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Report of 8 cases" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "467" "paginaFinal" => "468" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Brenda Geraldine Argüelles, Amparo Argudo Pechuán, Francisco Ripoll Orts" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Brenda Geraldine" "apellidos" => "Argüelles" "email" => array:1 [ 0 => "brenda.ge.arguelles@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Amparo" "apellidos" => "Argudo Pechuán" ] 2 => array:2 [ "nombre" => "Francisco" "apellidos" => "Ripoll Orts" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitari i Politècnic La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mastopatía diabética. Estudio de 8 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2233 "Ancho" => 990 "Tamanyo" => 254394 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(1) Bilateral mammography: dense breasts are observed, with retroareolar asymmetry. (2) Bilateral ultrasound: alteration of echostructure and echogenicity, hypoechoic, with posterior acoustic shadowing, no circumscribed limits. (3) MRI: dynamic study with contrast. T1 with contrast and fat suppression. Early phase (A). Subtraction image (B). Perfusion analysis, corresponding to a gradually ascending moderate uptake, with characteristics of benignity (C and D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetic mastopathy (DM) is a rare disease, which can simulate breast cancer clinically and radiologically. Appears generally in premenopausal middle-aged female patients, with long-term type 1 diabetes mellitus; it can also occur in patients with type 2 diabetes mellitus.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> It represents less than 1% of benign breast lesions, and can reach up to 13% in patients with type 1 diabetes.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Soler and Khadori were the first to publish on the disease after a study of 12 women who had breast fibrous lesions associated with long-term type 1 DM, poor metabolic control and microvascular complications. They concluded that, although rare, it is a possible complication of diabetes mellitus, which later became known as diabetic mastopathy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It usually associates another complication secondary to diabetes, often diabetic retinopathy, but also diabetic nephropathy, diabetic neuropathy, etc.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Its pathogenesis is multifactorial. Some authors suggest that hyperglycaemia associated with poor metabolic control causes glycation and abnormal deposition of collagen in the breast, triggering an autoimmune response with B lymphocyte proliferation and antibody formation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Some authors have suggested that the administration of exogenous insulin could trigger inflammatory and immune reactions that could lead to its development.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We review 8 cases of DM in patients with long-term type 1 diabetes mellitus diagnosed in our hospital between August 2002 and November 2014. All patients underwent a mammography (MammoDiagnost DR<span class="elsevierStyleSup">®</span>Philips) and ultrasound (ACUSON S2000<span class="elsevierStyleSup">®</span>Siemens) and, in 4 of them, also a MRI (HDxt 1.5T <span class="elsevierStyleSup">®</span> and 3T<span class="elsevierStyleSup">®</span>, General Electric, HD Breast Coil<span class="elsevierStyleSup">®</span>). A core needle biopsy (CNB) was performed under ultrasound control. Haematoxylin–eosin was used for the histological study. An excisional biopsy was performed in the case of one patient, as there were doubts regarding disease malignancy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The average age of patients was 40 years (range: 37–46). All cases showed long-term diabetes, with an average duration of 31 years (range: 26–46). The mean HbA<span class="elsevierStyleInf">1C</span> value was 8.4% (range: 6.7–9.4%), showing poor metabolic control.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Insulin administration was the diabetes treatment since diagnosis; 5 patients received a combination of insulin glargine (16–30<span class="elsevierStyleHsp" style=""></span>IU/day) and insulin aspart (18–24<span class="elsevierStyleHsp" style=""></span>IU/day); one case, insulin NPH and insulin aspart, and another case insulin glargine (4<span class="elsevierStyleHsp" style=""></span>IU/day) with insulin pump. The specific treatment for the rest of patients was unknown to us.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients except one had secondary disease to diabetes at the time of diagnosis of DM: 7 cases of diabetic retinopathy (88%), 4 cases of diabetic nephropathy (50%) and 3 cases of diabetic neuropathy (38%).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The reason for consultation was the finding of one or more breast nodules. The majority had single lesions in each breast, although 5 patients (63%) presented bilateral lesions. The size of the nodules was smaller than 30<span class="elsevierStyleHsp" style=""></span>mm in 5 cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The mammography showed a heterogeneous density increase in breasts, mainly retroareolar, although some presented asymmetric density.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Ultrasound examination showed hypoechoic, irregular and heterogeneous lesions, with posterior acoustic shadowing, more significant than in cancer. They were categorized as BI-RADS 3 lesions.</p><p id="par0060" class="elsevierStylePara elsevierViewall">4 patients underwent an MRI scan, administering contrast in 3 of them (it could not be administered in one case due to renal failure secondary to diabetic nephropathy). The most common finding was heterogeneous enhancement with progressive uptake kinetics, the first one suggestive of benign lesion and the second indeterminate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The histopathological study was performed with samples obtained by CNB and, in one case, with excisional biopsy. A lymphocytic mastopathy showing a breast parenchyma with extensive predominance of fibrous stroma and images of lobulitis and ductitis surrounded by a lymphocytic infiltrate were part of the histological findings.</p><p id="par0070" class="elsevierStylePara elsevierViewall">After the diagnosis, a conservative treatment was decided, performing follow-up through mammography and ultrasound, depending on the age of the patient. No new lesions likely to be biopsied have been reported.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion, DM is a benign disease that can mimic breast cancer requiring a differential diagnosis. CNB and subsequent histopathologic study is essential to reach an accurate diagnosis, since the clinical symptoms and radiology are not specific. The treatment is conservative, with strict control of diabetes, and follow-up with regular imaging tests according to the age of the patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Argüelles BG, Argudo Pechuán A, Ripoll Orts F. Mastopatía diabética. Estudio de 8 casos. Med Clin (Barc). 2016;147:467–468.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This article was presented as Oral Communication during the XX National Meeting of the Spanish Association of Surgeons (21–23/10/2015).</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2233 "Ancho" => 990 "Tamanyo" => 254394 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(1) Bilateral mammography: dense breasts are observed, with retroareolar asymmetry. (2) Bilateral ultrasound: alteration of echostructure and echogenicity, hypoechoic, with posterior acoustic shadowing, no circumscribed limits. (3) MRI: dynamic study with contrast. T1 with contrast and fat suppression. Early phase (A). Subtraction image (B). Perfusion analysis, corresponding to a gradually ascending moderate uptake, with characteristics of benignity (C and D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibrous disease of the breast, tiroiditis and cheiroarthropathy in type I diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.G. Soler" 1 => "R. 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Scientific letter
Diabetic mastopathy. Report of 8 cases
Mastopatía diabética. Estudio de 8 casos
Brenda Geraldine Argüelles
, Amparo Argudo Pechuán, Francisco Ripoll Orts
Corresponding author
Hospital Universitari i Politècnic La Fe, Valencia, Spain