Diabetic Mastopathy. Review of Diagnostic Methods and Therapeutic Options

Imaging enigma in mastitis: A comprehensive study of multifaceted causes, clinical and radiological presentations

BACKGROUND

Mastitis is an inflammatory condition of the breast which represents an array of underlying etiologies encompassing both infectious and non-infectious causes. Exacerbating factors include endemic infections, lack of awareness and suboptimal breastfeeding practices. Neglected cases lead to prolonged morbidity, recurrent episodes, and complications such as abscess or sinus formation, resulting in permanent breast disfigurement. Its overlapping clinical presentation with breast cancer necessitates an integrated multidisciplinary approach for diagnosis and treatment.

OBJECTIVES

The primary aim was to investigate demographic, radiological, and histopathological characteristics of mastitis. Objectives included correlating radiological and histopathological findings, classifying mastitis by etiology, identifying the clinical and imaging patterns across diverse clinical settings to enhance the understanding of mastitis.

MATERIAL AND METHOD

This is a retrospective observational study, analysing the clinical, radiological, and histopathological data from 65 patients with mastitis between February 2023 and February 2024.

RESULTS

The study included 65 patients, aged 18 to 65 years, with breast pain as the most prevalent clinical presentation. Cases were classified as infectious (47.6%) and non-infectious (52%). Acute puerperal mastitis (26.15%) and granulomatous mastitis (30%) were the most common subtypes. The commonest mammographic finding was focal asymmetry. On ultrasound, infectious mastitis showed oedema with other inflammatory changes, including diffuse skin thickening and collections; while non-infectious mastitis typically presented as solitary or multiple breast masses (p < 0.001). Surprisingly, idiopathic granulomatous mastitis constituted the largest percentage amongst various histopathological causes of mastitis in our study.

CONCLUSION

An integrated multidisciplinary approach with understanding of the pathogenesis is imperative for prompt diagnosis and optimizing treatment strategies, thereby improving patient outcome. Radiological imaging is critical for diagnosis, evaluating disease extent, conducting guided interventions, and monitoring treatment response.

Male Breast: A Review of the Literature and Current State of the Art of Diagnostic Imaging Work-Up

Pathological conditions affecting the male breast (MB) share some similarities with those found in women, while others are specific to men. The first part of this review provides an overview of MB disorders, exploring the most common types of MB diseases. The second part then emphasizes the state-of-the-art approaches proposed in the literature for screening and follow-up with MB cancer patients, which highlights the importance of tailored strategies for diagnosis, follow-up, and identifying high-risk populations. Considering the increasing attention in recent years on the topic, transgender individuals are also included in this review. Together with the MB, it is an understudied category thus far. This review aims to raise awareness among radiologists that MBs should be approached differently from female breasts, contributing to the advancement of medical knowledge, improving patient outcomes, and promoting early detection of MB disorders. The review also provides an update on breast cancer and screening in the transgender population.

Diabetic Fibrous Mastopathy: Imaging Features With Histopathologic Correlation

Diabetic fibrous mastopathy (DFM) is a rare benign fibrotic disease of the breast that develops in patients with longstanding and often uncontrolled diabetes mellitus. Clinically, patients may present with an irregular, firm, palpable mass, which may be solitary or multiple, occurring in one or both breasts. Diabetic fibrous mastopathy occurs most often in premenopausal women with heterogeneously or extremely dense breasts; mammography may show focal asymmetry or, less often, a noncalcified mass with indistinct or obscured margins, but there are usually no discrete findings. On US, DFM may have marked hypoechogenicity and posterior shadowing secondary to extensive fibrosis. Diabetic fibrous mastopathy features on contrast-enhanced MRI are also nonspecific, with gradual persistent nonmass enhancement reported. Because the clinical presentation and US features of DFM overlap with those of breast cancer, histopathologic correlation is needed to confirm diagnosis and exclude malignancy. These findings include collagenous stroma often with keloidal features and chronic perilobular and perivascular inflammation. Histopathologic findings of lymphocytic lobulitis and perivascular inflammation are common to other autoimmune conditions.