Breast
Fibrocystic changes
Fibrocystic changes


Topic Completed: 1 March 2010

Minor changes: 28 September 2020

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Fibrocystic disease [title] breast [title]

Hind Warzecha, M.D.
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Cite this page: Warzecha H. Fibrocystic changes. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastfcc.html. Accessed September 29th, 2020.
Definition / general
  • 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
  • Also called fibrocystic change, diffuse cystic mastopathy
Epidemiology
  • Common (50% incidence) in women ages 25 - 45 years, more common in Americans / Europeans than Japanese or South American women
  • Reduced incidence in postmenopausal 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 syndrome (multiple hamartomas including trichilemmomas, high risk of breast, uterine and nonmedullary thyroid cancer)
Etiology
  • Associated with hormonal imbalance (increased estrogen to progesterone ratio); decreased risk with oral contraceptives, perhaps due to balanced supply of estrogens and progesterone
Diagrams / tables

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Breast tissue with cysts

Clinical features
  • 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
  • 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)
Gross description
  • 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

Irregular fibrosis and small cysts

Fibrosis and dilated ducts

Microscopic (histologic) description
  • Primarily affects the terminal duct lobular unit, not the large ducts; see also specific types described separately
Microscopic (histologic) images

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Cysts in fibrocystic disease

Board review style question #1
Which of the following is true about proliferative fibrocystic changes in the breast?

  1. Apocrine metaplasia is part of proliferative fibrocystic changes
  2. Cystic duct ectasia is part of proliferative fibrocystic changes
  3. Proliferative fibrocystic change has an associated 1.5 - 2 fold increased lifetime risk of breast cancer
  4. Proliferative fibrocystic change has an associated 4 - 5 fold increased lifetime risk of breast cancer
  5. Proliferative fibrocystic change has no associated increased lifetime risk of breast cancer
Board review answer #1
C. Proliferative fibrocystic change has an associated 1.5 - 2 fold increased lifetime risk of breast cancer

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