Diabetic Mastopathy

Halfway

Step 1: View clinicals

A 50 year old postmenopausal woman presents with a lump in her left breast for 2 months. There was no associated pain or recent rapid enlargement. There is no history of previous breast disease, or a family history of breast, bowel or ovarian malignancy. She is nulliparous, while her menarche was at age 12. She was diagnosed with type 1 diabetes at age 20, which is now complicated by diabetic retinopathy, nephropathy and peripheral neuropathy.


Step 2: Order all relevant investigations

Mammography

There is dense glandular tissue in both breasts, more on the left side. No discrete nodules are seen; there are no microcalcifications; architectural distortion is absent.

Ultrasound Breasts

There is a poorly defined, irregular lesion of mixed echogenicity in the lower inner quadrant of the left breast; posterior acoustic shadowing is present. The right breast appears normal.

Fine Needle Aspiration Biopsy

Firm resistance felt during biopsy; samples obtained are inadequate. Only a few ductal cells without atypia are noted.

USS Guided Core Biopsy

There is a dense fibrous stroma consisting of thick bundles of collagen with keloid-like features. Lymphocytic lobulitis and perivascular lymphocytic infiltration without evidence of malignancy is seen.


Step 3: Select appropriate management

Counselling
Mastectomy
Tamoxifen
Radiotherapy


Score: ★★☆