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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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Ultrasound and FNA of cyst

 

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

 

 

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.

 

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