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Diabetic Mastopathy Masquerading as Breast Cancer

Mammogram right breast medio-lateral and spot compression craniocaudal views (A-B)

A 50-year-old woman with long-standing type 1 diabetes mellitus complicated by diabetic retinopathy, peripheral vascular disease and end-stage renal disease on hemodialysis was referred for screening mammography by her primary care physician. Her hemoglobin A1c was 7.1%, and she was on long-acting insulin along with mealtime coverage. Mammography revealed heterogeneouslydense breast tissue (Figures 1A and 1B). As a protocol for dense breast, ultrasonography of thebilateralbreast was performed, which showed a large(5.3 × 1.9 × 2.0 cm) irregular hypoechoic mass with posterior acoustic shadowing and prominent peripheral vascularity in the right breast at the 12:00 position (Figure1C). The BI-RADS category was 5, interpreted as highly suggestive of malignancy. An ultrasound-guided core needle biopsy (Figure1D) was performed, which revealed lymphocytic ductitis and sclerosing lobulitis with non-proliferative fibrocystic changes (Figures 1E-1G). A diagnosis of diabetic mastopathywas made after detailed discussion with the pathologist and radiologist. Subsequent annual mammograms continued to demonstrate the above findings andawareness of this diagnosis of diabetic mastopathy has helped her avoid repeated biopsies and other procedures.

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-Sonali Gupta, MDa, Pradeep Goyal, MDb, Soumya Thumma, MDa, Joseph Mattana, MDa

This article originally appeared in the April 2019 issue of The American Journal of Medicine.

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