Difference between revisions of "Lymphocytic mastitis"

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#redirect [[Breast_pathology#Lymphocytic_mastitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =
| Width      =
| Caption    =
| Synonyms  =
| Micro      = lymphocytic infiltrates (breast lobules, perivascular), enlarged stromal fibroblasts, stromal collagen with keloid-like changes.
| Subtypes  =
| LMDDx      = [[lymphoma]] ([[small cell lymphomas|small cell]]), diabetic mastopathy (need history)
| Stains    =
| IHC        = CD20 > CD3, CD43 -ve
| EM        =
| Molecular  = negative for clonality
| IF        =
| Gross      =
| Grossing  =
| Site      = [[breast]]
| Assdx      = +/-[[diabetes mellitus]] (known as [[diabetic mastopathy]])
| Syndromes  =
| Clinicalhx =
| Signs      = +/-tenderness
| Symptoms  =
| Prevalence = rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = breast tumour - possibly malignant
| Tx        = +/-excision
}}
'''Lymphocytic mastitis''' is a rare pathology of the [[breast]]. If the individual has [[diabetes mellitus]] (DM) it is called '''diabetic mastopathy'''.<ref name=pmid12640102>{{Cite journal  | last1 = Valdez | first1 = R. | last2 = Thorson | first2 = J. | last3 = Finn | first3 = WG. | last4 = Schnitzer | first4 = B. | last5 = Kleer | first5 = CG. | title = Lymphocytic mastitis and diabetic mastopathy: a molecular, immunophenotypic, and clinicopathologic evaluation of 11 cases. | journal = Mod Pathol | volume = 16 | issue = 3 | pages = 223-8 | month = Mar | year = 2003 | doi = 10.1097/01.MP.0000056627.21128.74 | PMID = 12640102 }}</ref>
 
==General==
*Typically in long-standing [[diabetes mellitus]].<ref name=pmid23966831>{{Cite journal  | last1 = Alhabshi | first1 = SM. | last2 = Rahmat | first2 = K. | last3 = Westerhout | first3 = CJ. | last4 = Md Latar | first4 = NH. | last5 = Chandran | first5 = PA. | last6 = Aziz | first6 = S. | title = Lymphocytic mastitis mimicking breast carcinoma, radiology and pathology correlation: review of two cases. | journal = Malays J Med Sci | volume = 20 | issue = 3 | pages = 83-7 | month = May | year = 2013 | doi =  | PMID = 23966831 }}</ref><ref>{{Cite journal  | last1 = Bayer | first1 = U. | last2 = Horn | first2 = LC. | last3 = Schulz | first3 = HG. | title = Bilateral, tumorlike diabetic mastopathy-progression and regression of the disease during 5-year follow up. | journal = Eur J Radiol | volume = 26 | issue = 3 | pages = 248-53 | month = Feb | year = 1998 | doi =  | PMID = 9587750 }}</ref>
*Rare -- less the 1% of breast lesions, though may be seen in up 13% of individuals with long-standing (insulin-dependent) diabetes mellitus.<ref name=pmid9269908>{{Cite journal  | last1 = Hunfeld | first1 = KP. | last2 = Bässler | first2 = R. | title = Lymphocytic mastitis and fibrosis of the breast in long-standing insulin-dependent diabetics. A histopathologic study on diabetic mastopathy and report of ten cases. | journal = Gen Diagn Pathol | volume = 143 | issue = 1 | pages = 49-58 | month = Jul | year = 1997 | doi =  | PMID = 9269908 }}</ref>
 
Clinical:<ref name=pmid23966831/>
*+/-Tenderness.
*May mimic malignancy clinically.
*May be managed with follow-up if diabetic.<ref name=pmid22371658/>
 
==Microscopic==
Features:<ref>URL: [http://www.breastpathology.info/Case_of_the_month/2007/COTM_0707%20discussion.html http://www.breastpathology.info/Case_of_the_month/2007/COTM_0707%20discussion.html]. Accessed on: 28 November 2010.</ref>
* Lymphocytic infiltrates - '''key feature''':
** Lobules.
** Perivascular.
* Enlarged stromal fibroblasts.
* Stromal collagen with keloid-like changes.
 
DDx:
*Diabetic mastopathy - if individual has diabetes.
*Primary [[lymphoma]] of the breast.
 
===Images===
www:
*[http://www.webpathology.com/image.asp?n=1&Case=655 Lymphocytic mastitis - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=655&n=2 Lymphocytic mastitis - high mag. (webpathology.com)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743988/figure/f3-mjms-20-3-083/ Lymphocytic mastitis (nih.gov)].<ref name=pmid23966831/>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282604/figure/f2-ijwh-4-035/ Diabetic mastopathy (nih.gov)].<ref name=pmid22371658>{{Cite journal  | last1 = Dilaveri | first1 = CA. | last2 = Mac Bride | first2 = MB. | last3 = Sandhu | first3 = NP. | last4 = Neal | first4 = L. | last5 = Ghosh | first5 = K. | last6 = Wahner-Roedler | first6 = DL. | title = Breast manifestations of systemic diseases. | journal = Int J Womens Health | volume = 4 | issue =  | pages = 35-43 | month =  | year = 2012 | doi = 10.2147/IJWH.S27624 | PMID = 22371658 }}</ref>
 
==IHC==
*B cell predominant (CD20 > CD3).<ref name=pmid12640102/>
**B cells CD43 -ve.
 
==Molecular==
*Negative clonality studies.
 
==Sign out==
*''Lymphocytic mastitis'' if no history of diabetes mellitus.
*''Diabetic mastopathy'' if there is a well-documented history of [[diabetes mellitus]].
 
==See also==
*[[Breast pathology]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Breast pathology]]

Latest revision as of 21:02, 16 February 2014

Lymphocytic mastitis
Diagnosis in short
LM lymphocytic infiltrates (breast lobules, perivascular), enlarged stromal fibroblasts, stromal collagen with keloid-like changes.
LM DDx lymphoma (small cell), diabetic mastopathy (need history)
IHC CD20 > CD3, CD43 -ve
Molecular negative for clonality
Site breast
Associated Dx +/-diabetes mellitus (known as diabetic mastopathy)
Signs +/-tenderness
Prevalence rare
Prognosis benign
Clin. DDx breast tumour - possibly malignant
Treatment +/-excision

Lymphocytic mastitis is a rare pathology of the breast. If the individual has diabetes mellitus (DM) it is called diabetic mastopathy.[1]

General

  • Typically in long-standing diabetes mellitus.[2][3]
  • Rare -- less the 1% of breast lesions, though may be seen in up 13% of individuals with long-standing (insulin-dependent) diabetes mellitus.[4]

Clinical:[2]

  • +/-Tenderness.
  • May mimic malignancy clinically.
  • May be managed with follow-up if diabetic.[5]

Microscopic

Features:[6]

  • Lymphocytic infiltrates - key feature:
    • Lobules.
    • Perivascular.
  • Enlarged stromal fibroblasts.
  • Stromal collagen with keloid-like changes.

DDx:

  • Diabetic mastopathy - if individual has diabetes.
  • Primary lymphoma of the breast.

Images

www:

IHC

  • B cell predominant (CD20 > CD3).[1]
    • B cells CD43 -ve.

Molecular

  • Negative clonality studies.

Sign out

  • Lymphocytic mastitis if no history of diabetes mellitus.
  • Diabetic mastopathy if there is a well-documented history of diabetes mellitus.

See also

References

  1. ↑ 1.0 1.1 Valdez, R.; Thorson, J.; Finn, WG.; Schnitzer, B.; Kleer, CG. (Mar 2003). "Lymphocytic mastitis and diabetic mastopathy: a molecular, immunophenotypic, and clinicopathologic evaluation of 11 cases.". Mod Pathol 16 (3): 223-8. doi:10.1097/01.MP.0000056627.21128.74. PMID 12640102.
  2. ↑ 2.0 2.1 2.2 Alhabshi, SM.; Rahmat, K.; Westerhout, CJ.; Md Latar, NH.; Chandran, PA.; Aziz, S. (May 2013). "Lymphocytic mastitis mimicking breast carcinoma, radiology and pathology correlation: review of two cases.". Malays J Med Sci 20 (3): 83-7. PMID 23966831.
  3. ↑ Bayer, U.; Horn, LC.; Schulz, HG. (Feb 1998). "Bilateral, tumorlike diabetic mastopathy-progression and regression of the disease during 5-year follow up.". Eur J Radiol 26 (3): 248-53. PMID 9587750.
  4. ↑ Hunfeld, KP.; Bässler, R. (Jul 1997). "Lymphocytic mastitis and fibrosis of the breast in long-standing insulin-dependent diabetics. A histopathologic study on diabetic mastopathy and report of ten cases.". Gen Diagn Pathol 143 (1): 49-58. PMID 9269908.
  5. ↑ 5.0 5.1 Dilaveri, CA.; Mac Bride, MB.; Sandhu, NP.; Neal, L.; Ghosh, K.; Wahner-Roedler, DL. (2012). "Breast manifestations of systemic diseases.". Int J Womens Health 4: 35-43. doi:10.2147/IJWH.S27624. PMID 22371658.
  6. ↑ URL: http://www.breastpathology.info/Case_of_the_month/2007/COTM_0707%20discussion.html. Accessed on: 28 November 2010.
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