Diabetic Mastopathy/Lymphocytic Mastopathy
Key Facts
Terminology
Chronic inflammation and stromal changes occurring primarily in women with diabetes mellitus or other autoimmune diseases
Etiology/Pathogenesis
Majority of patients have longstanding insulin-dependent diabetes
Fewer patients have autoimmune thyroid disease
Some patients do not have autoimmune disease; it is unknown if DM is risk factor for developing these diseases
Clinical Issues
Very hard palpable mass, well circumscribed or ill defined
May be multiple and bilateral
Treatment is unnecessary once carcinoma is excluded
Imaging findings may mimic carcinoma or be nonspecific
Microscopic Pathology
Dense lymphocytic infiltrates surround lobules, ducts, and blood vessels
Lymphocytes are predominantly B cells intermingled with smaller population of T cells
Top Differential Diagnoses
Pseudoangiomatous stromal hyperplasia (PASH)
Fibrous nodule
Lymphoma
IgG4-related sclerosing mastitis
Lymphocytic lobulitis associated with carcinomas
 Diabetic mastopathy forms breast masses that may be palpable or present as circumscribed or ill-defined mammographic densities. In this case, a clip  from a prior core needle biopsy is present within the mass. |
 DM is characterized by extremely dense stroma with a glassy appearance to the collagen  . Ducts, lobules  , and blood vessels are surrounded by a dense lymphocytic infiltrate. |
TERMINOLOGY
Abbreviations
Diabetic mastopathy (DM)
Synonyms
Diabetic fibrous mastopathy
Lymphocytic mastopathy
Sclerosing lymphocytic lobulitis
Definitions
Periductal, perilobular, and perivascular lymphocytic infiltrate accompanied by proliferation of fibroblasts and myofibroblasts, occurring primarily in women with diabetes mellitus or other autoimmune diseases
ETIOLOGY/PATHOGENESIS
Etiology
Majority of patients have longstanding insulin-dependent diabetes
Fewer patients have autoimmune thyroid disease
Stromal changes may be due to abnormal glucose deposition on collagen
However, some patients do not have autoimmune disease; it is unknown if DM is risk factor for developing these diseases
CLINICAL ISSUES
Presentation
Very hard palpable mass, well circumscribed or ill defined
May be multiple and bilateral
Occurs in both men and women at any age
Imaging findings may mimic carcinoma or be nonspecific
MR may be helpful as there is characteristic slow gradual enhancement
Treatment
Unnecessary once carcinoma is excluded
Prognosis
Lesion is benign, but new masses may form
IMAGE FINDINGS
Mammographic Findings
Usually appears as circumscribed or ill-defined mass or may not be seen
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