Breast: Fibrocystic changes

 

 

 

 

 

A 40 yr old woman noted a vague mass in each breast, associated with tenderness premenstrually.  Palpation revealed ill-defined nodularity which was more marked in the outer left quadrant of the breast.  This area was biopsied.

 

1.    What is the most likely clinical diagnosis?

 

Breast cancer, fibrocystic changes, fibroadenoma.

 

2.    Why was the UOQ chosen for the biopsy?

 

Most common site for breast carcinoma (50%)

Important to confirm or exclude the diagnosis of breast carcinoma

 

 

3.    What are the key histological features?

 

Cyst formation

      Double layer of lining cells (cuboidal epithelium, myoepithelium, hyperplastic)

      Atrophy of lining cells due to compression

      Apocrine metaplasia

Large, polygonal cells

Eosinophilic, granular cytoplasm

Small, round, deeply chromatic nuclei

Apical buds

      Macrophages may be present in cysts

Fibrosis of stroma

Adenosis

      Increase number of acini per lobule

      Gland lumen not distorted but enlarged

 

 

4.    What are the important histological features that increase risk for malignancy?

 

Epithelial hyperplasia or atypia

Sclerosing adenosis

Small duct papillomas

 

 

5.    What is the relationship to

 

Menstrual cycle:

Absolute or relative excess of oestrogen

Exaggerated response of breast tissue to hormonal stimulus leads to fibrocystic changes.

 

Oral contraceptives

 

Supply balance source of oestrogen and progesterone which lower risk of fibrocystic changes

 

Family history of breast cancer?

 

Increased risk of breast cancer

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