International Journal of Clinical Case Reports 2017, Vol.7, No.18, 81-85
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2 Discussion
(DM) also called fibrous breast disease (Soler and Khardori, 1984) or Sclerosing lymphocytic lobulitis (Williams
et al., 1995; Boutéet al., 2003) is an entity recent pathological, rare and benign; about 200 cases are reported in
the literature. The prevalence of this disease is unknown because of the ignorance of the affection and the
publications reported only sporadic cases. The frequency of occurrence of these (DM) is estimated at 0.06%
according to Logan and 13% for Soler and Khardori (1984). According to Hunfeld and Bassler (1997), the (DM)
represents less than 1% of all the benign lesions of the breasts, this rate rises to 13% if we only for Type I diabetic
patients.
This condition mainly affects young women with type I diabetes, often at the stage of degenerative complications
(Kudva et al., 2003). More rarely same anatomical lesions have been described in other autoimmune diseases
(thyroiditis, lupus) or diabetes type II insulin requiring (Soler and Khardori, 1984; Hadj et al., 2002). Bilaterality
is found in about 63% of cases (Murakami et al., 2009). Male involvement is exceptionally, 5 cases have been
reported in diabetic men (Hadj et al., 2002; Kudva et al., 2003). Our patient is type I diabetic, carrier retinal
degenerative complications, renal and oste articular.
The pathophysiology of (DM) is not totally elucidated. It would be multifactorial and many assumptions have
been advanced:
Hyperglycemia is thought to be the cause of a accumulation abnormal and decreased conjunctiva tissue
degradation in the extracellular matrix (Tomaszewski et al., 1992; Boutéet al., 2003; Murakami et al., 2009).
Many authors (Hadj et al., 2002; Boutéet al., 2003; Murakami et al., 2009) evoke the hypothesis of a
immune reaction, secondary to excess glycosylation, involving lymphocyte B cells and macrophages; the
presence of cytokines would accentuate the Collagenization phenomenon. The presence of mast cells could
promote the secretion of collagen VIII.
Some authors suggest possible toxicity to exogenous insulin. Seidman et al. (1994) reported cases of (DM) in type
II diabetic patients becoming Insulino necessitantes. They incriminate exogenous insulin in the genesis of these
(DM) through an inflammatory or immune reaction.
Clinically, the (DM) constantly presents itself as a single, or multiple, uni or bilateral breast nodule, of recent
appearance, irregular contours, consistency hard, even stony, painless, often growing fast, mobile compared to
both shallow and deep variable, but frequently retro-areolar measuring 0.5 to 6 cm long axis. It is not associated
with a nipple flow or to inflammatory phenomena skin.
These lesions simulate clinically breast cancer and it is difficult to distinguish these two entities by the simple
physical examination. It is for this reason that recourse to additional exams or surgery is essential.
Radiological examinations provide little information; so the mammograms show frequently overdensities,
opacities more or less regular, even dense breasts but without architectural distortion or micro calcification foci
(Hadj et al., 2002; Murakami et al., 2009).
On ultrasound, the aspects are variable. Typically, the lesion results in a hypoechoic formation, more or less
irregular contours responsible for a marked attenuation of ultrasound (Williams et al., 1995; Andrews-Tang et al.,
2000; Murakami et al., 2009). These anomalies ultrasound were found in our patients.
Breast MRI has been tested in limited cases; but it does not differentiate the (DM) from a possible breast cancer
(Andrews-Tang et al., 2000; Boutéet al., 2003).
According to the majority of the studies consulted, radiological examinations are not very reliable and not very
specific to this pathology, histological examinations are therefore always essential for a definitive diagnosis.
Fine needle cytopoints are difficult to achieve because of the sclerous nature of the lesion. Williams et al. (1995)
and Logan report a 50% rate of punctures uninterpretable because of their cellular material poverty. Gump and Mc
