Case of the month - September 2007 - discussion
Diagnosis - Suspected autoimmune associated mastopathy
The thumbnail images alongside remind you of the main features in this biopsy - click on each thumbnail to return to the original images.
Features
The following features are seen:
- Patchy but intense lymphocytic infiltration of lobules - best seen in area 'A'
- The infiltrate is composed of predominantly small lymphocytes with very occasional plasma cells
- Focal lobular atrophy associated with lymphocytic infiltration - see area 'B'
- Probable lymphocytic vasculitis
- The lymphocytic infiltrate is polytypic for CD3, CD20, kappa & lambda
Additional information:
- A biopsy of the skin rash was consistent with an autoimmune disorder - polytypic perivascular lymphocytic infiltration in the deep and superficial dermis
- A serum autoantibody screen was negative
- The patient was not diabetic
Differential diagnosis:
- Low grade non-Hodgkins lymphoma, especially marginal zone lymphoma
- .... the lymphocytic infiltrate is strikingly polytypic making this very unlikely
- Diabetic mastopathy
- ......excluded - two separate random blood glucose measurements well within normal range. Also does not explain skin rash
- Autoimmune disease e.g. SLE
- The pattern in the breast is consistent with a so called 'lupus mastopathy' - but is not specific
- The skin rash similarly shows features consistent with lupus
- 10% of cases of connective tissue disorders are negative for serum autoantibodies
- This is our favoured diagnosis and further investigation is currently underway
