Diabetic mastopathy

Diabetic mastopathy is a condition characterized by the presence of a benign tumor like breast masses in women with long-standing type 1 or type 2 insulin-dependent diabetes mellitus. The condition has also been reported in men. A similar condition is lymphocytic mastitis but this occurs in non-diabetics. 

Clinical presentation

Diabetic mastopathy manifests clinically as a large, painless, hard breast mass that is usually clinically indistinguishable from breast cancer. Multicentric or bilateral involvement is a relatively frequent phenomenon, often occurring in late stages of the disease. Other systemic complications of long-standing diabetes mellitus are common. 

Pathology

It is a form of lymphocytic mastitis and stromal fibrosis. There is dense fibrosis, and predominantly B-cell lymphocytic infiltrate surrounding the ducts, lobules and vessels.

Its exact pathogenesis is poorly understood and likely multifactorial, possibly relating to an immunologic reaction. It is considered a form of lymphocytic mastitis and is grouped with others immunologic breast diseases such as Hashimoto thyroiditis, Sjogren syndrome, and systemic lupus erythematosus.

Radiographic features

Mammography

The most common mammographic findings are ill-defined masses or asymmetric densities. Such lesions are often masked by dense glandular tissue, making mammographic evaluation difficult. 

Ultrasound

Ultrasound often reveals the most characteristic imaging findings of the disease: irregular hypoechoic masses with marked posterior acoustic shadowing. Sometimes sonographic features can mimic more sinister pathology such as breast malignancy ⁴.

MRI

Reported MR imaging findings are variable, ranging from decreased diffuse contrast material enhancement to rapid, intense enhancement that is indistinguishable from breast carcinoma.

Treatment and prognosis

Although surgical excision was usually performed in the past to exclude malignancy, core biopsy is currently accepted as adequate for the diagnosis of this disease. A fine needle aspiration (FNA) is not usually used as it does not provide enough cellular material for sufficient evaluation as well as being technically-difficult to perform due to lesions being very firm. It has recently been reported that surgery may increase the number and extent of recurrences.

Diabetic mastopathy is usually a self-limiting disease that does not require treatment, although recurrences are frequent. 

History and etymology

It was first described by Maltese endocrinologist Norman Griscti Soler (1942-2014) and American endocrinologist Romesh Khardori (fl. 2018) in 1984 ^2,3,15.