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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Diabetic Mastopathy / Lymphocytic Mastitis

Definition

  • A fibrous breast mass witha prominent lymphocytic infiltrate most often occurring in patients with longstanding diabetes

Alternate/Historical Names

  • Diabetic fibrous mastopathy
  • Diabetic lymphocytic lobulitis
  • Fibrous disease of the breast in juvenile diabetics
  • Lymphocytic mastopathy
  • Sclerosing lymphocytic lobulitis

Diagnostic Criteria

  • Prominent keloidal fibrosis
  • Prominent lymphocytic infiltrate
    • Perivascular, perilobular, periductal
      • May infiltrate lobular epithelium forming lymphoepithelial lesions
    • Sharply circumscribed infiltrate
    • May form nodules but germinal centers not seen
    • Predominantly B cells
    • One case reported of a postmenopausal patient with an exuberant lymphohistiocytic and granulomatous response (Fong 2006)
  • Epithelioid stromal cells
    • No mitotic figures described in stromal cells
    • Variable staining for actin
  • No epithelial proliferation
  • Virtually all female patients premenopausal
  • Nearly all reported cases with the full constellation of histologic features have occurred in diabetics

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: May 15, 2006

Supplemental studies

Immunohistology

  • Lymphoid infiltrate is predominantly B cells
    • No CD43 coexpression
  • Epithelioid stromal cells
    • Variably reactive for actin
    • Negative for desmin, S100, CD34

Genetic analysis

  • No evidence of B cell clonality

Differential Diagnosis

Fibrocystic disease

  • Combined epithelial and stromal process
  • Lacks keloidal fibrosis
  • Lacks epithelioid stromal cells
  • Lacks characteristic B cell infiltrates

Nonspecific mastitis

  • Mixed B and T cells or predominantly T cells
  • Lacks keloidal fibrosis
  • Lacks epithelioid stromal cells

Diabetic Mastopathy / Lymphocytic Mastitis Mammary Hamartoma
Epithelioid stromal cells No epithelioid stromal cells
Prominent B cell infiltrates No significant B cell infiltrates
Both have keloidal fibrosis

Clinical

  • Nearly all reported cases with full constellation of histologic features have occurrred in diabetics
    • Most often associated with Type I diabetes
    • One report of association with longstanding insulin use rather than type of diabetes (Seidman)
    • Occasional cases reported in non-diabetics with some but not all of the diagnostic histologic features
      • Significance of such lesions is unclear
      • Autoantibodies reported in some cases (Schwartz)
  • Generally presents as a fibrous mass or masses
    • May be unilateral or bilateral
    • One prospective series of diabetics found non-palpable lesions with some but not all of the diagnostic histologic features (Lammie)
  • Most patients female
    • Virtually all premenopausal
    • Rare male cases reported
  • May recur

Bibliography

  • Valdez R, Thorson J, Finn WG, Schnitzer B, Kleer CG. Lymphocytic mastitis and diabetic mastopathy: a molecular, immunophenotypic, and clinicopathologic evaluation of 11 cases. Mod Pathol. 2003 Mar;16(3):223-8.
  • Ely KA, Tse G, Simpson JF, Clarfeld R, Page DL. Diabetic mastopathy. A clinicopathologic review. Am J Clin Pathol. 2000 Apr;113(4):541-5.
  • Tomaszewski JE, Brooks JS, Hicks D, Livolsi VA. Diabetic mastopathy: a distinctive clinicopathologic entity. Hum Pathol. 1992 Jul;23(7):780-6.
  • Schwartz IS, Strauchen JA. Lymphocytic mastopathy. An autoimmune disease of the breast? Am J Clin Pathol. 1990 Jun;93(6):725-30.
  • Lammie GA, Bobrow LG, Staunton MD, Levison DA, Page G, Millis RR. Sclerosing lymphocytic lobulitis of the breast--evidence for an autoimmune pathogenesis. Histopathology. 1991 Jul;19(1):13-20.
  • Morgan MC, Weaver MG, Crowe JP, Abdul-Karim FW. Diabetic mastopathy: a clinicopathologic study in palpable and nonpalpable breast lesions. Mod Pathol. 1995 May;8(4):349-54.
  • Ashton MA, Lefkowitz M, Tavassoli FA. Epithelioid stromal cells in lymphocytic mastitis--a source of confusion with invasive carcinoma. Mod Pathol. 1994 Jan;7(1):49-54.
  • Seidman JD, Schnaper LA, Phillips LE. Mastopathy in insulin-requiring diabetes mellitus. Hum Pathol. 1994 Aug;25(8):819-24.
  • Fong D, Lann MA, Finlayson C, Page DL, Singh M. Diabetic (lymphocytic) mastopathy with exuberant lymphohistiocytic and granulomatous response: a case report with review of the literature. Am J Surg Pathol. 2006 Oct;30(10):1330-6.

     

     

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