糖尿病性乳腺病52例临床分析

Clinical analysis of 52 patients with diabetic mastopathy

目的:分析糖尿病性乳腺病(DM)的诊治过程,并结合文献复习总结病变特征。方法:回顾性分析天津医科大学肿瘤医院2011年9月至2021年6月收治的经过病理诊断证实的52例DM患者的临床资料,分析其临床表现、影像学特征和病理结果。结果:患者均为女性,年龄为62(59,68)岁。糖尿病患者占96.15%(50/52),其中94.00%(47/50)为2型糖尿病。随访时间为40.7(22.5,46.0)个月。98.08%(51/52)的患者表现为可触及的乳房肿块,临床表现多为质硬、边界不清、无压痛、活动欠佳的乳房肿块;乳腺X线多表现为不确定、局限致密的乳腺实质(79.17%,38/48),偶尔伴有良性钙化或明确的肿块区域;超声表现从腺体局限性增厚到边界不清的肿块都有,回声欠均匀,形状不规则,结构紊乱,BI-RADS 4~5类(88.64%,39/44);乳腺MRI表现为非肿块异常强化病灶。所有患者均接受肿块切除活组织检查或穿刺活组织检查,病理特征为乳腺间质纤维化,伴有导管炎和小叶炎,部分伴淋巴细胞浸润。19例观察到淋巴细胞或炎细胞浸润,且与DM合并其他自身免疫性疾病有相关性(P=0.007)。结论:DM是一种罕见的乳腺良性病变,临床与影像学表现均与乳腺癌类似。对合并糖尿病的乳腺肿块患者,应该积极行切除活组织检查或穿刺活组织检查以明确组织病理学诊断。

Objective:To analyze the diagnosis and treatment of diabetic mastopathy(DM)and summarize the characteristics of DM based on literature review.Methods:A retrospective analysis was performed in 52 patients with pathologically confirmed DM in Tianjin Cancer Hospital from September 2011 to June 2021.The clinical data of these patients were collected to analyze their clinical manifestations,imaging features and pathological results.Results:All patients were female,with the age of 62(59,68)years.Fifty patients had diabetes(96.15%,50/52),of which 94.00%(47/50)had type 2 diabetes.The follow-up period was 40.7(22.5,46.0)months.Palpable breast masses were observed in 51 patients(98.08%,51/52),mostly with firmness,unclear border,no tenderness and poor mobility.Breast X-ray revealed indeterminate,localized and dense breast parenchyma in 38 patients(79.17%,38/48),with benign calcifications or well-defined mass areas in some cases.The ultrasound manifestation of DM ranged from localized thickening of the glands to undefined masses,with uneven echoes,irregular shapes,and structural derangement.Most of them were at the grade of BI-RADS 4-5(88.64%,39/44).Breast MRI shows non-mass-type enhancement lesions,indicating the possibility of breast cancer.All patients underwent biopsy by tumor resection or aspiration.The pathological features were fibrosis of the breast stroma,accompanied by ductal inflammation and lobular inflammation,even lymphocyte infiltration in some cases.Lymphocyte or inflammatory cell infiltration were observed in 19 cases,which was significantly correlated with the comorbidity of other autoimmune diseases(P=0.007).Conclusions:DM was a rare benign breast lesion,with clinical and imaging manifestations similar to breast cancer.For patients with breast masses and diabetes,biopsy by tumor resection or aspiration is recommended for a clear histopathological diagnosis.