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Breast-nonmalignant
Fibrocystic disease
General
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 7 October 2012, last major update March 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● A general category for numerous entities, described separately
● Cystic features are usually prominent, but there may not be fibrosis
● Not necessarily a disease that requires treatment, but Rosai favors "fibrocystic disease" over “fibrocystic change” because the constellation of findings fulfills the criteria for a disease, similar to nodular hyperplasia of the prostate
Terminology
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● Also called fibrocystic change, diffuse cystic mastopathy
Epidemiology
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● Common (50% incidence) in women ages 25-45 years, more common in Americans/Europeans than Japanese or South American women
● Reduced incidence in post-menopausal women due to reduced serum estrogens, but is maintained by estrogen replacement therapy or estrones in adipose tissue in obese women
● More common in women with polycystic ovaries (Minerva Ginecol 2000;52:321, Arch Gynecol Obstet 2009;280:249)
● Also associated with Cowden’s syndrome (multiple hamartomas including trichilemmomas, high risk of breast, uterine and non-medullary thyroid cancer)
Etiology
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● Associated with hormonal imbalance (increased estrogen to progesterone ratio); decreased risk with oral contraceptives, perhaps due to balanced supply of estrogens and progesterone
Clinical features
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● Benign, not neoplastic, but may be confused with malignancy
● Usually bilateral, although one breast may be affected more than the other
● Either proliferative (adenosis, hyperplasia) or nonproliferative (cysts)
Prognostic factors
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● The specific proliferative disease present (if any) determines the relative risk for subsequent carcinoma, varying from 1x (no increased risk) to 5x for atypical ductal hyperplasia (Am J Surg Pathol 2003;27:836)
Treatment
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Clinical images
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Gross description (Macroscopy)
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● Clear or blue-domed cysts, usually 1-2 mm but also up to 2 cm
● Variable soft-white fibrous tissue
Gross images
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Cysts surrounded by fibrous tissue
Other images: irregular fibrosis and small cysts; fibrosis and dilated ducts
Micro description (Histopathology)
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● Primarily affects the terminal duct lobular unit, not the large ducts; see also specific types described separately
Micro images
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Cysts in fibrocystic disease
Various images
Drawings
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Virtual Slides
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Videos
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Cytology description
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Cytology images
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Positive stains
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Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● (link to topic)
Additional references
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End of Breast-nonmalignant > Fibrocystic disease > general
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