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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 cystsfibrosis 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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Fibrocystic change

 

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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Wikipedia

 

End of Breast-nonmalignant > Fibrocystic disease > general

 

 

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