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Scientific letter
Diabetic mastopathy. Report of 8 cases
Mastopatía diabética. Estudio de 8 casos
Brenda Geraldine Argüelles
Corresponding author
brenda.ge.arguelles@gmail.com

Corresponding author.
, Amparo Argudo Pechuán, Francisco Ripoll Orts
Hospital Universitari i Politècnic La Fe, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetic mastopathy &#40;DM&#41; is a rare disease&#44; which can simulate breast cancer clinically and radiologically&#46; Appears generally in premenopausal middle-aged female patients&#44; with long-term type 1 diabetes mellitus&#59; it can also occur in patients with type 2 diabetes mellitus&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> It represents less than 1&#37; of benign breast lesions&#44; and can reach up to 13&#37; in patients with type 1 diabetes&#46;<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&#44; poor metabolic control and microvascular complications&#46; They concluded that&#44; although rare&#44; it is a possible complication of diabetes mellitus&#44; which later became known as diabetic mastopathy&#46;<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&#44; often diabetic retinopathy&#44; but also diabetic nephropathy&#44; diabetic neuropathy&#44; etc&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Its pathogenesis is multifactorial&#46; Some authors suggest that hyperglycaemia associated with poor metabolic control causes glycation and abnormal deposition of collagen in the breast&#44; triggering an autoimmune response with B lymphocyte proliferation and antibody formation&#46;<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&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;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&#46; All patients underwent a mammography &#40;MammoDiagnost DR<span class="elsevierStyleSup">&#174;</span>Philips&#41; and ultrasound &#40;ACUSON S2000<span class="elsevierStyleSup">&#174;</span>Siemens&#41; and&#44; in 4 of them&#44; also a MRI &#40;HDxt 1&#46;5T <span class="elsevierStyleSup">&#174;</span> and 3T<span class="elsevierStyleSup">&#174;</span>&#44; General Electric&#44; HD Breast Coil<span class="elsevierStyleSup">&#174;</span>&#41;&#46; A core needle biopsy &#40;CNB&#41; was performed under ultrasound control&#46; Haematoxylin&#8211;eosin was used for the histological study&#46; An excisional biopsy was performed in the case of one patient&#44; as there were doubts regarding disease malignancy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The average age of patients was 40 years &#40;range&#58; 37&#8211;46&#41;&#46; All cases showed long-term diabetes&#44; with an average duration of 31 years &#40;range&#58; 26&#8211;46&#41;&#46; The mean HbA<span class="elsevierStyleInf">1C</span> value was 8&#46;4&#37; &#40;range&#58; 6&#46;7&#8211;9&#46;4&#37;&#41;&#44; showing poor metabolic control&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Insulin administration was the diabetes treatment since diagnosis&#59; 5 patients received a combination of insulin glargine &#40;16&#8211;30<span class="elsevierStyleHsp" style=""></span>IU&#47;day&#41; and insulin aspart &#40;18&#8211;24<span class="elsevierStyleHsp" style=""></span>IU&#47;day&#41;&#59; one case&#44; insulin NPH and insulin aspart&#44; and another case insulin glargine &#40;4<span class="elsevierStyleHsp" style=""></span>IU&#47;day&#41; with insulin pump&#46; The specific treatment for the rest of patients was unknown to us&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients except one had secondary disease to diabetes at the time of diagnosis of DM&#58; 7 cases of diabetic retinopathy &#40;88&#37;&#41;&#44; 4 cases of diabetic nephropathy &#40;50&#37;&#41; and 3 cases of diabetic neuropathy &#40;38&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The reason for consultation was the finding of one or more breast nodules&#46; The majority had single lesions in each breast&#44; although 5 patients &#40;63&#37;&#41; presented bilateral lesions&#46; The size of the nodules was smaller than 30<span class="elsevierStyleHsp" style=""></span>mm in 5 cases&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The mammography showed a heterogeneous density increase in breasts&#44; mainly retroareolar&#44; although some presented asymmetric density&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Ultrasound examination showed hypoechoic&#44; irregular and heterogeneous lesions&#44; with posterior acoustic shadowing&#44; more significant than in cancer&#46; They were categorized as BI-RADS 3 lesions&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">4 patients underwent an MRI scan&#44; administering contrast in 3 of them &#40;it could not be administered in one case due to renal failure secondary to diabetic nephropathy&#41;&#46; The most common finding was heterogeneous enhancement with progressive uptake kinetics&#44; the first one suggestive of benign lesion and the second indeterminate &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The histopathological study was performed with samples obtained by CNB and&#44; in one case&#44; with excisional biopsy&#46; 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&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">After the diagnosis&#44; a conservative treatment was decided&#44; performing follow-up through mammography and ultrasound&#44; depending on the age of the patient&#46; No new lesions likely to be biopsied have been reported&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion&#44; DM is a benign disease that can mimic breast cancer requiring a differential diagnosis&#46; CNB and subsequent histopathologic study is essential to reach an accurate diagnosis&#44; since the clinical symptoms and radiology are not specific&#46; The treatment is conservative&#44; with strict control of diabetes&#44; and follow-up with regular imaging tests according to the age of the patient&#46;</p></span>"
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