Diabetic Mastopathy. Review of Diagnostic Methods and Therapeutic Options

Abstract

Diabetic mastopathy is a rare breast condition that may occur in insulin-treated men and women of any age. The etiology is still unclear; however, the autoimmunological background of the disease is highly suspected. The changes in diabetic mastopathy may mimic breast cancer; therefore, its diagnostic process is demanding, and treatment options are not clear and limited. Lesions in DM are usually multiple; therefore, surgical removal is not fully effective. A well-done anamnesis with core-needle biopsy is essential and definitive in most cases. In this review, we summarize up-to-date knowledge of diagnostic methods and therapeutic options for diabetic mastopathy treatment and present three cases of diabetic mastopathy-type lesions in ultrasound and radiological examinations.

Keywords: breast degeneration; breast surgery; breast tumor; breast ultrasonography; diabetes in breast; diabetic mastopathy; lymphocytic mastopathy.

Figure A1

Ultrasound image of a BI-RADS-US class 4c diabetic mastopathy-type lesion measuring 22 × 10 × 11 mm in a 39-year-old female.

Figure A2

Ultrasound image of the BI-RADS-US class 4b, diabetic mastopathy-type lesion measuring 11 × 8 × 9 mm in a 37-year-old female.

Figure A3

Ultrasound image of the BI-RADS-US class 4b, diabetic mastopathy-type lesion measuring 12 × 7 × 6 mm in a 62-year-old female.

Figure 1

Microscopic examination of core-needle breast biopsy sample: (a–c) dense periductal, perilobular and perivascular chronic inflammatory reaction. Hematoxylin and eosin staining. Photos from Rosen’s Breast Pathology, 5th Edition.

Figure 2

Screening mammograms of a 55-year-old female during insulin therapy, no breast symptoms, negative breast cancer family history, diabetic mastopathy confirmed microscopically following core-needle biopsy: (a) RCC view, 6 mm asymmetrical density of the right breast, (b) RMLO view, 6 mm asymmetrical density of the right breast, (c) “spot view”, atrophy of the ducts, periductal lymphocyte infiltration.

Figure 3

B-mode ultrasound of a 41-year-old female with type I diabetes mellitus and Hashimoto disease, positive family history of melanoma, diabetic mastopathy, and following core-needle biopsy: (a) 16 × 14 mm irregular, hypoechogenic lesion with blurred/spicular margins, BI-RADS-US class 4c (b) 18 × 6 mm irregular, hypoechogenic lesion with blurred/spicular margins, visible vascularity on color Doppler, BI-RADS-US class 4c (c) 25.7 × 20 mm oval shape breast lesion with parallel to the skin orientation, well-defined margins, heterogeneous echogenic structure and acoustic shadowing, BI-RADS-US class 4a.