Breast
Inflammatory
Lymphocytic / diabetic mastitis

Editorial Board Member: Gary Tozbikian, M.D.
Editor-in-Chief: Debra Zynger, M.D.
Kristen E. Muller, D.O.

Topic Completed: 19 October 2020

Minor changes: 19 October 2020

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PubMed Search: breast lymphocytic / diabetic mastitis

Kristen E. Muller, D.O.
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Cite this page: Muller KE. Lymphocytic / diabetic mastitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastlymphocyticmastitis.html. Accessed October 20th, 2020.
Definition / general
  • Histologic triad of keloidal type fibrosis, lymphocytic inflammation and epithelioid myofibroblasts
  • Associated with type I (insulin dependent) diabetes or other autoimmune diseases
Essential features
  • Young to middle aged women presenting with breast mass(es)
  • Histologic triad of keloidal type fibrosis, lymphocytic infiltrates and epithelioid stromal myofibroblasts
  • Associated with type I (insulin dependent) diabetes or other autoimmune diseases
Terminology
  • Lymphocytic mastopathy / diabetic mastopathy
  • Sclerosing lymphocytic mastitis / lobulitis
  • Diabetic fibrous breast disease
ICD coding
  • ICD-10: N61 - inflammatory disorders of breast
  • ICD-11: GB21 - inflammatory disorders of breast
Epidemiology
Sites
  • Breast
Pathophysiology
  • Unknown
  • Theories include:
    • Hyperglycemia leads to stromal matrix expansion and accumulation of glycosylation end products and a B cell inflammatory response (Hum Pathol 1992;23:780)
    • Immunologic response to exogenous insulin (Hum Pathol 1994;25:819)
Etiology
  • Unknown
Clinical features
Diagnosis
  • Needle core biopsy or surgical excision with histologic examination
Laboratory
  • Correlate with serologic markers for diabetes and other autoimmune diseases
Radiology description
Radiology images

Contributed by Kristen E. Muller, D.O.
Acoustic shadowing

Acoustic shadowing

Prognostic factors
Case reports
Treatment
Gross description
  • Firm, ill defined, homogenous, tan-white or white-gray cut surface
  • Size variable, up to 6.0 cm
Gross images

Images hosted on other servers:
Dense white fibrous stroma

Dense white fibrous stroma

Firm white cut surface

Firm white cut surface

Microscopic (histologic) description
  • Triad of dense, keloidal type fibrosis, periductal, perilobular and perivascular lymphocytic infiltrates and epithelioid stromal myofibroblasts
  • Epithelioid characteristics of myofibroblasts include enlarged cells with round to polygonal nuclei, prominent nucleoli and abundant cytoplasm
  • Epithelioid features of myofibroblasts may be subtle or absent
  • Stromal mitoses absent
  • Mature lymphocytic infiltrates are nonclonal, predominantly B lymphocytes and lack germinal centers (Mod Pathol 2003;16:223)
Microscopic (histologic) images

Contributed by Kristen E. Muller, D.O.
Dense fibrous stroma

Dense fibrous stroma

Perivascular lymphocytic inflammation Perivascular lymphocytic inflammation

Perivascular lymphocytic inflammation

Enlarged myofibroblasts

Enlarged myofibroblasts

Fibrous stroma, periductal and perivascular inflammation

Fibrous stroma, periductal and perivascular inflammation

Periductal lymphocytes

Periductal lymphocytes


Epithelioid myofibroblasts

Epithelioid myofibroblasts

CD20

CD20

CD3

CD3

Virtual slides

Images hosted on other servers:
Lymphocytic mastopathy

Lymphocytic mastopathy

Cytology description
Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Left breast, needle core biopsy:
    • Breast tissue with dense stromal keloidal type fibrosis, epithelioid myofibroblasts and perilobular lymphocytic inflammation (see comment)
    • Comment: The histologic findings are compatible with lymphocytic / diabetic mastopathy in the appropriate clinical context.
Differential diagnosis
Board review style question #1

For the breast stroma shown, which of the following is true?

  1. Lesion is associated with increased risk of developing lymphoma
  2. Lymphocytes are predominantly T cells and are clonal
  3. Patient may have insulin dependent diabetes or an autoimmune disorder
  4. Spindle cells in the stroma show beta catenin nuclear expression
Board review answer #1
C. Patient may have insulin dependent diabetes or an autoimmune disorder

Comment Here

Reference: Lymphocytic / diabetic mastitis
Board review style question #2
Which of the following is true regarding diabetic / lymphocytic mastopathy?

  1. All patients have a history of diabetes
  2. Characteristic histologic triad includes dense keloid-like fibrosis, epithelioid myofibroblasts and periductal, perilobular and perivascular lymphocytic inflammation
  3. If surgically excised, these lesions never recur
  4. Typical mammographic finding is an infiltrative mass lesion
Board review answer #2
B. Characteristic histologic triad includes dense keloid-like fibrosis, epithelioid myofibroblasts and periductal, perilobular and perivascular lymphocytic inflammation

Comment Here

Reference: Lymphocytic / diabetic mastitis
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