The diagnosis and management of diabetic mastopathy

Abstract

Sclerosing lymphocytic lobulitis is strongly associated with type one diabetes, when it is then known as diabetic mastopathy. This very rare benign condition tends to present in premenopausal women, often with diabetic complications particularly retinopathy. Patients present with clinically suspicious fibrous breast lumps; these are commonly multiple, bilateral, and recurrent. Mammograms show asymmetric densities and no focal mass and ultrasound investigation tends to show ill-defined hypoechoic attenuation with strong posterior acoustic shadowing. Magnetic resonance imaging can be used to further differentiate the lesion from malignancy. However, a core biopsy or excisional biopsy is essential so that a pathologic diagnosis can be made. The constellation of pathologic findings is: lymphocytic lobulitis and ductitis with glandular atrophy, lymphocytic/mononuclear perivascular inflammation which is predominantly B-cell and dense often keloid-like fibrosis, with or without epithelioid-like fibroblasts. A review of the current literature on diabetic mastopathy was carried out as it was noted that there has been no recent review of the literature. Detailed Pubmed and other medical data base searches were carried out and all publications were considered, irrespective of language and date, wherever possible.