Diabetic mastopathy (DMP) is a rare and specific type of mastitis that accounts for 1% of all benign breast diseases [
1]. Due to its non-specific clinical and imaging manifestations and different histopathological manifestations, it is difficult to accurately diagnose before surgery, often resulting in missed diagnosis and misdiagnosis. DMP is associated with diabetes, autoimmune diseases, lymphocytic lobulitis, vasculitis, and so on. The main manifestations of this disease are lymphocytic lobulitis, ductitis, vasculitis, and dense keloid fibrillation [
2]. DMP was first reported by Soler
et al. in 1984. DMP can occur in patients with type I and type II diabetes, but it is more common in patients with type I diabetes [
3]. Its pathogenesis is still unclear, and it may be related to the secondary autoimmune reaction caused by hyperglycemia. It is almost indistinguishable from breast cancer in terms of its clinical and imaging manifestations. Clinically, painless, immobile masses are often palpable. The majority of cases in ultrasound images are hypoechoic masses with unclear boundaries, irregular morphology, and posterior echo attenuation. Mammography is usually unremarkable because lesions usually appear in abnormally dense breast tissue. The typical radiological presentation is dense breast tissue, as the mass is often covered by dense breast tissue. The early pathology of the disease is lobular hyperplasia with many lymphocytes and varying numbers of plasma and mononuclear cells in the lobular, ductal, and perivascular regions. Cell infiltration was dominated by mature B cells. Epithelioid fibroblasts within the lobular interstitium are also frequently observed [
4]. Historically, diabetic breast disease was primarily an overgrowth of fibrous connective tissue, usually accompanied by vasculitis and some ductal epithelial hyperplasia. The lesion was dominated by dense keloid fibrosis. There is usually little or no adipose tissue or cellular component at the site of the injury, as well as infiltration of lymphocytes, mainly B cells (inflammatory part of the lesion), around the ducts, lobules, or blood vessels.
If we come across a patient whose clinical characteristics are likely to be malignant breast masses, and she has a long history of diabetes, then we need to consider the possibility of DMP before surgery. In addition, a minimally invasive and appropriate approach must be chosen to assist in the diagnosis. There are no standardized guidelines for the treatment of DMP, and surgery has always been the focus of discussion among scholars. Some researchers have used surgery to treat this disease and found that the recurrence rate is 21.25% [
5]. Another scholar believes that surgical resection should be avoided in the treatment of DMP because it can stimulate disease progression and recurrence rate after resection. Regular follow-up after the diagnosis of DMP is recommended [
6]. Therefore, whether surgery should be performed and the appropriate treatment is always the focus of debate among scholars. Core needle biopsy is an alternative treatment option because it allows access to sufficient tissue to meet the needs of pathological diagnosis and avoids excessive surgery. However, there is still a lack of strong clinical evidence to support it. Therefore, this will be an interesting case for future research and deserves further attention and research.