Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review

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Clinically, the lesion can mimic carcinoma. Biopsy remains the gold standard for a definitive diagnosis. Radical surgery is generally unnecessary when histological verification can be achievedusing core needle biopsy. This case report details the clinical and radiological findings, as well as the management of a 33-year-old patient with a 22-year history of type I diabetes who presented with sclerosing lymphocytic lobulitis." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-967/v1", "name": "Case Report: Sclerosing lymphocytic lobulitis of the breast: case..." } } ] } Home Browse Case Report: Sclerosing lymphocytic lobulitis of the breast: case... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Magdoud K, Bayar S, Arifi N et al. Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.12688/f1000research.154671.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] Khaoula Magdoud 1,2 , Sirine Bayar 1,2 , Nejla Arifi https://orcid.org/0009-0002-4782-7075 1,2 , Sana Menjli 2 , Rim Ben Hmid 1,2 Khaoula Magdoud 1,2 , Sirine Bayar 1,2 , [...] Nejla Arifi https://orcid.org/0009-0002-4782-7075 1,2 , Sana Menjli 2 , Rim Ben Hmid 1,2 PUBLISHED 27 Aug 2024 Author details Author details 1 Faculty of Medicine of Tunis, University Tunis El Manar Tunisia, Tunis, Tunisia 2 Maternity and Neonatology Center of Tunis, Tunis, Tunisia Khaoula Magdoud Roles: Conceptualization, Supervision, Validation, Writing – Original Draft Preparation Sirine Bayar Roles: Conceptualization, Validation, Visualization, Writing – Original Draft Preparation Nejla Arifi Roles: Conceptualization, Writing – Original Draft Preparation Sana Menjli Roles: Supervision, Validation, Visualization Rim Ben Hmid Roles: Conceptualization, Supervision, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Sclerosing lymphocytic lobulitis, also known as diabetic mastopathy, is a rare and benign pathology predominantly observed in young women with type I diabetes, typically with degenerative complications. Clinically, the lesion can mimic carcinoma. Biopsy remains the gold standard for a definitive diagnosis. Radical surgery is generally unnecessary when histological verification can be achievedusing core needle biopsy. This case report details the clinical and radiological findings, as well as the management of a 33-year-old patient with a 22-year history of type I diabetes who presented with sclerosing lymphocytic lobulitis. READ ALL READ LESS Keywords Sclerosing lymphocytic lobulitis, type I diabetes, complication, microbiopsy Corresponding Author(s) Khaoula Magdoud ( [email protected] ) Close Corresponding author: Khaoula Magdoud Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Magdoud K et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Magdoud K, Bayar S, Arifi N et al. Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.12688/f1000research.154671.1 ) First published: 27 Aug 2024, 13 :967 ( https://doi.org/10.12688/f1000research.154671.1 ) Latest published: 22 Aug 2025, 13 :967 ( https://doi.org/10.12688/f1000research.154671.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction It has long been believed that the mammary gland is not affected by degenerative complications of diabetes. This was thought to be true until 1984, when Soler and Khardorifirst described a case of mammary lesions associated with type I diabetes. 1 Sclerosing lymphocytic lobulitis (SCLL) is a rare and benign tumor that accounts for less than 1% of all benign breast lesions. 2 SCLL mostly occurs in women with type I diabetes at the stage of degenerative complications. However, cases of SCLL have also been described in patients with type II diabetes, autoimmune diseases such as Hashimoto’s thyroiditis, as well as in healthy individuals and in men. 3 It sets a diagnostic trap since it mimics clinically a breast carcinoma. 4 We present a case of SCLL occurring in a patient with type I diabetes for 22 years, detailing the associated clinical, radiological, and evolutionary aspects, along with the particularities of its management. Case report Our patient was a 33-year-old nulliparous woman without a family history of breast cancer, who presented with swelling in her right breast. She was diagnosed with type I diabetes 22 years ago and was administered a high insulin dose. Her diabetes was at the stage of degenerative complications, with hypertension for three years, managed with an angiotensin-converting enzyme inhibitor, and stage III retinopathy. The glycosylated hemoglobin level was 8.2%. The patient was referred to us for consultation with a right-sided breast tumor. On inspection, asymmetry of the two breasts was noted, with an increased right breast size. On palpation, a 5 cm retroareolar tumor on the right side was identified, characterized by stony consistency and slight mobility with respect to the deeper layers, without signs of inflammation or palpable lymph nodes. No particular mention was made of the left breast. Breast ultrasound revealed a heterogeneous retroareolar hypoechoic formation on the right, measuring 5 × 3 cm, with irregular contours and attenuation of posterior echoes ( Figure 1 ). Figure 1. Mammary ultrasoundfindings. It revealed a right heterogeneous retroareolarhypoechoic, not well-limited formation of irregular contours of 5 × 3 cm in size with attenuation of the posterior echoes. A microbiopsy was performed, concluding that SCLL is a pathological finding with intralobular, periductal, and perivascular nodular lymphocyte infiltrations associated with marked lobular atrophy and extensive interlobular hyaline fibrosis ( Figure 2 ). Figure 2. Histological findings. (HE X400): High-power photomicrograph of a hematoxylin and eosin-stained section of a breast biopsy specimen showingintralobular lymphocytic infiltration. Given the poorly controlled diabetes, the risk of mutilating surgery (small overall breast volume) and high risk of recurrence, annual clinic, and radiological monitoring werechosen. The patient has been monitored regularly since 2019, and there has been no increase in tumor size or changes in the breast ultrasound findings. Discussion SCLL or diabetic mastopathy are rare and benign pathological entity. 1 The prevalence of this disease is unknown becauseof poor knowledge of the condition. The incidence of SCLLranges from 0.6% to 13%. 1 , 5 According to Hunfeld and Bassler, 6 SCLL accounts for less than 1% of all benign breast lesions. This percentage increased to 13% when considering only patients with type I diabetes. 6 This condition mainly affects young women with type I diabetes, frequently at the stage of degenerative complications. 7 , 8 Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin. 3 The occurrence in men is exceptional; five cases have been reported in men. 9 , 10 Several physiopathological factors have been identified; notably, hyperglycemiaisbelieved to be responsible for abnormal accumulation and decreased connective tissue degradation in the extracellular matrix. 11 • The specific toxicity of exogenous insulin explains the appearance of this condition in type II diabetes after the use of insulin. 12 • An autoimmune process secondary to excess glycosylation in the extracellular matrix, thus forming neoantigens. This causesan autoimmune reaction against these neoantigens with lymphocytic infiltration, predominantly of B cells and macrophages. The presence of cytokines accentuatescollagenization. 4 , 10 – 13 Clinically, SCLL typically presents as one or multiple unilateral or bilateral breast nodules with recent onset. These nodules had irregular contours, were hard or even stony in consistency, and were painless. They often grow rapidly and are mobile with respect to both superficial and deeper layers. 3 It is frequently retroareolar and measures from 0.5 to 6cm in size. 3 It was not associated with nipple discharge or inflammatory skin phenomena. Our patient presented with a stony retroareolar nodule that was poorly circumscribed, measured 5 cm, and suspected malignant. These lesions clinically mimic those of breast cancer. Therefore, the use of complementary examinations or surgery is essential. Mammography frequently shows overdensities, more or less regular opacities, and even dense breasts, but without architectural distortion or calcific foci. 12 – 15 However, mammography remains difficult to interpret because of the young age of patients and the density ofbreast tissue. Ultrasound, on the other hand, is more concerning, as the lesion often appears as a hypoechoic formation with irregular contours and strong ultrasound attenuation, which are characteristics frequently observed in polymitotic processes. 15 Among the signs suggestive of malignancy, posterior acoustic shadowing and indistinct margins. 16 Ultrasonographic abnormalities were observed in our patient. Contrast-enhanced MRI may be indicativeof doubts regarding the diagnosis of malignant lesion. 3 SCLL lesions present a homogeneously low enhancement with a gradual and progressive course and subsequent contrast wash-out seen on MRI imaging. 17 Fine-needle aspiration is difficult to achieve becauseof the sclerotic nature of the lesion. Williams et al 8 and Logan 5 report an uninterpretable aspiration rate of 50% due to the poverty of cellular elements. Biopsy is therefore the examination of choice, which establishes the diagnosis. 16 Fine-needle biopsy is not recommended due to increased fibrosis. Coreneedle biopsy is the gold standard. 14 Histological study revealed three types of elementary, non-specific associated lesions 16 : lymphocytic lobulitis: mononuclear inflammatory infiltration, more or less dense, associatedwithsmall B lymphocytes, plasma cells, and histiocytes. It is found mainly in the mammary lobulesand less markedly in the perivascular spaces and sometimes in the periductalspaces. • Fibrosis of intralobular connective tissue is always found, homogeneous, and dense. • Inconsistently, stromal epithelioid cells are homogeneously distributed. There are two types of lymphocytic lobulitis (LL): SCLL and non-sclerosing LL (NSCLL). 18 The two types of LL are distinguished by stromal features and a predominant population of B-cells in the former and T-cells in the latter. 18 Immunohistochemistry is only of interest to exclude the differential diagnosis of infiltrating lobular carcinoma (anti-keratin antibody) in cases where epithelioid cells are particularly numerous 4 , 11 • low-grade non-Hodgkin’s lymphomas when lymphoid infiltration appears suspicious. 7 Conservative management can be considered when a histological diagnosis has been confirmed through a core-needle biopsy. 2 In cases in which a conservative approach is chosen, it is crucial to educate the patient on proper breast self-examination techniques. A schedule for regular follow-up visits should be established, and an annual mammography is recommended. 19 For cases involving a single lesion, surgical excision with an adequate margin of normal breast tissue remains the primary treatment option, particularly when no definitive histological diagnosis has been made, if the core biopsy findings are inconclusive, or if the patient has significant concerns regarding the breast lump. 20 A literature review indicated that 90% of the patients underwent excisional biopsy. 2 The reasons cited included patient requests, anxiety, insufficient findings on fine-needle aspiration, the necessity to definitively rule out breast carcinoma, and clinician unfamiliarity with this condition. 2 Wider margins during excision may help decrease the recurrence rate. 21 Despite treatment, a high recurrence rate (30–60% within 5 years) has been reported, with recurrences often affecting a wider region than the initial lesion. 22 Bilateral and contralateral recurrences have also been documented. 22 Most patients with recurrence undergo re-excision; however, this should be avoided in patients with a history of SCLL. 2 In cases of multiple or recurrent lesions, once the diagnosis is established, subcutaneous mastectomy can be considered, especially for patients with multiple symptomatic lesions and small breasts, to avoid significant distortions from lumpectomy. 23 Each diagnosed case of SCLL should be individually managed. The type of surgery (mastectomy with immediate reconstruction or lumpectomy) should be carefully planned to ensure the best quality of life and optimal aesthetic outcomes. 3 The surgical treatment plan should also consider the tumor and breast size, number of lesions, patient expectations, family history, and experience of the surgical team. 3 Conclusion SCLL is a rare and benign disease associated with degenerative complications in women with type I diabetes. It is a diagnostic trap because it can clinically imitate breast carcinoma. Histological examination of the microbiopsies is sufficient to establish the diagnosis, thus avoiding mutilating surgery in these young diabetics. Consent Written informed consent for publication of their clinical details and images was obtained from the patient on January 2024. Author’s contribution KhaoulaMagdoud: Conception, manuscript drafting, final approval.sirine Bayar: Conception, manuscript drafting, and final approval. Nejlaarifi: manuscript drafting andfinal approval. Sana Menjli: manuscript drafting andfinal approval. Rim Ben Hmid:conception, manuscript drafting, and final approval Data availability statement No data are associated with this article. Extended data Reporting guidelines This work has been reported in line with the SCARE 2023 criteria. 24 Harvard Dataverse: CARE checklist for “Sclerosing lymphocytic lobulitis of the breast: case report and literature review” doi.org/10.7910/DVN/50LCHP . 25 Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). References 1. Soler NG, Khardori R: Fibrous disease of the breast, thyroiditis, and cheiroarthropathy in type I diabetes mellitus. Lancet. 1984 Jan 28; 1 (8370): 193–195. PubMed Abstract | Publisher Full Text 2. Agochukwu NB, Wong L: Diabetic Mastopathy: A Systematic Review of Surgical Management of a Rare Breast Disease. Ann. Plast. Surg. 2017; 78 : 471–475. Publisher Full Text 3. Guzik P, Gęca T, Topolewski P, et al. : Diabetic Mastopathy Review of Diagnostic Methods and Therapeutic Options. Int. J. Environ. Res. Public Health. 2021 Dec31; 19 (1): 448. PubMed Abstract | Publisher Full Text | Free Full Text 4. Chen XX, Shao SJ, Wan H: Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature. World J. Clin. Cases. 2021 May 16; 9 (14): 3458–3465. PubMed Abstract | Publisher Full Text | Free Full Text 5. Logan WW, Hoffman NY: Diabetic fibrous breast disease. Radiology. 1989 Sep; 172 (3): 667–670. PubMed Abstract | Publisher Full Text 6. Hunfeld KP, Bässler R: Lymphocytic mastitis and fibrosis of the breast in long-standing insulin-dependent diabetics. A histopathologic study on diabetic mastopathy and report of ten cases. Gen. Diagn. Pathol. 1997 Jul; 143 (1): 49–58. PubMed Abstract 7. Bouté V, Denoux Y, Feilel V, et al. : La mastopathie diabétique: complication peu commune du diabète de type I. J. Le Sein. 2003; 13 : 261–269. 8. Williams PH, Rubin CM, Theaker JM: Sclerosing lymphocytic lobulitis of the breast. Clin. Radiol. 1995 Mar; 50 (3): 165–167. PubMed Abstract | Publisher Full Text 9. Kudva YC, Reynolds CA, O’Brien T, et al. : Mastopathy and diabetes. Curr. Diab. Rep. 2003 Feb; 3 (1): 56–59. PubMed Abstract | Publisher Full Text 10. Hadj AI, Ben Abdallah N, Kand K, et al. : Mastopathie fibreuse diabétique à propos d’un cas. Ann. Endocrinol. 2002; 63 : 235–239. 11. Murakami R, Kumita S, Yamaguchi K, et al. : Diabetic mastopathy mimicking breast cancer. Clin. Imaging. 2009 May-Jun; 33 (3): 234–236. PubMed Abstract | Publisher Full Text 12. Seidman JD, Schnaper LA, Phillips LE: Mastopathy in insulin-requiring diabetes mellitus. Hum. Pathol. 1994 Aug; 25 (8): 819–824. PubMed Abstract | Publisher Full Text 13. Lammie GA, Bobrow LG, Staunton MD, et al. : Sclerosing lymphocytic lobulitis of the breast-evidence for an autoimmune pathogenesis. Histopathology. 1991 Jul; 19 (1): 13–20. PubMed Abstract | Publisher Full Text 14. Andrews-Tang D, Diamond AB, Rogers L, et al. : Diabetic Mastopathy: Adjunctive Use of Ultrasound and Utility of Core Biopsy in Diagnosis. Breast J. 2000 May; 6 (3): 183–188. PubMed Abstract | Publisher Full Text 15. Lin W, Bao L: Mammography and Ultrasonography Manifestations of Sclerosing Lymphocytic Lobulitis of the Breast: A Series of Seven Case Reports. Curr Med Imaging. 2023 Sep 4; 20 : 1–6. Epub ahead of print. Publisher Full Text PubMed Abstract | 16. Sato LT, de Mello GGN , Stiepcich MMA, et al. : Ultrasound as a Valuable Imaging Modality in Sclerosing Lymphocytic Lobulitis: Imaging Features Based on a Retrospective Cohort Analysis of 51 Cases. Can. Assoc. Radiol. J. 2021 Nov; 72 (4): 767–774. PubMed Abstract | Publisher Full Text 17. Tuncbilek N, Karakas HM, Okten O: Diabetic fibrous mastopathy: Dynamic contrast-enhanced magnetic resonance imaging findings. Breast J. 2004; 10 : 359–362. PubMed Abstract | Publisher Full Text 18. Ngo MH, Pinkus GS, Yeh ED, et al. : Non-sclerosing (T-cell) and sclerosing (B-cell) lymphocytic lobulitis in diagnostic breast biopsies: Clinical, imaging, and pathologic features. Hum. Pathol. 2024 Apr; 146 : 28–34. PubMed Abstract | Publisher Full Text 19. Sankaye S, Kachewar S: Diabetic mastopathy. Australas Med J. 2012; 5 (6): 296–299. PubMed Abstract | Publisher Full Text | Free Full Text 20. David G, Hicks MD, Susan C: Diagnostic Pathology, Breast. 2nd ed.Philadelphia, PA, USA: Elsevier; 2016; 530–531. 21. Baratelli GM, Riva C: Diabetic fibrous mastopathy:sonographic-pathologic correlation. J. Clin. Ultrasound. 2005 Jan; 33 (1): 34–37. PubMed Abstract | Publisher Full Text 22. Salati SA, AlSulaim L: Diabetic mastopathy: A review of a breast carcinoma mimic. J Diabetology. 2024 Marc; 15 (1): 4–11. Publisher Full Text 23. Perret WL, Malara FA, Hill PA, et al. : Painful diabetic mastopathy as a reason for mastectomy. Breast J. 2006 Nov-Dec; 12 (6): 559–562. PubMed Abstract | Publisher Full Text 24. Sohrabi C, Mathew G, Maria N, et al. : The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int. J. Surg. 2023 May 1; 109 (5): 1136–1140. PubMed Abstract | Publisher Full Text | Free Full Text 25. Magdoud K: Sclerosing lymphocytic lobulitis of the breast: case report and literature review. Harvard Dataverse. 2024; V1 . Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 27 Aug 2024 ADD YOUR COMMENT Comment Author details Author details 1 Faculty of Medicine of Tunis, University Tunis El Manar Tunisia, Tunis, Tunisia 2 Maternity and Neonatology Center of Tunis, Tunis, Tunisia Khaoula Magdoud Roles: Conceptualization, Supervision, Validation, Writing – Original Draft Preparation Sirine Bayar Roles: Conceptualization, Validation, Visualization, Writing – Original Draft Preparation Nejla Arifi Roles: Conceptualization, Writing – Original Draft Preparation Sana Menjli Roles: Supervision, Validation, Visualization Rim Ben Hmid Roles: Conceptualization, Supervision, Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 22 Aug 2025, 13:967 https://doi.org/10.12688/f1000research.154671.2 version 1 Published: 27 Aug 2024, 13:967 https://doi.org/10.12688/f1000research.154671.1 Copyright © 2024 Magdoud K et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Magdoud K, Bayar S, Arifi N et al. Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.12688/f1000research.154671.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 27 Aug 2024 Views 0 Cite How to cite this report: Hammood ZD. Reviewer Report For: Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.5256/f1000research.169723.r405619 ) The direct URL for this report is: https://f1000research.com/articles/13-967/v1#referee-response-405619 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Aug 2025 Zuhair Dahham Hammood , Smart Health Tower & Kscien Organization, Tikrit Teaching Hospital, Saladin, Iraq Approved VIEWS 0 https://doi.org/10.5256/f1000research.169723.r405619 Recommendations for Revision Revise English syntax thoroughly for clarity and fluency. Standardize imaging descriptions with BI-RADS terminology. Correct figure legends (size, shape, margins). Clarify clinical details of Poor ... Continue reading READ ALL Recommendations for Revision Revise English syntax thoroughly for clarity and fluency. Standardize imaging descriptions with BI-RADS terminology. Correct figure legends (size, shape, margins). Clarify clinical details of Poor diabetic control and Left breast status. Highlight that conservative management is preferred in biopsy-proven SCLL. Strengthen conclusion by reiterating: “Core needle biopsy avoids unnecessary surgery, and routine follow-up is the recommended management.” Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Breast Oncosurgeon I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hammood ZD. Reviewer Report For: Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.5256/f1000research.169723.r405619 ) The direct URL for this report is: https://f1000research.com/articles/13-967/v1#referee-response-405619 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 22 Aug 2025 khaoula magdoud , University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia 22 Aug 2025 Author Response Comment 1: Revise English syntax thoroughly for clarity and fluency. Response 1: I have made changes to the manuscript for clarity Comment 2: Standardize imaging descriptions with BI-RADS terminology. Response ... Continue reading Comment 1: Revise English syntax thoroughly for clarity and fluency. Response 1: I have made changes to the manuscript for clarity Comment 2: Standardize imaging descriptions with BI-RADS terminology. Response 2: I changed imaging description (lines 39-40) Comment 3: Correct figure legends (size, shape, margins). Response 3: yes, I changed it (lines 150-152) Comment 4: Clarify clinical details of Poor diabetic control and Left breast status. Highlight that conservative management is preferred in biopsy-proven SCLL. Response 4: it was mentioned in the manuscript lines 107-111 Comment 1: Revise English syntax thoroughly for clarity and fluency. Response 1: I have made changes to the manuscript for clarity Comment 2: Standardize imaging descriptions with BI-RADS terminology. Response 2: I changed imaging description (lines 39-40) Comment 3: Correct figure legends (size, shape, margins). Response 3: yes, I changed it (lines 150-152) Comment 4: Clarify clinical details of Poor diabetic control and Left breast status. Highlight that conservative management is preferred in biopsy-proven SCLL. Response 4: it was mentioned in the manuscript lines 107-111 Competing Interests: no Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 22 Aug 2025 khaoula magdoud , University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia 22 Aug 2025 Author Response Comment 1: Revise English syntax thoroughly for clarity and fluency. Response 1: I have made changes to the manuscript for clarity Comment 2: Standardize imaging descriptions with BI-RADS terminology. Response ... Continue reading Comment 1: Revise English syntax thoroughly for clarity and fluency. Response 1: I have made changes to the manuscript for clarity Comment 2: Standardize imaging descriptions with BI-RADS terminology. Response 2: I changed imaging description (lines 39-40) Comment 3: Correct figure legends (size, shape, margins). Response 3: yes, I changed it (lines 150-152) Comment 4: Clarify clinical details of Poor diabetic control and Left breast status. Highlight that conservative management is preferred in biopsy-proven SCLL. Response 4: it was mentioned in the manuscript lines 107-111 Comment 1: Revise English syntax thoroughly for clarity and fluency. Response 1: I have made changes to the manuscript for clarity Comment 2: Standardize imaging descriptions with BI-RADS terminology. Response 2: I changed imaging description (lines 39-40) Comment 3: Correct figure legends (size, shape, margins). Response 3: yes, I changed it (lines 150-152) Comment 4: Clarify clinical details of Poor diabetic control and Left breast status. Highlight that conservative management is preferred in biopsy-proven SCLL. Response 4: it was mentioned in the manuscript lines 107-111 Competing Interests: no Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Krishnan S. Reviewer Report For: Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.5256/f1000research.169723.r329968 ) The direct URL for this report is: https://f1000research.com/articles/13-967/v1#referee-response-329968 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Dec 2024 Sweta Krishnan , AIIMS, Rishikesh, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.169723.r329968 Dear Authors, This is a nice case report illustrating a case of diabetic mastopathy, the clinical and imaging findings and the subsequent management. However, I suggest you go through my recommendations for changes in the manuscript and revise if ... Continue reading READ ALL Dear Authors, This is a nice case report illustrating a case of diabetic mastopathy, the clinical and imaging findings and the subsequent management. However, I suggest you go through my recommendations for changes in the manuscript and revise if needed. - Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. - Write “including men” instead of “and in men” in line 6 of the introduction as healthy individuals will include men as well. - Please mention explicitly if the patient had poor diabetic control and also detail the reasons for the same because you have mentioned that the patient was on high-dose insulin. - Please clarify what “No particular mention was made of the left breast” means. If the left breast was normal, please mention that it was normal. - For the imaging findings, please use the ACR BI-RADS 5 th edition lexicon to describe the imaging findings used throughout the manuscript. I am putting the link here for your reference should you wish to go through it: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads - In Figure 1, the lesion appears to be oval-shaped with circumscribed margins. It is not possible to evaluate the shape and margins on one static image, however, I would suggest using a representative image as per the description used or changing the description of the mass as per the provided image. Comment about the vascularity within the lesion if the same was evaluated using Doppler, else you can ignore it. Please correct the size used in the description as per the image provided in Figure 1 because there is a large disparity of over 8mm. - Kindly clarify “Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin.” What is meant by “similar anatomical lesions”? Are the lesions the same clinically, on imaging, histologically, or a combination of these? - “The occurrence in men is exceptional; five cases have been reported in men.” I suggest an alternative way to frame this: The occurrence of the disease is very rare in men with only five cases reported in literature to date. - I suggest using the word “lump” instead of nodule to describe the lesion clinically. - The MRI part needs clarification. A lesion cannot show both a progressive enhancement and a wash out pattern. If both types of enhancement are seen in literature, please frame the sentence accordingly to avoid any confusion to the readers. - You have mentioned in detail the need for surgeries for different indications in a histologically diagnosed case of diabetic mastopathy. To my knowledge, surgeries are seldom performed in a biopsy-proven case of diabetic mastopathy. Please reiterate that routine clinical and imaging follow-up is the mainstay of management and surgeries are performed only for certain indications. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Breast Imaging and Interventions I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Krishnan S. Reviewer Report For: Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.5256/f1000research.169723.r329968 ) The direct URL for this report is: https://f1000research.com/articles/13-967/v1#referee-response-329968 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 22 Aug 2025 khaoula magdoud , University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia 22 Aug 2025 Author Response Comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Comment ... Continue reading Comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Comment 2: Write “including men” instead of “and in men” in line 6 of the introduction as healthy individuals will include men as well. Response 2: yes, I changed it (line 21) Comment 3: Please mention explicitly if the patient had poor diabetic control and also detail the reasons for the same because you have mentioned that the patient was on high-dose insulin. Response 3: I added this sentence (line 28-29) Comment 4: Please clarify what “No particular mention was made of the left breast” means. If the left breast was normal, please mention that it was normal. Response 4: The left breast was normal (line 36) Comment 5: For the imaging findings, please use the ACR BI-RADS 5 th edition lexicon to describe the imaging findings used throughout the manuscript. I am putting the link here for your reference should you wish to go through it: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads Response 5: I added the description of breast ultrasound according to ACR Bi-RADS(lines 39-40) Comment 6: In Figure 1, the lesion appears to be oval-shaped with circumscribed margins. It is not possible to evaluate the shape and margins on one static image, however, I would suggest using a representative image as per the description used or changing the description of the mass as per the provided image. Comment about the vascularity within the lesion if the same was evaluated using Doppler, else you can ignore it. Please correct the size used in the description as per the image provided in Figure 1 because there is a large disparity of over 8mm. Response 6: I changed the description, but I don’t have another image.(lines 150-152) Comment 7: Kindly clarify “Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin.” What is meant by “similar anatomical lesions”? Are the lesions the same clinically, on imaging, histologically, or a combination of these? Response 7: it is the same histological lesion (line 54) Comment 8: “The occurrence in men is exceptional; five cases have been reported in men.” I suggest an alternative way to frame this: The occurrence of the disease is very rare in men with only five cases reported in literature to date. Response 8: yes, I changed it (line 57, 58) Comment 8: I suggest using the word “lump” instead of nodule to describe the lesion clinically. Response 8: Yes, I changed the word (line 69) Comment 9: The MRI part needs clarification. A lesion cannot show both a progressive enhancement and a wash out pattern. If both types of enhancement are seen in literature, please frame the sentence accordingly to avoid any confusion to the readers. Response 9: yes, I changed the sentence (lines 87-88) Comment 10: You have mentioned in detail the need for surgeries for different indications in a histologically diagnosed case of diabetic mastopathy. To my knowledge, surgeries are seldom performed in a biopsy-proven case of diabetic mastopathy. Please reiterate that routine clinical and imaging follow-up is the mainstay of management and surgeries are performed only for certain indications Response 10: it was mentioned in the manuscript lines 107-111 Comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Comment 2: Write “including men” instead of “and in men” in line 6 of the introduction as healthy individuals will include men as well. Response 2: yes, I changed it (line 21) Comment 3: Please mention explicitly if the patient had poor diabetic control and also detail the reasons for the same because you have mentioned that the patient was on high-dose insulin. Response 3: I added this sentence (line 28-29) Comment 4: Please clarify what “No particular mention was made of the left breast” means. If the left breast was normal, please mention that it was normal. Response 4: The left breast was normal (line 36) Comment 5: For the imaging findings, please use the ACR BI-RADS 5 th edition lexicon to describe the imaging findings used throughout the manuscript. I am putting the link here for your reference should you wish to go through it: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads Response 5: I added the description of breast ultrasound according to ACR Bi-RADS(lines 39-40) Comment 6: In Figure 1, the lesion appears to be oval-shaped with circumscribed margins. It is not possible to evaluate the shape and margins on one static image, however, I would suggest using a representative image as per the description used or changing the description of the mass as per the provided image. Comment about the vascularity within the lesion if the same was evaluated using Doppler, else you can ignore it. Please correct the size used in the description as per the image provided in Figure 1 because there is a large disparity of over 8mm. Response 6: I changed the description, but I don’t have another image.(lines 150-152) Comment 7: Kindly clarify “Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin.” What is meant by “similar anatomical lesions”? Are the lesions the same clinically, on imaging, histologically, or a combination of these? Response 7: it is the same histological lesion (line 54) Comment 8: “The occurrence in men is exceptional; five cases have been reported in men.” I suggest an alternative way to frame this: The occurrence of the disease is very rare in men with only five cases reported in literature to date. Response 8: yes, I changed it (line 57, 58) Comment 8: I suggest using the word “lump” instead of nodule to describe the lesion clinically. Response 8: Yes, I changed the word (line 69) Comment 9: The MRI part needs clarification. A lesion cannot show both a progressive enhancement and a wash out pattern. If both types of enhancement are seen in literature, please frame the sentence accordingly to avoid any confusion to the readers. Response 9: yes, I changed the sentence (lines 87-88) Comment 10: You have mentioned in detail the need for surgeries for different indications in a histologically diagnosed case of diabetic mastopathy. To my knowledge, surgeries are seldom performed in a biopsy-proven case of diabetic mastopathy. Please reiterate that routine clinical and imaging follow-up is the mainstay of management and surgeries are performed only for certain indications Response 10: it was mentioned in the manuscript lines 107-111 Competing Interests: no Close Report a concern Author Response 10 Sep 2025 khaoula magdoud , University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia 10 Sep 2025 Author Response comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Competing Interests: no comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Competing Interests: no Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 22 Aug 2025 khaoula magdoud , University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia 22 Aug 2025 Author Response Comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Comment ... Continue reading Comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Comment 2: Write “including men” instead of “and in men” in line 6 of the introduction as healthy individuals will include men as well. Response 2: yes, I changed it (line 21) Comment 3: Please mention explicitly if the patient had poor diabetic control and also detail the reasons for the same because you have mentioned that the patient was on high-dose insulin. Response 3: I added this sentence (line 28-29) Comment 4: Please clarify what “No particular mention was made of the left breast” means. If the left breast was normal, please mention that it was normal. Response 4: The left breast was normal (line 36) Comment 5: For the imaging findings, please use the ACR BI-RADS 5 th edition lexicon to describe the imaging findings used throughout the manuscript. I am putting the link here for your reference should you wish to go through it: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads Response 5: I added the description of breast ultrasound according to ACR Bi-RADS(lines 39-40) Comment 6: In Figure 1, the lesion appears to be oval-shaped with circumscribed margins. It is not possible to evaluate the shape and margins on one static image, however, I would suggest using a representative image as per the description used or changing the description of the mass as per the provided image. Comment about the vascularity within the lesion if the same was evaluated using Doppler, else you can ignore it. Please correct the size used in the description as per the image provided in Figure 1 because there is a large disparity of over 8mm. Response 6: I changed the description, but I don’t have another image.(lines 150-152) Comment 7: Kindly clarify “Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin.” What is meant by “similar anatomical lesions”? Are the lesions the same clinically, on imaging, histologically, or a combination of these? Response 7: it is the same histological lesion (line 54) Comment 8: “The occurrence in men is exceptional; five cases have been reported in men.” I suggest an alternative way to frame this: The occurrence of the disease is very rare in men with only five cases reported in literature to date. Response 8: yes, I changed it (line 57, 58) Comment 8: I suggest using the word “lump” instead of nodule to describe the lesion clinically. Response 8: Yes, I changed the word (line 69) Comment 9: The MRI part needs clarification. A lesion cannot show both a progressive enhancement and a wash out pattern. If both types of enhancement are seen in literature, please frame the sentence accordingly to avoid any confusion to the readers. Response 9: yes, I changed the sentence (lines 87-88) Comment 10: You have mentioned in detail the need for surgeries for different indications in a histologically diagnosed case of diabetic mastopathy. To my knowledge, surgeries are seldom performed in a biopsy-proven case of diabetic mastopathy. Please reiterate that routine clinical and imaging follow-up is the mainstay of management and surgeries are performed only for certain indications Response 10: it was mentioned in the manuscript lines 107-111 Comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Comment 2: Write “including men” instead of “and in men” in line 6 of the introduction as healthy individuals will include men as well. Response 2: yes, I changed it (line 21) Comment 3: Please mention explicitly if the patient had poor diabetic control and also detail the reasons for the same because you have mentioned that the patient was on high-dose insulin. Response 3: I added this sentence (line 28-29) Comment 4: Please clarify what “No particular mention was made of the left breast” means. If the left breast was normal, please mention that it was normal. Response 4: The left breast was normal (line 36) Comment 5: For the imaging findings, please use the ACR BI-RADS 5 th edition lexicon to describe the imaging findings used throughout the manuscript. I am putting the link here for your reference should you wish to go through it: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads Response 5: I added the description of breast ultrasound according to ACR Bi-RADS(lines 39-40) Comment 6: In Figure 1, the lesion appears to be oval-shaped with circumscribed margins. It is not possible to evaluate the shape and margins on one static image, however, I would suggest using a representative image as per the description used or changing the description of the mass as per the provided image. Comment about the vascularity within the lesion if the same was evaluated using Doppler, else you can ignore it. Please correct the size used in the description as per the image provided in Figure 1 because there is a large disparity of over 8mm. Response 6: I changed the description, but I don’t have another image.(lines 150-152) Comment 7: Kindly clarify “Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin.” What is meant by “similar anatomical lesions”? Are the lesions the same clinically, on imaging, histologically, or a combination of these? Response 7: it is the same histological lesion (line 54) Comment 8: “The occurrence in men is exceptional; five cases have been reported in men.” I suggest an alternative way to frame this: The occurrence of the disease is very rare in men with only five cases reported in literature to date. Response 8: yes, I changed it (line 57, 58) Comment 8: I suggest using the word “lump” instead of nodule to describe the lesion clinically. Response 8: Yes, I changed the word (line 69) Comment 9: The MRI part needs clarification. A lesion cannot show both a progressive enhancement and a wash out pattern. If both types of enhancement are seen in literature, please frame the sentence accordingly to avoid any confusion to the readers. Response 9: yes, I changed the sentence (lines 87-88) Comment 10: You have mentioned in detail the need for surgeries for different indications in a histologically diagnosed case of diabetic mastopathy. To my knowledge, surgeries are seldom performed in a biopsy-proven case of diabetic mastopathy. Please reiterate that routine clinical and imaging follow-up is the mainstay of management and surgeries are performed only for certain indications Response 10: it was mentioned in the manuscript lines 107-111 Competing Interests: no Close Report a concern Author Response 10 Sep 2025 khaoula magdoud , University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia 10 Sep 2025 Author Response comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Competing Interests: no comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Competing Interests: no Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 27 Aug 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 22 Aug 25 Version 1 27 Aug 24 read read Sweta Krishnan , AIIMS, Rishikesh, India Zuhair Dahham Hammood , Tikrit Teaching Hospital, Saladin, Iraq Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Hammood Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Aug 2025 | for Version 1 Zuhair Dahham Hammood , Smart Health Tower & Kscien Organization, Tikrit Teaching Hospital, Saladin, Iraq 0 Views copyright © 2025 Hammood Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Recommendations for Revision Revise English syntax thoroughly for clarity and fluency. Standardize imaging descriptions with BI-RADS terminology. Correct figure legends (size, shape, margins). Clarify clinical details of Poor diabetic control and Left breast status. Highlight that conservative management is preferred in biopsy-proven SCLL. Strengthen conclusion by reiterating: “Core needle biopsy avoids unnecessary surgery, and routine follow-up is the recommended management.” Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Breast Oncosurgeon I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 22 Aug 2025 khaoula magdoud, University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia Comment 1: Revise English syntax thoroughly for clarity and fluency. Response 1: I have made changes to the manuscript for clarity Comment 2: Standardize imaging descriptions with BI-RADS terminology. Response 2: I changed imaging description (lines 39-40) Comment 3: Correct figure legends (size, shape, margins). Response 3: yes, I changed it (lines 150-152) Comment 4: Clarify clinical details of Poor diabetic control and Left breast status. Highlight that conservative management is preferred in biopsy-proven SCLL. Response 4: it was mentioned in the manuscript lines 107-111 View more View less Competing Interests no reply Respond Report a concern Hammood ZD. Peer Review Report For: Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.5256/f1000research.169723.r405619) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-967/v1#referee-response-405619 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Krishnan S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Dec 2024 | for Version 1 Sweta Krishnan , AIIMS, Rishikesh, India 0 Views copyright © 2024 Krishnan S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (2) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors, This is a nice case report illustrating a case of diabetic mastopathy, the clinical and imaging findings and the subsequent management. However, I suggest you go through my recommendations for changes in the manuscript and revise if needed. - Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. - Write “including men” instead of “and in men” in line 6 of the introduction as healthy individuals will include men as well. - Please mention explicitly if the patient had poor diabetic control and also detail the reasons for the same because you have mentioned that the patient was on high-dose insulin. - Please clarify what “No particular mention was made of the left breast” means. If the left breast was normal, please mention that it was normal. - For the imaging findings, please use the ACR BI-RADS 5 th edition lexicon to describe the imaging findings used throughout the manuscript. I am putting the link here for your reference should you wish to go through it: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads - In Figure 1, the lesion appears to be oval-shaped with circumscribed margins. It is not possible to evaluate the shape and margins on one static image, however, I would suggest using a representative image as per the description used or changing the description of the mass as per the provided image. Comment about the vascularity within the lesion if the same was evaluated using Doppler, else you can ignore it. Please correct the size used in the description as per the image provided in Figure 1 because there is a large disparity of over 8mm. - Kindly clarify “Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin.” What is meant by “similar anatomical lesions”? Are the lesions the same clinically, on imaging, histologically, or a combination of these? - “The occurrence in men is exceptional; five cases have been reported in men.” I suggest an alternative way to frame this: The occurrence of the disease is very rare in men with only five cases reported in literature to date. - I suggest using the word “lump” instead of nodule to describe the lesion clinically. - The MRI part needs clarification. A lesion cannot show both a progressive enhancement and a wash out pattern. If both types of enhancement are seen in literature, please frame the sentence accordingly to avoid any confusion to the readers. - You have mentioned in detail the need for surgeries for different indications in a histologically diagnosed case of diabetic mastopathy. To my knowledge, surgeries are seldom performed in a biopsy-proven case of diabetic mastopathy. Please reiterate that routine clinical and imaging follow-up is the mainstay of management and surgeries are performed only for certain indications. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Breast Imaging and Interventions I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (2) Author Response 22 Aug 2025 khaoula magdoud, University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia Comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. Comment 2: Write “including men” instead of “and in men” in line 6 of the introduction as healthy individuals will include men as well. Response 2: yes, I changed it (line 21) Comment 3: Please mention explicitly if the patient had poor diabetic control and also detail the reasons for the same because you have mentioned that the patient was on high-dose insulin. Response 3: I added this sentence (line 28-29) Comment 4: Please clarify what “No particular mention was made of the left breast” means. If the left breast was normal, please mention that it was normal. Response 4: The left breast was normal (line 36) Comment 5: For the imaging findings, please use the ACR BI-RADS 5 th edition lexicon to describe the imaging findings used throughout the manuscript. I am putting the link here for your reference should you wish to go through it: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads Response 5: I added the description of breast ultrasound according to ACR Bi-RADS(lines 39-40) Comment 6: In Figure 1, the lesion appears to be oval-shaped with circumscribed margins. It is not possible to evaluate the shape and margins on one static image, however, I would suggest using a representative image as per the description used or changing the description of the mass as per the provided image. Comment about the vascularity within the lesion if the same was evaluated using Doppler, else you can ignore it. Please correct the size used in the description as per the image provided in Figure 1 because there is a large disparity of over 8mm. Response 6: I changed the description, but I don’t have another image.(lines 150-152) Comment 7: Kindly clarify “Similar anatomical lesions have been less frequently described in other autoimmune pathologies (such as thyroiditis and lupus) and in patients with type II diabetes requiring insulin.” What is meant by “similar anatomical lesions”? Are the lesions the same clinically, on imaging, histologically, or a combination of these? Response 7: it is the same histological lesion (line 54) Comment 8: “The occurrence in men is exceptional; five cases have been reported in men.” I suggest an alternative way to frame this: The occurrence of the disease is very rare in men with only five cases reported in literature to date. Response 8: yes, I changed it (line 57, 58) Comment 8: I suggest using the word “lump” instead of nodule to describe the lesion clinically. Response 8: Yes, I changed the word (line 69) Comment 9: The MRI part needs clarification. A lesion cannot show both a progressive enhancement and a wash out pattern. If both types of enhancement are seen in literature, please frame the sentence accordingly to avoid any confusion to the readers. Response 9: yes, I changed the sentence (lines 87-88) Comment 10: You have mentioned in detail the need for surgeries for different indications in a histologically diagnosed case of diabetic mastopathy. To my knowledge, surgeries are seldom performed in a biopsy-proven case of diabetic mastopathy. Please reiterate that routine clinical and imaging follow-up is the mainstay of management and surgeries are performed only for certain indications Response 10: it was mentioned in the manuscript lines 107-111 View more View less Competing Interests no reply Respond Report a concern Author Response 10 Sep 2025 khaoula magdoud, University Tunis El Manar Tunisia, Faculty of medicine of Tunis, Tunisia comment 1: Please correct the syntax errors present throughout the manuscript, especially in the case report and discussion parts. response 1: I changed the manuscript according to your comments. View more View less Competing Interests no reply Respond Report a concern Krishnan S. Peer Review Report For: Case Report: Sclerosing lymphocytic lobulitis of the breast: case report and literature review [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2024, 13 :967 ( https://doi.org/10.5256/f1000research.169723.r329968) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-967/v1#referee-response-329968 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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