Home Chapter Home Jobs Conferences Fellowships Books
Advertisement
Breast-nonmalignant
Fibrocystic disease
Cystic hypersecretory hyperplasia
Editor: Hind Nassar, M.D., Johns Hopkins Medical Institute (see Reviewers page)
Revised: 6 October 2012, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
=========================================================================
● 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
=========================================================================
● 48 year old woman with mass exhibiting atypia (Arch Pathol Lab Med 2003;127:e389)
Treatment
=========================================================================
● Wide excision (Cancer 1988;61:1611)
● If atypia present at core biopsy, excise entire lesion because DCIS can be present (Am J Surg Pathol 2004;28:789)
Gross description (Macroscopy)
=========================================================================
● 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
Micro description (Histopathology)
=========================================================================
● 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)
Micro images
=========================================================================
Cysts lined by flat cuboidal epithelium contain eosinophilic material
Intraluminal secretions show fine, parallel cracks and shrinkage
of the cyst content with peripheral scalloping
Atypia - focal atypical epithelium between cysts (AFIP)
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
=========================================================================
● ER
Differential Diagnosis
=========================================================================
End of Breast-nonmalignant > Fibrocystic disease > Cystic hypersecretory hyperplasia
This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.
All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).