Lymphocytic Mastitis and Diabetic Mastopathy: A Molecular, Immunophenotypic, and Clinicopathologic Evaluation of 11 Cases

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/mucosaassociated 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.

Patterns and prevalence of benign breast disease in Western India

“…Valdez et al stated, Lymphocytic mastitis and the closely related entity of diabetic mastopathy are uncommon benign breast diseases that are believed to be induced by autoimmune phenomena. 16 A very rare case of fat necrosis was found in patient of 88 years of age with history of trauma, in our study. It is important to diagnose fat necrosis because it can often mimic carcinoma of the breast.…”

Diabetic mastopathy: a diagnostic challenge

“…When associated with other autoimmune conditions such as systemic lupus erythematous and Hashimoto's disease, DMP has been described as lymphocytic mastopathy due to associated lymphoid infiltrates composed of B cells. 3 Patients classically present with a painless, hard and irregular mass within the breast tissue.…”

“…There is an association between Hashimoto's thyroiditis and Sjögren's syndrome with B cell non-Hodgkin's lymphoma of the thyroid gland and stomach; however, there is no associated risk with lymphocytic mastitis or DMP. 3 …”

Mammography Findings of Male Breast Diseases

“…Characteristically, it is seen in patients with long-standing type 1 diabetes (28). Diabetic mastopathy is not among risk factors for breast cancer (29).…”

“…Diabetic mastopathy mimics breast cancer and a biopsy is usually required for definitive diagnosis. It can be seen as a nonspecific mass or local asymmetry on mammography (28).…”