There are many complications of diabetes, common ones like diabetic retinopathy, butDiabetic mastochropathyIt is a rare complication of insulin-dependent diabetes mellitus, a benign neoplastic fibroproliferative breast disease that was first reported internationally in 1984.
Huang Heqing (second from left).
Huang Heqing has worked in the Breast Department of Dongguan People's Hospital for 15 years, and has only seen diabetic breast disease in books, and has not encountered a single case in clinical practice.
In April 2022, Huang Heqing was selected by Dongguan People's Hospital and Dongguan Municipal Health Bureau and was assigned to Wanshan District People's Hospital, Tongren City, Guizhou Province as a member of the Party Committee and vice president, starting a two-year assistance work.
In March and November 2023, she vigorously promoted it in WanshanBreast CenterDuring the construction of the project, two women were diagnosed with diabetic breast disease. One of the women was suspected of breast cancer elsewhere and both breasts were removed. Huang Heqing helped her keep her breasts and keep her happiness.
Huang Heqing (first from left).
Huang Heqing still clearly remembers that on March 8, 2023, 52-year-old Ms. Yang was killedThe left breast was swollen and painful for more than half a yearCame to Wanshan District People's Hospital for treatment, she sufferedDiabetes for more than 10 years, usually regular injection of insulin to control blood sugar, but blood sugar fluctuates greatly, and the effect is not good. After Huang Heqing received the consultation, he carefully examined her. Ms. YangA palpable lump is palpable in the lower inner quadrant of the left breast near the nipple, about 3 3 cm in size, tender, the mass ** palpable fluctuation, hard, unclear border, ** slightly red locally, no discharge and bleeding when squeezing the nipple.
In order to find **, on March 9, Huang Heqing arranged for Ms. Yang to undergo breast and axillary lymph node ultrasound examination and breast molybdenum and palladium examination; On March 10, he underwent puncture and drainage of abscess in the left breast under local anesthesia. Postoperative pathological examination report suggests:Lymphocytic mastopathy (left breast tissue).
Lymphocytic breast disease is diabetic mastopathy (DMP), which mostly occurs in women with a history of long-term diabetes, and the age of onset is more common in 30 to 60 years, and the incidence of this disease is reported in the literature to be about 06%～13%。The pathogenesis remains unclear and may be related to secondary autoimmune reactions caused by hyperglycemia.
DMP manifests clinically:PalpableofFix the hard lump, whose surface is not only intact but also behaves like breast cancer, is therefore easily misdiagnosed. When a diabetic patient has a breast mass, the possibility of complication of diabetic breast disease should be considered.
DMP is a type of mammary glandBenign lesions, which is not a precancerous lesion, and regular follow-up observation is generally recommended to avoid surgical resection as much as possible. Studies have shown that 63% of people with diabetic breast disease who have undergone surgical removal can find a new part of the ipsilateral or contralateral breast**, and the number and size of the lump increases with age.
Huang Heqing (third from left).
Huang Heqing suggested that Ms. Yang should focus on controlling her blood sugar; Follow-up dynamic observation of breast mass changes; For redness, swelling and pain, blood routine indicates inflammatory reaction, anti-inflammatory symptomatic**, and at the same time, the combination of traditional Chinese and Western medicine, plus traditional Chinese medicine physiotherapy.
A month later, Ms. Yang came for a follow-up check-up, and her blood sugar was well controlled, and the symptoms of breast redness, swelling and pain were completely improved, and the lump was significantly reduced. Half a year later, the blood sugar was well controlled, the breast mass was significantly reduced on imaging examination, and the physical examination was almost palpable. This made Ms. Yang particularly happy.
In the blink of an eye, in early November 2023, Ms. Shu, 41, came to Wanshan District People's Hospital for treatment because she found bilateral breast lumps for 3 months. She suffersType 2 diabetesIt has been 6 years, and it has been more than two years since diabetic retinopathy; CauseUremiaLong-term hemodialysis for more than a year.
Huang Heqing said that she found Ms. Shu when she received a free clinic at the hospital in September 2023There are lumps in both breasts, with a diameter of more than 15 cm. At that time, Ms. Shu did a free B-ultrasound, but because the lump was too large, the B-ultrasound probe could not detect the extent of the breast lump, and the patient had many underlying diseases, so Huang Heqing suggested that she be hospitalized for relevant examinations.
Ms. Shu was not hospitalized that day, and then went to other hospitals, where the doctor suspected breast cancer and recommended that she do itDouble mastectomy surgery。Talking about cancer discoloration, and also considering the cost of **, Ms. Shu has not dared to come to the hospital after that, and has not done follow-up examinations.
Huang Heqing attaches great importance to the follow-up of patients, and after working in Tongren, she brought the good experience of follow-up in Dongguan to the past, outpatient and inpatient management, lifelong follow-up, and one patient and one file.
In October 2023, "Pink Ribbon Month", *call** to Ms. Shu and invite her to come to the hospital to participate in the event. On October 27, Wanshan District People's Hospital held the first "Rukang Friendship Party", and Ms. Shu finally came, and the lumps in both breasts were slightly larger and harder than before. After painstaking persuasion and professional breast health science, she agreed to be hospitalized.
Pathology Department Remote Digital Consultation Room (after renovation).
Because of the large lumps in both breasts, ultrasound and mammography are not ideal, and the diagnosis is difficult, and breast MRI examination is required, but the patient's long-term hemodialysis leads to poor vascular conditions and cannot be MRI. November 2, Dongguan expert5G ultrasound remote consultationReal-time guidance, preoperative ultrasound positioning, intraoperative ultrasound guidance, escorted by ultrasound throughout the process, to avoid excessive injury, reduce the false negative rate of biopsy, and did a breast biopsy for her.
On November 5, the results of the pathological examination were reportedLymphocytic mammosisAfter the remote consultation of the multidisciplinary joint consultation of the Department of Breast, Endocrinology, Nephrology, Ultrasound, Radiology and Pathology of Dongguan People's Hospital, the diagnosis is basically clear, and a set of scientific and reasonable programs are tailored according to the specific situation of the patient.
Huang Heqing suggested that Ms. Shu should focus on controlling blood sugar and kidney function; Surgical excision of the breast mass is not recommended, and follow-up dynamic observation of the breast mass is recommended. Now, Ms. Shu's breast lumps are slowly softening and shrinking. She is very grateful to the experts in Dongguan for their professional and high-level diagnosis, which avoided the pain of double mastectomy.
Text: Guangzhou**Reporter Wang Wanli
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