Sclerosing lymphocytic lobulitis of the breast associated to autoimmune thyroiditis

Abstract

Background: Sclerosing lymphocytic lobulitis (SLL) of the breast
is a rare benign mastopathy, usually associated to diabetes
mellitus type 1 or, very rarely, to other autoimmune diseases. The
authors describe a patient where this condition is associated to autoimmune thyroiditis.
Case report: A 32 year-old woman, with chronic migraine
and no past history of diabetes or breast cancer, complaining
of severe headaches, palpitations, irritability and arterial hypertension. Hyperthyroidism and diffuse goiter due to autoimmune
thyroiditis were diagnosed, with positive anti-thyroperoxidase
and anti-thyroglobulin antibodies. A 3 cm sub-areolar mass
was noted in the right breast, diffuse, firm and slightly painful,
with no lymph node enlargement. Several fine-needle aspiration cytologies were negative for malignant cells; core biopsy
showed periductal, vascular and lobular phenotypically normal
lymphocytic infiltration with severe stromal fibrosclerosis. The
patient was prescribed thiamazole withdrawn after progression
for hypothyroidism. Attempt to treat the SLL with oral corticoid
therapy was not successful. About 1.5 years after the diagnosis
of autoimmune thyroiditis, mastopathy remains stable with few
symptoms without specific treatment.
Discussion: The etiology of breast LLE is unknown, but its
strong association with autoimmune diseases and increased
expression of HLA-DR in affected epithelial cells suggests that
an immune reaction to components of the mammary stroma can
lead to fibro-inflammatory changes. To date, there is no evidence
of neoplastic potential although data are scarce. It is unknown
whether treatment of the underlying autoimmune disease may
influence the natural history of this disease. In the absence of targeted therapy, watchful waiting seems to be the most appropriate