PMC3346992_01
Three separate tumors of the breast by palpation and imaging, two hard tumors in the CDA and A areas of the right breast and one nonpalpable solid tumor in the C area of the left breast were found.
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Upon palpation, two hard lumps in the right breast were discovered (Figure 1, right breast). A area 25 mm from the nipple, a well-defined hypoechoic mass with posterior acoustic shadowing was seen. At the 2.5-o'clock position 25 mm from the nipple of the left breast, an ill-defined, irregular-shaped hypoechoic area with acoustic shadowing was seen (Figure 1, left breast).
Magnetic resonance imaging of the breast dense microlobulated masses with irregular margins, 43 x 52 x 37 mm and 17 x 23 x 14 mm, were seen in the CDA and A areas of the right breast, respectively. In the C area of the left breast, a similar characteristic mass, 11 x 20 x 15 mm, was also seen.
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Dense microlobulated masses with irregular margins, 43 x 52 x 37 mm and 17 x 23 x 14 mm, were revealed by magnetic resonance imaging (Figure 2), in the CDA and A areas of the right breast, respectively.
Macroscopic cut sections of the tumor A well-defined elastic hard mass, 2.5 x 2 x 1 cm, was excised from the A area of the right breast. Meshwork composed of whitish fibers separating atrophic fatty breast tissue was observed.
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Cut sections revealed a meshwork composed of whitish fibers separating atrophic fatty breast tissue (Figure 3).
Histology of the breast tumor (x40). Many small lymphocytes infiltrated periducts with surrounding dense collagen fibers, accompanied by lymph follicles with germinal centers.
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High magnification of the tumor (x400). Small lymphocytes infiltrated between ductal epithelia forming lymphoepithelial lesions.
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Small lymphocytes had infiltrated between ductal epithelia forming lymphoepithelial lesions (Figure 5).
Lymphocyte markers by immunostaining. Infiltrating lymphocytes consisted more of CD20-positive cells than CD3-positive cells. IgG4-positive lymphocytes were rarely found compared with IgG positive cells.
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These lymphocytes comprised more of CD20-positive cells (Figure 6) than sparse CD3-positive cells.
Autoantibody reacting to the patient's own (a), other DM patient's (b), and non-DM patient's (c) breast tissue. Using the patient's serum as the primary antibody, ductal epithelium showed positive staining at a 1 : 200 dilution.
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Using the patient's serum as a primary antibody resulted in positive staining of ductal epithelia at dilutions of 1 : 100 to 1 : 200 (Figure 7(a)). Ductal epithelia from other diabetic (Figure 7(b)) or nondiabetic patients (Figure 7(c)) also showed a positive reaction.
Antibody absorption test with insulin added to the primary serum at 40 ng/mL (a), 4 mug/mL (b), and 40 mug/mL (c). Staining intensity attenuated corresponding to insulin concentration. At 40 ng/mL, positive staining of ductal epithelia remained, while at 4 mug/mL, staining intensity decreased significantly and almost disappeared at 40 mug/mL.
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At 40 ng/mL, positive staining of ductal epithelia remained (Figure 8(a)), while at 4 mug/mL, staining intensity decreased significantly (Figure 8(b)) and almost disappeared at 40 mug/mL (Figure 8(c)).