Diabetic mastopathy: imaging and management
Zorica Milosevic1, Vesna Plesinac Karapandzic1, Biljana Markovic2, Zoran Radojicic3 & Nenad Borojevic1
Diabetic mastopathy or sclerosing lymphocitic lobulitis of the breast in the patients with diabetes mellitus is a rare, benign disease that simulates breast malignancy.
Among 489 women with firm breast lump(s), three women aged 32, 38 and 47 years with long standing diabetes mellitus type 1 were identified. Mammography and breast ultrasound were performed in all patients and contrast enhanced breast MRI in one patient with bilateral lumps. The histological examination revealed a sclerosing lymphocitic lobulitis.
In our study, the prevalence of mastopathy was 0.6% (P=0.04, proportion test). Total of eight masses were detected by palpation. Mammograms showed unilateral asymmetric densities, without calcifications in two patients and bilateral dense parenchyma in one. Breast ultrasound showed nine lesions measured from 0.8 to 3 cm (three hypoechoic lobulated lesions and six areas of posterior acoustic shadowing). Breast MRI revealed irregular areas of low signal intensity with poor enhancement in early phase after contrast material injection and benign, gradual increase in enhancement in delayed phase, without typical signs of malignancy.
If the physical examination is suggestive of diabetic mastopathy, the safe and minimally invasive initial approach is recommended as follows: mammography, ultrasound and MRI prior the core needle biopsy of dominant breast mass, with 6 months ultrasound follow-up after histological confirmation of disease. In the case of recurrent disease, MRI can be used to differentiate the mastopathy from malignancy and avoid an unnecessary biopsy.