- Premenopausal type 1 diabetic women. Painless, hard, irregular breast masses
- Dense, irregular masses with shadowing on ultrasound and increased density on mammography.
Description
Diabetic mastopathy is a rare fibroinflammatory breast disease seen primarily in patients with a long-standing history of type 1 diabetes, although it can occasionally occur in those with type 2 diabetes. It is characterised by the benign proliferation of dense fibrous tissue in the breast.
Pathogenesis
The pathogenesis is not completely understood but is believed to be related to the chronic autoimmune process associated with diabetes, leading to keloid-like fibrosis and lymphocytic infiltration in the breast tissue.
Subtypes
Diabetic mastopathy is a singular clinical entity but can vary in terms of the number of lesions, unilateral or bilateral presentation, and association with other autoimmune conditions.
Epidemiology, Risk Factors & Associations
- More common in premenopausal women with a long-standing history of type 1 diabetes (insulin- dependent)
- Occasionally seen in type 2 diabetics with exogenous insulin.
- Association with autoimmune thyroid disease (uncommon).
- Rare in men and non-diabetic individuals.
Clinical Features
- Typically presents as a unilateral or bilateral, hard, painless breast mass.
- Can mimic carcinoma due to its firmness and irregularity.
- Usually asymptomatic, but some patients may experience mild discomfort.
Complications
- Diagnostic dilemma: Can mimic breast carcinoma clinically and radiologically.
- Anxiety and psychological distress due to the fear of breast cancer.
Pathological Features
Histopathology
- Macroscopic: Dense, fibrous, poorly defined breast tissue.
- Microscopic: Dense keloid-like fibrosis, periductal and perivascular lymphocytic infiltration, epithelioid fibroblasts.
Radiological Features
General Features
- Dense, irregular masses, often with marked posterior acoustic shadowing on ultrasound.
- Multicentric or bilateral involvement is fairly common often occurring in late disease.
MG
- Most common appearance is of increased breast density, ill-defined non-calcified mass with indistinct or obscured margins or focal asymmetry.1
US
- B-mode: Irregular, hypoechoic, ill-defined masses with posterior acoustic shadowing due to extensive fibrosis, often marked though can be variable.
- Colour Doppler: Typically shows minimal vascularity.
- FNA: Firm resistance to the back-and-forth motion of the needle for fine needle aspiration
MRI
- Generally not helpful in diagnosis
- Gd+: Nonspecific, with gradual persistent nonmass enhancement reported.
Grading and Staging
No grading or staging system; the condition is benign with no malignant potential.
Diagnosis
- Clinical examination in the context of insulin-dependent diabetes history.
- Imaging findings suggestive of mastopathy.
- Biopsy and histopathological examination for definitive diagnosis2.
Differential Diagnosis
- Breast carcinoma: Clinically and radiologically similar but different histopathology.
- Fibroadenoma: Typically less dense and more circumscribed.
- Sclerosing adenosis: Similar histological features but different clinical context.
Management
- Reassurance and clinical monitoring due to its benign nature.
- Biopsy in cases with atypical presentation to rule out malignancy.
- Symptomatic treatment for discomfort, if present.
- Recurrences are common.
References
- Patel, P.B., Carter, G.J. and Berg, W.A., 2023. Diabetic fibrous mastopathy: imaging features with histopathologic correlation. Journal of Breast Imaging, 5(5), pp.585-590. ↩︎
- Thorncroft, K., Forsyth, L., Desmond, S. and Audisio, R.A., 2007. The diagnosis and management of diabetic mastopathy. The Breast Journal, 13(6), pp.607-613. ↩︎