Anatomic Pathology: Breast Pathology

• Diabetic mastopathy is associated with type 1 or type 2 diabetes mellitus and has been reported in nondiabetic patients as well.

• Inflammatory infiltrates are composed of lymphocytes with variable numbers of plasma cells. In addition, dense keloidal fibrosis that contains embedded epithelioid fibroblasts has been described.

• Core biopsy can be used to monitor patients with recurrent lesions in a proven case of diabetic mastopathy because it can show ductal epithelial cells in clusters, lymphocytes, and epithelioid fibroblasts.

• Epithelioid fibroblasts appear uniquely in diabetic mastopathy and are diagnostic when found, although they are not present in all cases.

• The pathophysiology of this condition is unclear, although the most widely postulated theory relates to the production of nonenzymatically glycosylated proteins in diabetes. These proteins are often cross-linked and resistant to degradation and are deposited within the matrix of various tissues, including the breast, where they can stimulate an immunogenic response.

• Most cases are reported in women, although a few cases have been reported in men, and an association with gynecomastia has been reported. It is widely reported that this condition occurs mainly in premenopausal women.

• Most mammograms of patients with diabetic mastopathy are reported with terms such as “dense breast parenchyma,” “dense glandular tissue,” “asymmetric densities,” and “parenchymal deformity.” A discrete mass lesion is typically not visualized.