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Breast-nonmalignant
Fibrocystic disease
Cysts of breast
Reviewer: Hind Nassar, M.D. in January 2009 (see Reviewers page)
Revised: 6 October 2012, last major update June 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Round to ovoid structures of variable size, lined by an epithelium
Terminology
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● Blue dome cysts: based on gross appearance
● Type 1 cysts: Na/K ratio of 3 or less; increased breast cancer risk; associated with higher levels of estrogen, melatonin, epidermal growth factor and DHEA-S and lower levels of TGF-B2 than type 2 cysts (Breast Cancer Res Treat 2007;103:331)
● Type 2 cysts: Na/K above 3: reduced breast cancer risk, although patients may have both types of cysts, and type 2 cysts can be associated with cancer (Breast 2005;14:37)
● Note: type 1 and type 2 terminology is not commonly used
Epidemiology
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● Very common non-proliferative breast lesion
Sites
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● Usually multifocal and bilateral
Etiology
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● May arise from lobular acini that coalesce
Clinical features
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● Large cysts may present as a mass
● Associated with microcalcifications on imaging
Case reports
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● Rarely associated with autosomal dominant polycystic kidney disease (Iran J Kidney Dis 2009;3:246)
Treatment
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● Excision required after aspiration if no fluid, bloody or tenacious fluid, or mass persists (Am Fam Physician 2003;68:1983)
Gross description (Macroscopy)
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● Variable size, usually visible grossly, contains clear or yellow fluid
Gross images
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Unopened cyst
Extensive cystic disease
Large hemorrhagic cysts
Micro description (Histopathology)
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● Lined by double layer of flat/cuboidal cells or no lining
● May rupture and elicit inflammatory response with foamy macrophages, cholesterol clefts, fibrosis
● Variable apocrine metaplasia
Micro images
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Cysts in fibrocystic disease
Squamous metaplasia of Apocrine metaplasia of cyst lining
epithelium lining cyst (AFIP)
Calcifications in cystically dilated ducts
Virtual Slides
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Multiple dilated cysts
Videos
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Differential Diagnosis
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● Cystic hypersecretory hyperplasia: colloid-like secretions
● Duct ectasia: elastic tissue in wall, macrophages in lumen
Additional references
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● Am Fam Physician 2003;68:1983 (aspiration procedure)
End of Breast-nonmalignant > Fibrocystic disease > Cysts
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