molecular characteristics, and management of both gastric and non-gastric MALT lymphoma.
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Affiliation(s)
- Seth M Cohen
- St. Luke's-Roosevelt Hospital Center, New York, NY 10019, USA
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34
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Berrah A, Hakem D, Boucelma M, Chettibi O, Issiakhem M, Bendib A, Baba-Ahmed R, Lafer H, Ouadahi N. Sein et médecine interne. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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35
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Sotome K, Ohnishi T, Miyoshi R, Nakamaru M, Furukawa A, Miyazaki H, Morozumi K, Tanaka Y, Iri H. An uncommon case of diabetic mastopathy in type II non-insulin dependent diabetes mellitus. Breast Cancer 2006; 13:205-9. [PMID: 16755119 DOI: 10.1007/bf02966656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diabetic mastopathy is an uncommon tumor-like proliferation of fibrous tissue of the breast that usually occurs in a patient who has suffered from type I diabetes mellitus of long duration. Here we report a rare case of diabetic mastopathy that occurred in type II non-insulin dependent diabetes mellitus. This patient was a 63-year-old postmenopausal woman. Mammography, ultrasonography and MR imaging could not distinguish it from breast cancer. Although the core needle biopsy specimen showed fibrosis without evidence of malignancy, excisional biopsy was performed. Histological findings demonstrated typical diabetic mastopathy with keloid-like fibrosis, perivascular lymphocytic infiltration, and lymphocytic lobulitis without evidence of malignancy. These lymphocytes were composed predominantly of B-cells. Five months after surgical biopsy, a nodular formation approximately 4 cm in diameter recurred adjacent to the resected end of the biopsy.
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Affiliation(s)
- Keiichi Sotome
- Department of Surgery, Fussa Hospital, Fussa City, Tokyo, Japan.
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36
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Sotome K, Ohnishi T, Miyoshi R, Nakamaru M, Furukawa A, Miyazaki H, Morozumi K, Tanaka Y, Iri H. An Uncommon Case of Diabetic Mastopathy in Type II Non-Insulin Dependent Diabetes Mellitus. Breast Cancer 2006. [DOI: 10.2325/jbcs.13.205] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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37
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MESH Headings
- Aged
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Biopsy, Needle
- Breast/chemistry
- Breast/pathology
- Breast Diseases/complications
- Breast Diseases/metabolism
- Breast Diseases/pathology
- Breast Neoplasms/complications
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- CD3 Complex/analysis
- Carcinoma, Intraductal, Noninfiltrating/complications
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Humans
- Immunohistochemistry
- Leukocyte Common Antigens/analysis
- Lymphocytes/chemistry
- Lymphocytes/pathology
- Mastitis/metabolism
- Mastitis/pathology
- Middle Aged
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38
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Mastopathie diabétique. IMAGERIE DE LA FEMME 2005. [DOI: 10.1016/s1776-9817(05)80654-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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39
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Sabaté JM, Clotet M, Gómez A, De las Heras P, Torrubia S, Salinas T. Radiologic Evaluation of Uncommon Inflammatory and Reactive Breast Disorders. Radiographics 2005; 25:411-24. [DOI: 10.1148/rg.252045077] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Baratelli GM, Riva C. Diabetic fibrous mastopathy: sonographic-pathologic correlation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:34-37. [PMID: 15690446 DOI: 10.1002/jcu.20077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Giorgio M Baratelli
- Unità Operativa di Chirurgia, Ospedale di Gravedona, 22015 Gravedona (Como), Italy
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41
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Haj M, Weiss M, Herskovits T. Diabetic sclerosing lymphocytic lobulitis of the breast. J Diabetes Complications 2004; 18:187-91. [PMID: 15145333 DOI: 10.1016/s1056-8727(03)00034-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2002] [Revised: 02/10/2003] [Accepted: 03/06/2003] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Mahmoud Haj
- Ambulatory Surgery, Western Galilee Hospital, Nahariya 22 100, Israel.
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42
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Kojima T, Kammori M, Hashimoto M, Ogawa T, Yasuda H, Takazawa Y, Takubo K, Kaminishi M. Diabetic mastopathy in an advanced elderly woman with insulin-dependent type 2 diabetes mellitus. Breast Cancer 2004; 10:374-7. [PMID: 14634519 DOI: 10.1007/bf02967661] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetic mastopathy is an unusual stromal fibrotic lesion, but typically occurs in long-standing insulin dependent and younger diabetic patients. We report a case of diabetic mastopathy in an older diabetic patient. The patient was a 76-year-old woman with a history of type 2 diabetes mellitus for 13 years and 3 years of insulin treatment. She developed a 3 cm, hard, mobile nodule in the left breast. Mammography revealed a dense mass. Ultrasonography showed an irregular-shaped hypoechoic lesion with an unclear boundary and acoustic shadowing. Since fine needle aspiration biopsy delivered insufficient material and core needle biopsy did not yield any specific findings for diagnosis, clinically diabetic mastopathy was the prime suspect but breast cancer could be completely ruled out. Surgical excision was thus performed and diabetic mastopathy was confirmed pathologically. We report on this rare case of diabetic mastopathy in a 76 year-old type 2 diabetic patient.
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Affiliation(s)
- Tetsu Kojima
- Department of Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Abstract
A 43-year-old woman presented to the endocrinologist with symptoms and signs of typical thyrotoxicosis caused by Graves' disease. Review of systems revealed that she had recently discovered a lump in her left breast. Evaluation of the left breast lesion led to a core biopsy that showed sclerosing lymphocytic lobulitis. This breast disease, well recognized in the pathology literature, occurs in various autoimmine disorders, particularly type 1 diabetes mellitus, and has occasionally been reported in Hashimoto's thyroiditis. The patient described here represents the first published association of sclerosing lymphocytic lobulitis of the breast with Graves' disease.
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Affiliation(s)
- Michael Dubenko
- Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York 10467, USA
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Valdez R, Thorson J, Finn WG, Schnitzer B, Kleer CG. Lymphocytic mastitis and diabetic mastopathy: a molecular, immunophenotypic, and clinicopathologic evaluation of 11 cases. Mod Pathol 2003; 16:223-8. [PMID: 12640102 DOI: 10.1097/01.mp.0000056627.21128.74] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lymphocytic mastitis and diabetic mastopathy are uncommon fibroinflammatory breast diseases. The lesions seen in these entities are unique in that the associated lymphoid infiltrates are composed of predominantly B cells. In addition, B-cell lymphoepithelial lesions, a finding commonly associated with extranodal marginal zone B-cell/mucosa-associated lymphoid tissue (MALT) lymphomas, are also often present in lymphocytic mastitis and diabetic mastopathy. Although the clinical and immunomorphologic features are well characterized, the clonality of the B-cell infiltrate and the lymphomatous potential of lymphocytic mastitis and diabetic mastopathy have not been emphasized in the literature. We evaluated 11 cases of lymphocytic mastitis/diabetic mastopathy for immunoglobulin heavy chain gene rearrangement and correlated the findings with all available clinical data. A longstanding history of Type I diabetes mellitus was present in seven patients. One nondiabetic patient had Sjogren's syndrome, and two patients had no history of diabetes mellitus or other autoimmune disease. Clinical data were unavailable for one patient. B-cell-predominant lymphoid infiltrates were seen in all cases, and B-cell lymphoepithelial lesions were found in five. No evidence of a B-cell clone was found in any of the 11 cases by appropriately controlled immunoglobulin heavy chain gene rearrangement studies, and none of the patients developed lymphoma during follow-up intervals ranging from 2-126 months. These findings suggest that despite the presence of B-cell-predominant lymphoid infiltrates and lymphoepithelial lesions, lymphocytic mastitis and diabetic mastopathy do not appear to be associated with an increased risk for lymphoma.
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Affiliation(s)
- Riccardo Valdez
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
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45
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Abstract
Sclerosing lymphocytic lobulitis or "diabetic mastopathy" is strongly associated with type 1 diabetes but may occur occasionally in its absence. It is characterized by keloid-type fibrosis, lymphocytic lobulitis, and perivasculitis and epithelioid cells. Infiltrating cells are predominantly B lymphocytes. It may be associated with retinopathy and neuropathy, but more research is needed to verify this association. The etiopathogenesis is unknown and the disorder does not seem to predispose to breast carcinoma or lymphoma.
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Affiliation(s)
- Yogish C Kudva
- Division of Endocrinology and Metabolism, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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Kambouchner M, Godmer P, Guillevin L, Raphaël M, Droz D, Martin A. Low grade marginal zone B cell lymphoma of the breast associated with localised amyloidosis and corpora amylacea in a woman with long standing primary Sjögren's syndrome. J Clin Pathol 2003; 56:74-7. [PMID: 12499440 PMCID: PMC1769862 DOI: 10.1136/jcp.56.1.74] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Primary low grade marginal zone B cell lymphoma (MZL) of the breast and localised mammary amyloidosis are exceedingly rare entities. This report describes the case of a woman with long standing Sjögren's syndrome presenting with asymptomatic MZL of the breast showing plasmacytic differentiation, associated with local ductular amyloidosis. The lesion was discovered incidentally in breast tissue resected for microcalcifications. Immunohistochemistry revealed kappa light chain restriction, supporting the neoplastic nature of the infiltrate. A retrospective molecular study of the salivary gland biopsy showed a B cell clone. This is the first report of the association of human mammary ductular amyloidosis with cartwheel shaped material identical to corpora amylacea, usually seen in brain, lung, and prostate, but unknown in the human breast. The excellent outcome without treatment seen in this patient further emphasises the need to distinguish between MZL with plasmacytic differentiation and extramedullary plasmacytoma.
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Affiliation(s)
- M Kambouchner
- Department of Pathology, Avicenne Hospital, 125 Route de Stalingrad, Bobigny 93009 Cedex, France.
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47
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Domchek SM, Hecht JL, Fleming MD, Pinkus GS, Canellos GP. Lymphomas of the breast: primary and secondary involvement. Cancer 2002; 94:6-13. [PMID: 11815954 DOI: 10.1002/cncr.10163] [Citation(s) in RCA: 158] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The involvement of the breast by lymphoma is a rare form of extralymph node lymphoma and represents either primary disease or systemic involvement. The authors hypothesized that screening mammography may influence the detection of lymphomatous involvement of the breast. METHODS All patients (n = 81 patients) who were diagnosed with lymphomatous involvement of the breast at the study institution between 1988 and 1999 were evaluated retrospectively. RESULTS Clinical information was available for 73 patients who could be classified into three major groups according to their diagnosis: primary breast lymphoma (PBL) (44%), breast involvement from disseminated disease at the time of initial diagnosis (29%), and recurrence of preexisting lymphoma to the breast (27%). The majority of PBL were of intermediate or high grade, and the majority of disseminated lymphomas involving the breast were of low grade. Lymphomatous recurrence to the breast was slightly more likely to be of intermediate grade rather than low grade. In 91% of patients, the diagnosis of lymphoma was made after the evaluation of a palpable mass. All patients who were identified after the evaluation of an abnormal screening mammogram (9%) had low-grade lymphomas. Of the 32 patients with PBL, screening mammography discovered only 1. Nineteen percent of patients with PBL also had a history of an autoimmune disorder. CONCLUSIONS These findings suggest that screening mammography has not altered substantially the detection of breast lymphoma. The clinical outcome of patients with breast lymphoma is dependent on histology and appears to parallel that of patients with lymphoma of similar histology involving other sites.
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Affiliation(s)
- Susan M Domchek
- Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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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; 25:121-6. [PMID: 11772912 DOI: 10.2337/diacare.25.1.121] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To demonstrate the strong association of diabetic mastopathy or sclerosing lymphocytic lobulitis with type 1 diabetes mellitus by studying appropriate control groups and to describe risk factors and natural history of the disorder. RESEARCH DESIGN AND METHODS This was a retrospective cross-sectional study of four groups of patients conducted at a setting tertiary care medical center. We examined benign breast biopsies (investigator masked to identity) from age-matched patients with types 1 and 2 diabetes, autoimmune thyroid disease, or none of the above disorders for sclerosing lymphocytic lobulitis. Several risk factors proposed for the disorder (age at diagnosis of benign breast disease, duration of diabetes, age at onset of diabetes, prevalence of retinopathy, neuropathy, nephropathy and cheiroarthropathy, glycemic control, parity, oral contraceptive use, menopausal status, or number of breast biopsies) were evaluated, and patients were contacted to describe the natural history of the disorder. RESULTS Sclerosing lymphocytic lobulitis was identified in 69.7% of the subjects with type 1 diabetes and 1.8% of those with autoimmune thyroid disease diagnosed with benign breast disease at surgery. It did not occur in patients with type 2 diabetes with or without insulin treatment or in control subjects. Only retinopathy and peripheral neuropathy were associated with sclerosing lymphocytic lobulitis. Breast carcinoma or lymphoma did not occur subsequently in any type 1 diabetes patient with or without sclerosing lymphocytic lobulitis. CONCLUSIONS Sclerosing lymphocytic lobulitis is strongly associated with type 1 diabetes. Retinopathy and neuropathy are associated with the disorder. The risk of malignancy is not increased.
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Affiliation(s)
- Yogish C Kudva
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota 55905-0001, USA.
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49
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Allen PW, Fisher C. Selected case from the Arkadi M. Rywlin International Pathology Slide Seminar: diabetic mastopathy. Adv Anat Pathol 2001; 8:298-301. [PMID: 11556538 DOI: 10.1097/00125480-200109000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P W Allen
- Department of Anatomical Pathology, Flinders Medical Centre, Bedford Park, South Australia
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50
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Naidoo P, Chetty R. Lymphoepithelioma-like carcinoma of the breast with associated sclerosing lymphocytic lobulitis. Arch Pathol Lab Med 2001; 125:669-72. [PMID: 11300942 DOI: 10.5858/2001-125-0669-llcotb] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this article is to highlight an unusual form of breast carcinoma and discuss its differential diagnosis. A 50-year-old woman underwent wide local excision of a breast lump. Microscopic examination revealed features of a lymphoepithelioma-like carcinoma. Individual tumor cells were present within an abundant lymphoid stroma. Immunohistochemistry revealed the epithelial nature of the cells and excluded a diagnosis of lymphoma. In addition, surrounding nontumorous breast tissue displayed the histologic features of sclerosing lymphocytic lobulitis or lymphocytic mastopathy. This is the second report of a lymphoepithelioma-like carcinoma of the breast, but to the best of our knowledge, it is the first description of coexistent sclerosing lymphocytic lobulitis.
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Affiliation(s)
- P Naidoo
- Division of Anatomical Pathology, School of Pathology and Laboratory Medicine, University of Natal, Durban, South Africa
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