Boumarah Dhuha N, AlSinan Ali S, AlMaher Eman M, Mashhour Miral, AlDuhileb Mohammed
Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
Int J Surg Case Rep. 2022 Jun;95:107151. doi: 10.1016/j.ijscr.2022.107151. Epub 2022 May 4.
Diabetic mastopathy is a rare entity affecting diabetic patients. It has been previously linked to type 1 diabetes mellitus; however, due to the several accompanying conditions, a theory of autoimmune factors contributing to the origin of this condition has been on the rise. In this paper, we report a case of diabetic mastopathy associated with several autoimmune diseases to highlight the immunological potential of this condition.
A 25-year-old female, known to have type 1 diabetes mellitus, hypertension, hypothyroidism, adrenal insufficiency, dilated cardiomyopathy and end-stage renal disease, was referred to our clinic for a breast lump. Radiological investigations showed a dense mass with irregular borders in the retroareolar area of the left breast. A core biopsy was obtained which revealed keloid-like fibrosis along with lymphocytes infiltrated, suggestive of lymphocytic mastopathy.
Fibrous mastopathy has been merely attributed to a long-standing use of insulin therapy by diabetic patients; recent observations, however, proved the major contribution of immunity to etiopathogenesis. Even though human leukocyte antigen (HLA) association has not been supported in the literature, the histological changes of breast lymphocytic infiltrate are seen in patients who not only have T1DM, but also thyroiditis, systemic lupus erythematosus, Sjogren's syndrome, and Addison's disease. The frequent presence of several possible autoimmune conditions has promoted the theory of an autoimmune process affecting connective tissues, however, these claims are yet to be proven by future studies.
Recent observations have proved the major contribution of immunity to etiopathogenesis of diabetic mastopathy. We shed light on the role of the immune system in triggering the disease process by reporting a case of diabetic mastopathy with a cluster of autoimmune diseases. Future studies should explore the genetic background of the condition as it would potentially have several clinical implications. The discussed pathophysiologic explanations raise the possibility of autoimmunity as a key driver in pathogenesis and indicate the need to change the nomenclature of this condition.
糖尿病性乳腺病是一种影响糖尿病患者的罕见病症。此前它被认为与1型糖尿病有关；然而，由于存在多种伴随病症，一种认为自身免疫因素导致该病症发生的理论正逐渐兴起。在本文中，我们报告一例与多种自身免疫性疾病相关的糖尿病性乳腺病病例，以突出该病症的免疫潜能。
一名25岁女性，已知患有1型糖尿病、高血压、甲状腺功能减退、肾上腺功能不全、扩张型心肌病和终末期肾病，因乳腺肿块被转诊至我们的诊所。影像学检查显示左乳乳晕后区域有一个边界不规则的致密肿块。进行了一次粗针活检，结果显示有瘢痕疙瘩样纤维化以及淋巴细胞浸润，提示淋巴细胞性乳腺病。
纤维性乳腺病仅仅被归因于糖尿病患者长期使用胰岛素治疗；然而，最近的观察结果证明免疫在病因发病机制中起主要作用。尽管文献中未支持人类白细胞抗原（HLA）关联，但不仅患有1型糖尿病，还患有甲状腺炎、系统性红斑狼疮、干燥综合征和艾迪生病的患者中可见乳腺淋巴细胞浸润的组织学变化。多种可能的自身免疫性病症频繁出现，推动了一种影响结缔组织的自身免疫过程的理论，但这些说法尚有待未来研究证实。
最近的观察结果证明免疫在糖尿病性乳腺病的病因发病机制中起主要作用。我们通过报告一例伴有一系列自身免疫性疾病的糖尿病性乳腺病病例，阐明了免疫系统在触发疾病过程中的作用。未来的研究应探索该病症的遗传背景，因为它可能具有多种临床意义。所讨论的病理生理学解释增加了自身免疫作为发病机制关键驱动因素的可能性，并表明需要改变该病症的命名。
