Jose Jobin Mathew, Varghese Anusha, Joseph George, Keerthi Susmitha, Varghese Jophy
Department of Radiodiagnosis, Lourdes Hospital, Pachalam, Kochi, India.
Department of Pathology, Lourdes Hospital, Pachalam, Kochi, India.
BJR Case Rep. 2016 May 15;2(2):20150234. doi: 10.1259/bjrcr.20150234. eCollection 2016.
Lymphocytic mastitis, also known as diabetic mastopathy or sclerosing lymphocytic lobulitis, is a benign clinicopathological entity that, in earlier studies, has been described as an uncommon cause of breast mass in adult females with long-standing insulin-dependent diabetes mellitus. Further studies have suggested an autoimmune aetiology owing to its association with other autoimmune diseases such as Hashimoto's thyroiditis. On clinical examination, mammography and ultrasound, this lesion may mimic breast carcinoma. The most common mammographic findings are ill-defined masses or asymmetric densities. Such lesions are often masked by dense glandular tissue, making mammographic evaluation difficult. Ultrasound often reveals the characteristic finding of an irregular, hypoechoic mass with marked posterior acoustic shadowing. We present a case of infiltrating ductal carcinoma with coexisting lymphocytic mastitis involving the right breast of a non-diabetic adult female who presented with complaints of a painless, hard palpable lump in her right breast for 2 months. Mammography and ultrasonography showed features of a malignant lesion that was subjected to fine needle aspiration cytology and tru-cut biopsy examination. Cytology revealed features suggestive of infiltrating ductal carcinoma in a background of severe inflammation and necrosis. Tru-cut biopsy showed features suggestive of lymphocytic mastitis. The patient underwent modified radical mastectomy of the right breast. Histopathological examination of right breast tissue revealed multifocal infiltrating ductal carcinoma, metastatic ipsilateral axillary lymph nodes, lymphovascular tumour emboli and tumour-free margins. The patient underwent adjuvant chemotherapy and radiotherapy. She is on hormone therapy with a selective oestrogen receptor modulator and is disease-free now.
淋巴细胞性乳腺炎，也称为糖尿病性乳腺病或硬化性淋巴细胞性小叶炎，是一种良性临床病理实体，在早期研究中，它被描述为成年女性长期胰岛素依赖型糖尿病患者乳腺肿块的罕见原因。进一步的研究表明，由于其与其他自身免疫性疾病如桥本甲状腺炎相关，其病因可能为自身免疫性。在临床检查、乳腺钼靶和超声检查中，这种病变可能类似于乳腺癌。最常见的乳腺钼靶表现是边界不清的肿块或不对称密度影。此类病变常被致密的腺组织掩盖，使得乳腺钼靶评估困难。超声检查常显示特征性表现，即不规则的低回声肿块伴明显的后方声影。我们报告一例非糖尿病成年女性右乳腺浸润性导管癌合并淋巴细胞性乳腺炎的病例，该患者因右乳无痛性可触及硬块2个月就诊。乳腺钼靶和超声检查显示为恶性病变特征，随后进行了细针穿刺细胞学检查和粗针活检。细胞学检查显示在严重炎症和坏死背景下提示浸润性导管癌的特征。粗针活检显示提示淋巴细胞性乳腺炎的特征。患者接受了右乳改良根治术。右乳组织的组织病理学检查显示多灶性浸润性导管癌、同侧腋窝淋巴结转移、淋巴管肿瘤栓子以及切缘无肿瘤。患者接受了辅助化疗和放疗。她正在接受选择性雌激素受体调节剂的激素治疗，目前无疾病复发。
