Citation, DOI and article data
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.
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.
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.
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 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.
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.
- 1. Sabaté JM, Clotet M, Gómez A et-al. Radiologic evaluation of uncommon inflammatory and reactive breast disorders. Radiographics. 25 (2): 411-24. doi:10.1148/rg.252045077 - Pubmed citation
- 2. Mak CW, Chou CK, Chen SY et-al. Case report: diabetic mastopathy. Br J Radiol. 2003;76 (903): 192-4. doi:10.1259/bjr/51145312 - Pubmed citation
- 3. Soler NG, Khardori R. Fibrous disease of the breast, thyroiditis, and cheiroarthropathy in type I diabetes mellitus. Lancet. 1984;1 (8370): 193-5. - Pubmed citation
- 4. Sakuhara Y, Shinozaki T, Hozumi Y et-al. MR imaging of diabetic mastopathy. AJR Am J Roentgenol. 2002;179 (5): 1201-3. AJR Am J Roentgenol (full text) - Pubmed citation
- 5. Ely KA, Tse G, Simpson JF et-al. Diabetic mastopathy. A clinicopathologic review. Am. J. Clin. Pathol. 2000;113 (4): 541-5. doi:10.1309/K5HM-9603-PQ5T-KY3F - Pubmed citation
- 6. Conant EF, Brennecke CM. Breast imaging, case review. Mosby Inc. (2006) ISBN:0323017460. Read it at Google Books - Find it at Amazon
- 7. Cardeñosa G. Clinical breast imaging, a patient focused teaching file. Lippincott Williams & Wilkins. (2006) ISBN:0781762677. Read it at Google Books - Find it at Amazon
- 8. Goel NB, Knight TE, Pandey S et-al. Fibrous lesions of the breast: imaging-pathologic correlation. Radiographics. 25 (6): 1547-59. doi:10.1148/rg.256045183 - Pubmed citation
- 9. Shaffrey JK, Askin FB, Gatewood OM et-al. Diabetic Fibrous Mastopathy: Case Reports and Radiologic-Pathologic Correlation. Breast J. 2000;6 (6): 414-417. Breast J (link) - Pubmed citation
- 10. Baratelli GM, Riva C. Diabetic fibrous mastopathy: sonographic-pathologic correlation. J Clin Ultrasound. 2005;33 (1): 34-7. doi:10.1002/jcu.20077 - Pubmed citation
- 11. Murakami R, Kumita S, Yamaguchi K et-al. Diabetic mastopathy mimicking breast cancer. Clin Imaging. 33 (3): 234-6. doi:10.1016/j.clinimag.2008.12.003 - Pubmed citation
- 12. Eurorad teaching files : Case 8545
- 13. Kirby RX, Mitchell DI, Williams NP et-al. Diabetic mastopathy: an uncommon complication of diabetes mellitus. Case Rep Surg. 2013;2013: 198502. doi:10.1155/2013/198502 - Free text at pubmed - Pubmed citation
- 14. Kudva YC, Reynolds C, O'Brien T et-al. "Diabetic mastopathy," or sclerosing lymphocytic lobulitis, is strongly associated with type 1 diabetes. Diabetes Care. 2002;25 (1): 121-6. doi:10.2337/diacare.25.1.121 - Pubmed citation
- 15. Soler DG. Obituary Dr. Norman Griscti Soler - 1942 - 2014. Malta Medical Journal 26 (2014); 1:57-57. http://www.um.edu.mt/umms/mmj/showpdf.php?article=427.