Fibrocystic Breast Disease

Updated: Aug 18, 2018



“Fibrocystic disease” is the wastebasket term for benign breast disease characterized by fibrosis, cysts, inflammation, and a host of other benign changes.


General


  • Benign lesion that is the cause of most breast lumps found in younger women of reproductive years (age 30-menopause)

  • Fibrocystic changes of the breast are NONPROLIFERATIVE and have NO increased risk of cancer in and of themselves.

  • Atypical hyperplasia (ductal or lobular) can mean there is an adjacent in situ or invasive cancer




Clinical picture

  • Old lady notices an ill defined lump in her breast.

  • Childbearing-aged lady complains her breast is “lumpy bumpy” all over.

  • Lesion “disappears” after FNA (because cyst fluid was drained to be sent for cytologic diagnosis)

Common Findings in Fibrocystic Changes

  • Irregular, cystically dilated ducts/lobules

  • Cysts are lined by uniform benign cuboidal to columnar epithelial cells

  • FNA of fluid from cyst= benign appearing cells

  • Intervening stromal fibrosis

  • Microcalcifications


Imaging Findings

One or more mammographic densities (dense breast tissue & cysts) +/- calcifications

  • UDH: Calcifications

  • Sclerosing Adenosis: Calcifications, focal asymmetry, architectural distortion

  • Columnar cell change ± flat epithelial atypia: Calcifications

  • Papilloma: Mass, calcifications

  • Radial sclerosing lesion: Architectural distortion, calcifications

  • Lobular neoplasia (ALH, LCIS): Typically incidental findings in biopsies for other lesions

  • Nonclassical LCIS can be associated with necrosis and calcifications

  • Atypical ductal hyperplasia: Calcifications


Fibrocystic Diseases



Histologic Patterns of FCC

  • Cyst formation/Duct ectasia

  • Stromal Fibrosis

  • Pseudoangiomatous Stromal Hyperplasia (PASH)

  • Sclerosing adenosis (adenosis= increased number of acini per lobule)

  • Apocrine metaplasia (large, tall, columnar epithelial cells with abundant pink cytoplasm lining the cysts, may be vacuolated)

  • Columnar Cell Changes

  • Squamous Metaplasia

  • Fibroadenomatoid changes

  • Flat epithelial atypia

  • Collagenous spherulosis



Columnar Cell Changes & Flat Epithelial Atypia


Mammary Duct Ectasia


Sclerosing Adenosis vs. Microglandular Adenosis


Complex Sclerosing Lesion/Radial Scar


Apocrine Metaplasia & Collagenous Spherulosis


Pseudoangiomatous Stromal Hyperplasia (PASH)


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