Mastopatía diabética: a propósito de un caso clínico / Diabetic mastopathy: a clinical case

La mastopatía diabética es una lesión fibroinflamatoria de la mama muy infrecuente, que característicamente se presenta en mujeres premenopáusicas y está fuertemente asociada a diabetes mellitus tipo I. La patogénesis es desconocida, sin embargo, histopatológicamente se ha observado una reacción en el tejido conectivo similar al de algunas enfermedades autoinmunes. La clínica y exámenes complementarios pueden ser sugerentes de neoplasia, por lo que se requiere estudio histopatológico para establecer el diagnóstico definitivo.

Diabetic mastopathy is a very infrequent fibro-inflammatory lesion generally found in pre-menopausal women and is strongly associated with type 1 diabetes mellitus. Its pathogenesis is unknown; however its histopathology shows a connective tissue reaction similar to that of some auto-immune diseases. Its clinical presentation and complementary tests may suggest neoplasm, thus definitive diagnosis requires a histopathological study.

Mastopatía diabética: una entidad infrecuente a diferenciar / Diabetic mastopathy: an uncommon entity to differentiate

Antecedentes. La diabetes mellitus produce microvasculitis y alteración histoarquitectural de la mama. Se encuentra en el 1% de la mastopatía benigna. Sin embargo, la distorsión del parénquima produce sintomatología inflamatoria clínicamente similar a las mastopatías inflamatorias infecciosas. Su diagnóstico imagenológico es, a su vez, de gran dificultad interpretativa. Estos parámetros inespecíficos desembocan en tratamientos que no logran eficacia en la enfermedad, más aún si se ignora el contexto de la enfermedad de origen, la cual es sistémica. Objetivos. Destacar la importancia del diagnóstico diferencial de esta infrecuente entidad patológica. Material y Métodos. Se revisaron historias clínicas de un servicio de mastología por el término de seis meses a efectos de recabar información estadística. Población. Se estudiaron dos pacientes en un universo de más de cien historias clínicas abordadas. Resultados. Histológicamente, estas pacientes presentaron rasgos microscópicos que consisten en una lobulitis linfocitaria que afecta al epitelio y gran vasculitis edematosa. El diagnóstico histológico es crucial para llegar al tratamiento. Discusión y conclusiones. La mastopatía de las pacientes diabéticas insulinodependientes es la manifestación crónica de eventos sistémicos, producida en un porcentaje muy bajo de pacientes con la enfermedad. La correcta interpretación clínica y mamográfica, además de la sospecha semiológica, desembocan en el adecuado tratamiento de esta enfermedad inserta en un contexto sistémico.

Background. Diabetes mellitus occurs histoarquitectural microvasculitis and alteration of the breast. It is found in 1% of benign breast disease. However, distortion occurs parenchymal inflammatory symptoms clinically similar to infectious inflammatory breast disease. Its diagnostic imaging is in turn highly interpretive difficulty. These nonspecific parameters lead to effective treatments that fail in the disease, especially if the context of disease origin is unknown, which is systemic. Objectives. To highlight the importance of the differential diagnosis of this rare disease entity. Material and methods. Clinical histories mastology service for a period of six months for the purpose of collecting statistical data were reviewed. Population. Two patients were studied in a universe of more than one hundred medical records addressed. Results. Histologically, these patients had microscopic features consisting lobulitis lymphocytic affecting large edematous epithelium and vasculitis. Histological diagnosis is crucial to get the treatment. Discussion and conclusions. Diabetic mastopathy in insulin dependent patients is chronic manifestation of systemic events produced in a very low percentage of patients with the disease. The correct clinical and mammographic interpretation, in addition to lead to suspicion semiológica proper treatment of this disease, inserted in a systemic context.

Mastopatia linfocítica simulando neoplasia de mama: relato de caso / Lymphocytic mastopathy mimicking breast malignancy: a case report

A mastopatia linfocítica acomete mulheres jovens e de meia idade e está frequentemente associada a doenças autoimunes. Seu diagnóstico é feito associando achados clínicos (espessamento ou nódulo mamário endurecido), radiológicos (aumento da densidade mamária, nódulo e calcificações), ultrassonográficos (nódulo com sombra acústica posterior), histopatológicos (fibrose e infiltrado linfocítico) e imuno-histoquímicos. É uma entidade benigna que pode simular carcinoma. Neste artigo, relata-se um caso de paciente com mastopatia linfocítica.

Lymphocytic mastopathy affects both young and middle-aged women and is frequently associated with autoimmune diseases. Diagnosis is done by associating clinical (breast tissue thickening or hardened breast lump), radiological (increased breast density, presence of mass and calcifications), sonographic (nodule with posterior acoustic shadowing), histopathological (fibrosis and lymphocytic infiltrate) and immunohistochemical findings. Lymphocytic mastopathy is a benign entity that may mimic carcinoma. The authors report the case of a patient with lymphocytic mastopathy.

Mastopatia Diabética: una entidad infrecuente a diferenciar / Diabetic mastitis: an uncommon entity differentiate

Introducción: La Diabetes mellitus produce microvasculitis y alteración histoarquitectural de la mama. Se encuentra en el 1% de la mastopatía benigna. Sin embargo, la distorsión delparénquima produce sintomatología inflamatoria clínicamente similar a las mastopatías inflamatorias infecciosas. Su diagnóstico imagenológico, es a su vez, de gran dificultad interpretativa. Estos parámetros inespecíficos, desembocan a tratamientos que no logran eficacia en la enfermedad, más aún si se ignora el contexto de la enfermedad de origen, la cual essistémica. Objetivos: destacar la importancia del diagnóstico diferencial de esta infrecuente entidad patológica. Material y Métodos: se revisaron historias clínicas de un servicio de mastología por el término de seis meses, a efectos de recabar información estadística. Resultados: histológicamente, estas pacientes presentaron rasgos microscópicos que consisten en una lobulitis linfocitaria que afecta al epitelio y gran vasculitis edematosa. El diagnóstico histológico es crucial para llegar al tratamiento. Conclusiones: la mastopatía de las pacientes diabéticas insulinodependientes es la manifestación crónica de eventos sistémicos, producido en un porcentaje muy bajo de pacientes con la enfermedad. La correcta interpretación clínica y mamográfica, además de la sospecha semiológica desembocanen el adecuado tratamiento de esta enfermedad, inserta en un contexto sistémico.

Introduction: Diabetes mellitus occurs histoarquitectural microvasculitis and alteration of the breast. It is found in 1% of benign breast disease . However, distortion occurs parenchymal inflammatory symptoms clinically similar to infectious inflammatory breast disease. Its diagnostic imaging , is in turn highly interpretive difficulty. These non specific parameters lead to effective treatments that fail in the disease , especially if the context of disease origin is unknown, which is systemic. Objectives: To highlight the importance of the differential diagnosis of this rare disease entity. Material and Methods : Clinical histories mastology service for a period of six months for the purpose of collecting statistical data were reviewed.Results: Histologically , these patients had microscopic features consisting lobulitis lymphocytic affecting large edematous epithelium and vasculitis. Histological diagnosis is crucial to get the treatment. Conclusions: Diabetic mastopathy in insulin dependent patients is chronic manifestation of systemic events , produced in a very low percentage of patients with the disease. The correct clinical and mammographic interpretation, in addition to lead to suspicion semiológica proper treatment of this disease, inserted in a systemic context.

Concordancia clínica, mamográfica y anatomopatológica en el cáncer mamario / Clinical mammographic, and pathologic concordance in breast cancer

Se efectuó un estudio observacional, descriptivo y transversal para caracterizar, según variables generales, clínicas, anatomopatológicas e imagenológicas, a las 100 pacientes con cáncer de mama que acudieron a la Consulta de Mastología en el Hospital Oncológico Docente Conrado Bení­tez de Santiago de Cuba, desde agosto de 2009 hasta julio de 2010. Se utilizaron el porcentaje como medida de resumen para validar estadísticamente los resultados y el í­ndice de Kappa para determinar la concordancia diagnóstica. En la casuística primaron las féminas de 40-49 años, con antecedentes de mastopatías fibroquísticas y lesión palpable, así­ como también el nódulo en la mama derecha, cuadrante superior externo y periferia del seno; el tumor mayor de un centímetro de dá¡metro y el carcinoma ductal infiltrante en las etapas III-b y IV.

An observational descriptive and cross-sectional study was carried out in 100 patients with breast cancer, who attended the Breast Care Department at Conrado Benítez Teaching Oncology Hospital in Santiago de Cuba from August 2009 to July 2010, to characterize them according to imaging, pathological, clinical, and general variables. Percentage as summary measure to statically validate the results and Kappa index to determine diagnostic concordance were used. Women between 40-49 years with history of fibrocystic breast disease and palpable lesions, as well as lump in the right breast, upper outer quadrant and periphery of the breast, tumor greater than one centimeter in diameter and infiltrating ductal carcinoma in the stages III-b and IV prevailed in the case material.

Sistema para diagnóstico citológico de la mastopatía fibroquística por biopsia aspirativa con aguja fina / The cytodiagnosis of fibrocystic mastopathy use of fine needle aspiration biopsy (FNAB)

Se estudiaron 124 mastopatías benignas con hiperplasia epitelial diagnosticadas por citología aspirativa durante los años 2005-2006 y que fueron intervenidas quirúrgicamente. OBJETIVO: establecer criterios diagnósticos citológicos para los grados de Mastopatía fibroquística y crear un sistema cito patológico. MÉTODOS: en las láminas revisadas se definió, grado de celularidad con el análisis de 10 campos ópticos panorámicos 5x, patrones citológicos, atipia celular y elementos del fondo. RESULTADOS: la celularidad aumenta de leve a marcada desde la Mastopatía fibroquística Grado I a la Mastopatía fibroquística Grado III; en el patrón de agrupación presentado, las sábanas monoestratificadas en panal de abeja de talla pequeña y mediana se presentaron en los Grados del I al III, pero los grupos poliestratificados en bolas circunscritos con o sin empalizadas periféricas predominaron en los Grados II y III, al igual que la presencia de sábanas de epitelio apocrino con o sin papilomatosis; los grupos poliestratificados, discohesivos fueron característicos del Grados III. La atipia leve o moderada se presentó en aislados casos de los Grados I y II y la severa en el Grado III. En los elementos del fondo analizados las células mioepiteliales o núcleos bipolares desnudos fueron un elemento constante en los Grados del I al III. CONCLUSIONES: los errores presentados que provocaron la no correlación cito histológica fueron de muestreo e interpretación de la biopsia aspirtiva con aguja fian (BAAF) y en menor frecuencia errores de muestreo de la biopsia convencional cuyas causas fundamentales pueden ser en el momento de la exéresis del nódulo por el cirujano o por la toma de un número inadecuado de fragmentos por el anatomopatólogo en la pieza quirúrgica.

One hundred and twenty four benign mastopathies with epithelial hyperplasia were studied, diagnosed by aspiration cytology during 2005-2006 operated on. OBJECTIVE: To establish cytology diagnostic criteria for fibrocystic mastopathy degrees, and to create a cytopathology system. METHODS: In study slides it was defined the cellular degree with analysis of ten 5x- panoramic optical fields, cytological patterns, cellular atypia, and background elements. RESULTS: Cellularity increase from slight to marked of Grade I fibrocystic mastoplasty to Grade III fibrocystic mastoplasty in grouping pattern presented; monostratified sheets in little and medium size honeycomb were in I and III degrees, but in polystratified groups in limited balls with or without peripheral stockades predominate in II and III Grades, as well as presence of sheets of aprocrine epithelium with or without papillomatosis; non-cohesive polystratified groups were characteristic of III Grades. Slight or moderade atypia was present in isolated cases of I and II Grades, and the severe one in III Grade. In analyzed background elements myoepithelial cells or naked bipolar nuclei were a persistent element in I and III Grades. CONCLUSIONS: Errors presented provoking the non-cytohistological correlation were sampling end interpretation of fine needle aspiration biopsy (FNAB), and in a lower frequency, the sampling errors of conventional biopsy whose main causes may be at nodule exeresis by surgeon, or by taking of a unsuitable number of fragments by anatomist-pathologist in surgical sample.

Imágenes en mastopatia diabética / Mr imaging of diabetic mastopathy

Objective: To retrospectively analyze the clinical records and imaging data of patients with diabetic mastopathy according to pathological findings of samples obtained by histological puncture with ultrasound guidance. Methods: Between 2002 and 2007, six patients were diagnosed with diabetic mastopathy, and their medical records and MR images were assessed. All patients underwent both mammography and ultrasound examination. One of them was additionally submitted to MRI. Results: The patients' mean age was 36.6 years. Mammograms showed asymmetric tissue densifications without micro calcifications, while ultrasound examination evidenced ill-defined solid nodular or pseudonodular areas greater than 2 cm, with posterior sonic attenuation. Magnetic resonance imaging revealed a nodular area with poorly defined contours with enhancement similar to normal breast tissue. By performing eco-guided biopsy, it was possible to establish the differential histological diagnosis of breast carcinoma and to confirm diabetic mastopathy. Conclusion: Diabetic mastopathy presents mammographic and ultrasound imaging features indistinguishable from breast cancer. Since MRI does not reveal pathological stromal enhancement it can be helpful for a differential diagnosis. The echo-guided biopsy allows the diagnosis of this condition.

Objetivo: Analizar retrospectivamente las historias clínicas e imágenes de pacientes conmastopatía diabética, según hallazgos en anatomía patológica de muestras obtenidas por punción histológica con guía ecográfica. Material y Métodos: Entre los años 2002 y 2007, se diagnosticaron 6 pacientes con mastopatía diabética, evaluándose sus historias clínicas e imágenes. A todas las pacientes se le efectuó mamografía y ecografía; a una paciente se realizó además resonancia magnética. Resultados: La edad promedio de las pacientes fue de 36,6 años. Las mamografías mostraron densificaciones tisulares asimétricas sin microcalcificaciones; las ecografías evidenciaron áreas sólidas nodulares o seudonodulares mal definidas, mayores a 2 cm, con atenuación sónica posterior y la resonancia magnética: un área nodular de contornos mal delimitados con realce similar al tejido mamario normal. La punción biopsia ecoguiada pudo establecer el diagnóstico histológico diferencial con carcinoma mamario y confirmar mastopatía diabética. Conclusión: La mastopatía diabética presenta características imaginológicas en mamografía y ecografía que pueden ser similares al carcinoma. La resonancia magnética, al no presentar realce patológico estromal, puede colaborar en el diagnostico diferencial. La biopsia eco-guiada permite el diagnóstico de esta patología.

Mastopatia diabética: um inusitado diagnóstico diferencial: relato de caso / Diabetic mastopathy: an unusual differential diagnosis: a case report

A mastopatia diabética acomete mulheres na pré-menopausa com diabetes mellitus tipo 1 de longa data. Seu diagnóstico é feito associando achados clínicos (espessamento ou nódulo mamário endurecidos, uni ou bilateral), radiológicos (aumento da densidade mamária), ultra-sonográficos (acentuada sombra acústica posterior) e histopatológicos (fibrose e infiltrado linfocítico perivascular e periductal). Pode simular carcinoma. Neste artigo relata-se um caso de paciente com mastopatia diabética.

Diabetic mastopathy affects premenopausal women with longstanding type 1 diabetes mellitus. The diagnosis is based on clinical findings (uni or bilateral hardened, palpable mass) associated with radiological (increase in breast density), sonographic (marked posterior acoustic shadowing), and histopathological (fibrosis and perivascular and periductal lymphocytic infiltration) findings. This disease may clinically simulate a breast carcinoma. The case of a patient with diabetic mastopathy is reported.

Mastopatía diabética: presentación de caso / Diabetic masthopathy: case presentation

La mastopatía diabética es una entidad poco frecuente y de relativa nueva definición que puede simular una neoplasia maligna. Se presenta principalmente en pacientes diabéticas premenopáusicas insulino-dependientes con antecedentes de hiperglucemias prolongadas. Su etiopatogenia se asocia con el depósito estromal de colágeno y una infiltración linfocitaria de células B de causa autoinmune. La presentación clínica y radiológica no permiten concluir con un diagnóstico certero, siendo necesario la realización de biopsia con aguja gruesa y en la mayoría de los casos biopsia incisional. Presentamos el manejo de un caso en nuestra unidad.

Diabetic masthead is uncommon breast lesion and relative new definition that can be mistaken by a malignant neoplasia. It is mostly described in premenopausal patient’s diabetic and insulin dependent with history of persistent hyperglycemia. The ethiopatogenic is associated with extensive lymphocytic infiltration mostly B cells is detected an autoimmune reaction. Neither clinical nor radiologic exams rule out malignancy, so core biopsy and even incision biopsy are mandatory: Ephiteloid fibroblast in dense fibrous stroma is unique to the condition in diabetics. We present a case report, diagnosed and treated in our center.

Regression of the fibrous disease of the breast in a non-diabetic woman after pregnancy and breastfeeding

Fibrous mastopathy, also known as diabetic mastopathy and lymphocytic mastopathy, may mimic breast cancer at the physical examination, mammography, and ultrasound. We report a case of a woman who presented a non-tender mass clinically suggestive of breast carcinoma; however, the fine-needle aspiration cytology indicated atypia and the core needle biopsy revealed lymphocytic mastopathy. The magnetic resonance imaging of the breast showed a lesion with benign features. It was not demonstrated diabetics mellitus and autoimmune diseases. The patient got pregnant, breastfed, and it was observed the progressive regression of the lesion, with complete disappearance of the solid mass. Three years and three months later, there was no palpable mass at the clinical examination and ultrasound. In conclusion, fibrous mastopathy shall be considered for all breast lesions, regardless of the diagnosis of diabetes mellitus. Once a definitive diagnosis of this pathology is reached, it is recommended clinical, imaging studies and fine-needle aspiration biopsy follow-up of the patient, avoiding unnecessary surgical procedures.

A mastopatia fibrótica, também conhecida como mastopatia diabética e mastopatia linfocítica, pode, ao exame clínico, mamografia e ultra-som, simular um carcinoma mamário. Descrevemos o relato de uma mulher na qual o nódulo foi inicialmente suspeito de carcinoma mamário, mas o diagnóstico pela punção aspirativa com agulha fina foi de atipia, e o com biópsia com agulha grossa foi de mastopatia linfocítica. A ressonância magnética da mama mostrou a lesão com características de benignidade. Não foram demonstradas diabetes mellitus e doenças auto-imunes. A paciente engravidou, amamentou e foi observada regressão progressiva da lesão, com desaparecimento da mesma. A paciente persiste sem lesão na mama ao exame clínico e de ultra-som após acompanhamento de três anos e três meses. Em conclusão, a mastopatia fibrótica deve ser considerada para todas as lesões de mama, mesmo em pacientes sem diabetes mellitus. Quando o diagnóstico definitivo da patologia for realizado, é recomendável o acompanhamento da paciente com estudos clínicos e de imagem e biópsia com agulha fina, evitando-se procedimentos cirúrgicos desnecessários.

Mastopatia diabética bilateral- relato de caso / Bilateral diabetic mastopathy - case report

Objetivo: relatar um caso de mastopatia diabética bilateral, um tipo incomum e raro de doença inflamatória da mama. A associação entre mastopatia e diabete insulino-dependente é uma condição não muita conhecida. Relato do caso: paciente do sexo feminino, trinta e dois anos de idade, com diagnóstico de diabete desde os doze anos. A investigação clínica se baseou na anamnese e exame físico; realizada, também, ultra-sonografia e histopatologia. Considerações finais: o caso apresentado demonstra a importância do diagnóstico precoce das doenças que afetam a mama e a gravidade da mastopatia diabética, quando detectada tardiamente.

Objective: to report a case of diabetic mastopathy, an uncommon type of inflammatory breast pathology. The bilateral form is more rare. The association between mastopathy and insulin-dependent diabetes is a not very known condition. Case report: patient of female sex, thirtytwo years old, with diagnoses of diabetes at age of twelve. Final considerations: in the case reported above the authors emphasize the importance of early diagnosis in breast diseases.

Mastopatia diabética / Diabetic mastopaty

A mastopatia diabética é uma doença rara fibroinflamatória da mama, decorrente da reação auto-imune de acúmulo anormal de proteínas de matriz, causada pela hiperglicemia. Ocorre em pacientes diabéticas de longa data, principalmente as do tipo 1 e que se encontram na pré-menopausa. Aqui se relata um caso de mastopatia diabética em uma mulher de 71 anos de idade, com história de diabetes melito tipo 2, insulino-dependente, de 20 anos de duração, que tinha sido submetida a uma cirurgia plástica mamária aos 35 anos de idade. O exame físico mostrava uma massa endurecida, pouco definida e móvel no quadrante inferior externo, medindo 2 cm. Não possuía expressão mamográfica ou ultra-sonográfica. A biópsia excisional do nódulo e subseqüente exame histopatológico revelaram lobulite linfocítica esclerosante ou mastopatia diabética. O exame clínico pode mimetizar neoplasia maligna de mama e o diagnóstico histopatológico deve ser obrigatório para diagnóstico diferencial.

Diabetic mastopathy is a rare fibroinflammatory breast disease decurrent of autoimmune reaction to the accumulation of abnormal matrix proteins, caused by hyperglycemia. It occurs in long-standing insulin dependent, mainly with type I diabetes, and pre-menopause patients. We present a case of diabetic mastopathy in a 71-year-old woman with a history of insulin-dependent diabetes mellitus type 11 of 20 years duration who has done a mammary plastic surgery. Physical examination showed a stony-hard, ill-defined but freely movable mass at lower outer quadrant measuring 2 cm. It didn't have mammographic netheir ultrassonographic findings. Excisional biopsy of the nodule was performed and the histopathological examination of the lesion revealed sclerosing lymphocitic lobulitis or diabetic mastopathy. Clinical and ultrassonographic exams mimic breast cancer and for this reason the histological diagnosis must be useful for deferential diagnosis.