case_images: PMC3346992_01
case_images: 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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case_images: fig1
case_images: 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).
case_images: 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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case_images: fig2
case_images: 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.
case_images: 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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case_images: fig3
case_images: Cut sections revealed a meshwork composed of whitish fibers separating atrophic fatty breast tissue (Figure 3).
case_images: 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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case_images: fig4
case_images: High magnification of the tumor (x400). Small lymphocytes infiltrated between ductal epithelia forming lymphoepithelial lesions.
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case_images: fig5
case_images: Small lymphocytes had infiltrated between ductal epithelia forming lymphoepithelial lesions (Figure 5).
case_images: 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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case_images: fig6
case_images: These lymphocytes comprised more of CD20-positive cells (Figure 6) than sparse CD3-positive cells.
case_images: 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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case_images: fig7
case_images: 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.
case_images: 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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case_images: fig8
case_images: 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)).