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Breast-nonmalignant
Inflammatory / infectious
Lymphocytic mastitis
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 8 April 2010, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Uncommon finding associated with type I diabetes
Terminology
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● Also called diabetic mastopathy, sclerosing lymphocytic mastitis/lobulitis if prominent fibrosis
Epidemiology
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● Uncommon
● Usually women
● Often associated with type I / insulin dependent diabetes (Diabetes Care 2000; 25:121, Hum Pathol 1994;25:819, Hum Pathol 1992;23:780) or other autoimmune disease, but may occur in type II diabetes or non-diabetes
● May occur in men (Pathol Res Pract 1997;193:197)
Etiology
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●
Clinical features
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● Rarely associated with DCIS
● No increased risk of lymphoma
Prognostic factors
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●
Case reports
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● 50 year old woman with coexisting lymphoepithelioma-like carcinoma (Arch Pathol Lab Med 2001;125:669)
● 50 year old woman with core biopsy suspicious for lymphoma (Breast Cancer 2009;16:141)
● 66 year old woman with multiple bilateral masses (Am J Surg Pathol 2006;30:1330)
Treatment
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● Excision, but often recurs (30%, Am J Clin Path 2000;113:541)
Gross description (Macroscopy)
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● Clinically palpable mass, usually subareolar
● Gray-white, smooth cut surface
● Often bilateral
Gross images
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Micro description (Histopathology)
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● Ill defined lesion of dense intralobular, perilobular and perivascular lymphocytes
● Also lobular atrophy and sclerosis (keloidal fibrosis), B cell lymphoepithelial lesions, lymphoid follicles with germinal centers
● Also histiocytes and fibroblasts
● Epithelioid fibroblasts may be mistaken for carcinoma or granular cell tumor (Mod Pathol 1994;7:49)
● Variable fat necrosis and noncaseating granulomas
● No changes in overlying epidermis
Micro images
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Perivascular lymphocytic Keloid-like fibrosis and prominent
infiltrate sparing lobules lymphoid infiltrate around breast
ducts/lobules
Lymphoepithelial lesion CD20+/CD3- lymphocytes Various images
(B, not T cells)
Findings in men: periductal lymphocytes
and dense collagenous stroma
Virtual Slides
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Videos
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Cytology description
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● Clusters of ductal cells, lymphocytes and epithelioid fibroblasts in fragments of dense connective tissue (Acta Cytol 1997;41:1349)
Cytology images
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●
Positive stains
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● B cell markers
Negative stains
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●
Electron microscopy descriptions
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●
Electron microscopy images
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Molecular / cytogenetics description
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● Lymphocytes are not clonal (Mod Pathol 2003;16:223)
Molecular / cytogenetics images
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Differential Diagnosis
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● MALT lymphoma: no prominent sclerosis; clonal
● Sinus histiocytosis with massive lymphadenopathy
● Pubertal macromastia: perilobular lymphocytic infiltrate is CD3+, different clinical findings (J Clin Endocrinol Metab 2005;90:5287)
Additional references
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● Mod Pathol 1995;8:349, Radiology 2001;219:797 (men), Stanford University
End of Breast-nonmalignant > Inflammatory / infectious > Lymphocytic mastitis
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