Diabetic Mastopathy, or Lymphocytic Lobulitis

• Diabetic mastopathy, or lymphocytic lobulitis:
  • Is a benign condition found in premenopausal women:
    • With long-standing type 1 diabetes mellitus
  • Patients usually present with:
    • A firm, painless, irregular, suspicious mass in one or both breasts
  • Mammograms often show:
    • Dense fibroglandular tissue but no discrete mass
  • Ultrasound usually shows:
    • An ill-defined hypoehoic area with shadowing
  • Core needle biopsy:
    • Is the preferred technique to make the diagnosis
  • The pathologic findings are typically:
    • Glandular atrophy
    • Lymphocytic / mononuclear perivascular inflammation:
      • Which is predominantly B-cell
    • Dense, often keloid-like fibrosis:
      • With or without epithelioid-like fibroblasts
  • If the lesion is well-sampled and the pathology is concordant with the imaging:
    • There is no need for excision because it is not a premalignant lesion
  • In fact, up to 60% of diabetic mastopathy recurs after excision:
    • Therefore, surgical excision is not recommended
  • The etiology may be:
    • An autoimmune reaction:
      • To accumulated matrix related to hyperglycemia
  • Once diagnosed:
    • Patients should be aware of changes in their breasts and have any new lumps evaluated
  • Well-controlled blood sugar:
    • Is advocated as diabetic mastopathy often presents in patients with other complications of diabetes such as:
      • Retinopathy
      • Neuropathy
      • Nephropathy
    • Otherwise, there is no known treatment
• References:
  • Camuto PM, Zetrenne E, Ponn T. Diabetic mastopathy: a report of 5 cases and a review of the literature. Arch Surg. 2000;135(1):1190-1193.
  • Neetu G, Pathmanathan R, Weng NK. Diabetic mastopathy: a case report and literature review. Case Rep Oncol. 2010;3(2):245-251.
  • Thorncroft K, Forsyth L, Desmond S, Audisio RA. The diagnosis and management of diabetic mastopathy. Breast J. 2007;13(6):607-613.

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