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Breast-nonmalignant

Inflammatory / infectious

Lymphocytic mastitis

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 27 September 2012, 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

 

Other: #1#2#3#4#5 

 

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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