Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature

Abstract

Background: Diabetic mastopathy is a rare benign disease in clinical practice that mainly occurs in young and middle-aged women with type 1 diabetes. It has also been reported that this disease can be found in patients with type 2 diabetes and other autoimmune diseases, such as Hashimoto's thyroiditis, as well as in men. The pathogenesis of diabetic mastopathy is not yet clear, and it is easily confused with breast cancer due to their similar clinical manifestations and imaging features.

Case summary: A 69-year-old female patient was admitted because of painless breast masses, with a history of type 2 diabetes. The imaging and physical examination suggested a high risk of breast cancer. Further histopathological analysis showed dense lymphocytes infiltrating around the lobules of the breast, and extensive fibrosis of the surrounding stroma. Finally, diabetic mastopathy was diagnosed.

Conclusion: The diagnosis of diabetic mastopathy in elderly patients with painless breast masses is difficult to distinguish from breast cancer, and its imaging manifestations are not specific.

Keywords: Autoimmunity; Case report; Diabetes; Diabetic mastopathy; Literature review; Mammary gland disease.

Figure 1

Schematic diagram of breast masses. Three separate masses of the breast, including two solid masses in the left breast and one hard mass in the right breast, were palpable.

Figure 2

Ultrasonographic images of bilateral breasts. There is a very hypoechoic zone at the 1 o'clock position of the right breast and the left breast, about 19.2 mm × 14.7 mm × 17.1 mm and 15.9 mm × 10.5 mm × 9.5 mm in size, respectively, irregular in shape, with an unclear border. There is a hypoechoic area at the 12 o'clock area in the left breast, about 5.9 mm × 6.0 mm × 5.9 mm, irregular in shape, with an unclear boundary.

Figure 3

Axial enhanced magnetic resonance images of bilateral breasts. Cross-sectional contrast-enhanced FT1WI showed that focal and heterogeneous non-mass enhancement in the upper inner quadrant of the right breast and in the upper outer quadrant of the left breast.

Figure 4

Histopathological images (hematoxylin-eosin staining). A and B: At high and medium magnification, dense lymphocytes infiltrating around the lobules of the breast, and extensive fibrosis of the surrounding stroma were observed; C: At medium magnification, myofibroblasts presented epithelioid changes.