Breast - nonmalignant
Fibrocystic disease
Cystic hypersecretory hyperplasia of breast

Author: Hind Nassar, M.D. (see Authors page)

Revised: 31 July 2017, last major update May 2010

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PubMed Search: Cystic hypersecretory hyperplasia of breast

Cite this page: Cystic hypersecretory hyperplasia of breast. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastcystichypersecretoryhyperplasia.html. Accessed October 20th, 2017.
Definition / general
  • Cystically dilated ducts of various sizes with colloid-like material
  • Ducts are lined by flat, orderly, bland columnar epithelial cells
  • Not included in WHO classification of breast lesions
Terminology
  • Cystic hypersecretory carcinoma: lesions that resemble cystic hypersecretory hyperplasia but with proliferative atypical epithelium
Epidemiology
  • Rare
Etiology
  • Unknown
Clinical features
  • Palpable mass or occasionally asymptomatic with mammographic abnormality
  • Benign lesion with good prognosis when not associated with atypia or carcinoma
Case reports
Treatment
Gross description
  • Resembles juvenile papillomatosis
  • Large, ill defined, firm to rubbery, spongy mass of fibrous tissue containing multiple small cysts
  • Also abundant thick, sticky mucin within the cysts; resembles thyroid colloid
  • May coexist with atypia or DCIS of cystic hypersecretory type, so sample generously
Microscopic (histologic) description
  • Cystically dilated ducts of various sizes with colloid-like material, often with parallel fracture lines, retraction halo and overlapping due to processing
  • Ducts are lined by flat, orderly, columnar epithelial cells with eosinophilic cytoplasm; nuclei are round / oval, vesicular, bland
  • Atypical features are epithelial crowding, enlarged nuclei lacking normal polarization, hyperchromasia and rare mitotic figures
  • Can be associated with pregnancy-like (pseudolactational) hyperplasia (Am J Surg Pathol 2000;24:1670)
Microscopic (histologic) images

Images hosted on PathOut server:

Cysts lined by flat cuboidal epithelium contain eosinophilic material

Atypia - focal atypical epithelium between cysts (AFIP)

Intraluminal secretions show
fine, parallel cracks and
shrinkage of the cyst content
with peripheral scalloping



Images hosted on other servers:

Fig A: MRI shows 5 cm mass
Fig B: dilated epithelial cysts with colloid-like material
Fig C: epithelium is flat or cuboidal
Fig D: focal areas of cellular atypia and mitotic figures

Cytology description
  • Secretory material (same as histology) with isolated or clusters of epithelial cells
Positive stains
  • PR in a small subset
Negative stains
Differential diagnosis