Diabetic Mastopathy, a Clinicopathological Correlation of 32 Cases
Olena Dorokhova, Susan Fineberg, Anton Shapoval, Tova Koenigsberg, Yihong Wang. Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; St. Vincent's Medical Center, Bridgeport, CT
Background: Diabetic mastopathy (DMP) is a fibrous disease of the breast considered to be of autoimmune pathogenesis. Pathologic features include dense stromal fibrosis, lobular atrophy, circumferential mature B cells around small vessels, lobules and ducts, and increased stromal spindle and epithelioid-like cells. Imaging studies are often inconclusive. We present this case series of DMP in order to better define the clinicopathologic spectrum of this disease.
Design: Thirty-two patients with classical features of DMP were identified from the pathology files of Montefiore Medical Center from 1999 till 2011. All slides were independently reviewed by 2 breast pathologists and the relevant clinical information was collected.
Results: All 32 patients were female, 23 (76.7%) had documented diabetes mellitus (DM) (8 type 1, 11 type 2 and 4 DM of unknown type). One woman had Graves' disease. The remaining patients did not have documented autoimmune disorders. The mean age for patients with type 1 DM was 36, for women with type 2 and unknown type DM was 66 and 68, respectively. Clinically, 27 (84.4%) patients presented with palpable masses; 1 with nipple discharge; 3 were identified on mammogram and 1 on MRI. At the time of the initial presentation, 4 (12.5%) patients had multiple masses in the ipsilateral breast and 2 (6.3%) had bilateral lesions. Five patients (15.1%) developed additional masses (2 ipsilateral and 3 bilateral). DMP was described on mammography as heterogeneously dense parenchyma in 67.7% of the cases, as area of asymmetry in 12.9%, and as ill-defined mass in 16.1%. The most common finding on ultrasound was irregular hypoechoic lesion (36.7%); 26.7% showed area of heterogeneity, 3.3% were well-circumscribed solid masses, and 26.7% were negative on imaging. Interestingly, 86.1% of the DMP nodules occurred in the upper outer quadrant of either breast. Notably 11 patients (33.3%) had one biopsy, 21 (66.7%) had at least 2 procedures, among them 9 had more then 2 procedures. Six patients (18.7%) had recurrence. None of DMP nodules showed malignant transformation during follow up.
Conclusions: We outline the constellation of findings on clinical examination, medical history and imaging studies for DMP. The recognition of this benign entity is important because it might spare patients from repeated surgical procedures. A detailed pathological and radiological correlation and immunohistochemical study is underway.
Monday, March 19, 2012 1:00 PM
Poster Session II # 47, Monday Afternoon