Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature

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.

Diabetic Mastopathy. Review of Diagnostic Methods and Therapeutic Options

“…They may occur as single or as multiple lesions, may be unilateral or bilateral, and involve all quadrants of the breast. It has been shown that most cases of DM occur in the upper lateral/medial part of the breast (76%), and their size varies from 0.5 to 3.7 cm [ 3 ]. To date, in reported cases, axillary adenopathy was not present [ 14 , 15 ].…”

“…Tomaszewski et al [ 6 ] have suggested that the diagnosis of mastopathy should consist of the following criteria: (1) lymphocytic lobular and ductal inflammation with glandular atrophy; (2) lymphatic⁄ mononuclear perivascular inflammatory infiltrates, mainly of B cells; (3) dense, often keloid-like fibrosis; (4) presence of epithelial fibroblasts (EFB). Despite various clinical criteria proposed to date, the diagnosis of DM is not unequivocal and often requires further diagnostic workup due to its high similarity to breast cancer in clinical presentation and at imaging studies [ 3 ].…”

“…The condition is characterized by foci of dense fibrosis, lobular atrophy, and clusters of lymphocytes with periventricular and peritubular distribution [ 2 ]. Despite a considerable increase in our knowledge on DM that was gained in recent years and several new hypotheses, the pathogenesis of this disease remains unclear [ 3 ]. The main differential diagnosis is breast cancer because of similar clinical symptoms and imaging features [ 3 ].…”

“…Despite a considerable increase in our knowledge on DM that was gained in recent years and several new hypotheses, the pathogenesis of this disease remains unclear [ 3 ]. The main differential diagnosis is breast cancer because of similar clinical symptoms and imaging features [ 3 ]. Diagnosis is complex, and biopsy of the lesion is often necessary to establish a proper lesion classification.…”

Diabetic Mastopathy With an Associated History of Elevated Thyroid Peroxidase (TPO) and Antimitochondrial Antibodies (AMA)

“…Diabetic mastopathy, also known as fibrous mastopathy, is a rare condition that comprises less than 1% of benign breast pathologies and is a known complication of type 1 diabetes mellitus (T1DM) [1]. This disease affects 0.6% to 13% of young and middle-aged premenopausal females with T1DM, but there have been infrequent reports of diabetic mastopathy occurring in patients with type 2 diabetes mellitus, the elderly, and males [1][2][3][4]. Diabetic mastopathy was first described by Sloer and Khardori in 1984 and was officially named by Logan and Hoffman in 1989 [5,6].…”