Camuto P M, Zetrenne E, Ponn T
General Surgery Associates, 330 Orchard St, Suite 305, New Haven, CT 06511, USA.
Arch Surg. 2000 Oct;135(10):1190-3. doi: 10.1001/archsurg.135.10.1190.
Diabetic mastopathy is an unusual fibroinflammatory breast lesion that characteristically presents in premenopausal women with long-standing type 1 diabetes mellitus with multiple microvascular complications. The pathogenesis of this condition is believed to involve an autoimmune reaction to the accumulation of abnormal matrix induced by hyperglycemia. Clinicopathologic features include the development of dense keloidlike breast masses that are often recurrent or bilateral or both. Clinical distinction from a malignancy can be difficult. However, the benign nature of this lesion is easily recognized on histologic examination, and it is not associated with an increased incidence of epithelial or stromal neoplasia.
A constellation of histopathologic and clinical features is necessary to make the diagnosis of diabetic mastopathy. Unnecessary surgery can be avoided in the clinical follow-up of patients with multiple, bilateral, and recurrent lesions.
Case series.
Between December 1993 and December 1998, 5 premenopausal women with type 1 diabetes mellitus of 18 to 23 years' duration presented with nontender, palpable, firm-to-hard breast masses. To date, progression of the tumorlike proliferations has been bilateral and recurrent in 2 patients, bilateral in a third patient, and recurrent in a fourth. The fifth patient has developed neither bilateral nor recurrent lesions. Imaging studies did not in any patient demonstrate a focal lesion. All lesions were treated by either excisional (4 patients) or core (1 patient) biopsy. The resected specimens were examined histopathologically.
Gross examination of the specimens showed firm masses with homogeneous tannish-white cut surfaces. They measured between 3.0 and 6.0 cm in maximum diameter. Microscopic examination showed keloidal fibrosis with ductitis, lobulitis, and vasculitis. The clinical profile in combination with these pathologic features is characteristic of diabetic mastopathy.
Physicians should be aware of the association of long-standing diabetes mellitus with the development of benign fibroinflammatory breast lesions when managing these in premenopausal women. We outline the constellation of findings on clinical examination, medical history, imaging studies, and histopathologic examination that are required to make the diagnosis of diabetic mastopathy. Although these breast masses may be recurrent, they are not premalignant. In the appropriate setting, the diagnosis can be made by core biopsy, avoiding unnecessary surgeries in patients with multiple, bilateral, or recurrent lesions.
糖尿病性乳腺病是一种罕见的纤维炎性乳腺病变，典型表现为患有长期1型糖尿病且伴有多种微血管并发症的绝经前女性。这种疾病的发病机制被认为涉及对高血糖诱导的异常基质积累的自身免疫反应。临床病理特征包括致密的瘢痕疙瘩样乳腺肿块的形成，这些肿块常为复发性或双侧性或两者皆有。与恶性肿瘤进行临床鉴别可能较为困难。然而，这种病变的良性性质在组织学检查中很容易识别，并且它与上皮或间质肿瘤的发病率增加无关。
一系列组织病理学和临床特征对于诊断糖尿病性乳腺病是必要的。在对具有多发性、双侧性和复发性病变的患者进行临床随访时，可以避免不必要的手术。
病例系列。
1993年12月至1998年12月期间，5名患有18至23年病程的1型糖尿病的绝经前女性出现了无痛、可触及的、质地硬至坚硬的乳腺肿块。迄今为止，肿瘤样增生在2例患者中为双侧性且复发性，在第3例患者中为双侧性，在第4例患者中为复发性。第5例患者既未出现双侧性病变也未出现复发性病变。影像学检查在任何患者中均未显示局灶性病变。所有病变均通过切除活检（4例患者）或粗针活检（1例患者）进行治疗。对切除的标本进行组织病理学检查。
标本的大体检查显示质地硬的肿块，切面均匀呈黄褐色至白色。最大直径在3.0至6.0厘米之间。显微镜检查显示瘢痕疙瘩样纤维化伴导管炎、小叶炎和血管炎。临床特征与这些病理特征相结合是糖尿病性乳腺病的特征。
在处理绝经前女性的这些病变时，医生应意识到长期糖尿病与良性纤维炎性乳腺病变发生之间的关联。我们概述了临床检查、病史、影像学检查和组织病理学检查中用于诊断糖尿病性乳腺病所需的一系列发现。尽管这些乳腺肿块可能会复发，但它们并非癌前病变。在适当的情况下，通过粗针活检即可做出诊断，从而避免对具有多发性、双侧性或复发性病变的患者进行不必要的手术。
