Diabetic mastopathy: a case report

Abstract

Summary:

Diabetic mastopathy (MD) was described for the first time in 1984 by Soler and Khardori, in insulin-dependent patients with type I diabetes, representing 1% of benign mastopathy.

The clinical-imaging presentation raises carcinomas or benign lesions such as fibroadenomas as the main differential diagnoses, for which excisional biopsy is the treatment of choice.

The communication of this case aims to highlight the importance of the differential diagnosis of this low incidence breast disease entity whose etiology is systemic.

This is a 45-year-old patient, native from Córdoba capital, taxi driver, with a toxic history of smoking and alcoholism; Personal pathological history of type I diabetes treated with NPH insulin and good glycemic controls.

She consulted due to the presentation of a right breast phlogotic erythematous tumor of 40 days of evolution. She had undergone antibiotic treatment for two weeks, without obtaining a response.

A mammogram was performed in the right breast, finding a radiopaque area with diffuse lobulated edges that caused retraction of the nipple and frank skin thickening, with a proliferative appearance (BIRADS classification V).

An incisional biopsy and drainage are performed, indicating hospitalization and combined antibiotic treatment (clindamycin + gentamicin).

It evolves favorably and subsequently a pathological anatomy report is received. In the macroscopy, four irregularly shaped tissue fragments of approximately 2x1 cm are observed, which present a whitish color and firm consistency in the cut.

Histopathology reports slices processed with standard techniques and stained with H-E exhibiting in the breast tissue dense stroma, prominent hyaline bundles of collagen, blood vessels with thickened hyaline walls, which produce lumen stenosis. There is an important mononuclear inflammatory infiltrate, neutrophil polymorphonuclear leukocytes and histiocytes, ducts with epithelial cells reactive to the inflammatory process, and areas of necrosis and skin with polymorphonuclear leukocytes in transepithelial migration. This findings described are linked to diabetic mastopathy / acute nonspecific mastitis.

The clinical case, highlights the fact that when we are faced with a clinical-imaging lesion suggestive of malignancy, it is essential to always consider the clinical context, because despite its low prevalence, DM is an entity to consider, especially in patients with a history of type diabetes I.