BREAST: FIBROCYSTIC CHANGES
A 38 year old woman gave a history of lumps in both breasts which she first noticed 3 months earlier. These lumps became tender during menstrual periods.
The specimen is a portion of breast tissue 9 cm in maximum diameter which has been mounted to display the cut surface. The breast tissue contains several cysts up to 25 mm in diameter. The larger cysts are empty and have a smooth pale lining. Some of the smaller cysts 1-2 mm in diameter contain mucoid material. Histological examination showed fibrocystic changes.
"Fibrocystic changes" are common in the female breast between the ages of 25 and 45. (In the past this condition was known as "benign mammary dysplasia" or "fibrocystic disease"). The aetiology is unclear but hormonal factors are almost certainly involved. The condition is of clinical importance as it often presents as a breast lump. The histological changes involve both glandular (ductal) tissue and stroma and are listed below: (N.B. Some or all of the features listed may be present in any one biopsy). 1. increased stromal fibrous tissue. 2. cyst formation due to dilatation of obstructed ducts. 3. apocrine metaplasia. 4. benign proliferation of large duct or ductular lining cells - "epitheliosis". 5. "adenosis": increased numbers of ductules resulting in enlargement of individual breast lobules. 6. "sclerosing adenosis", in which there is proliferation of both stroma and small ductules in a breast lobule. "Fibrocystic change" is not associated with an increased risk of malignancy unless the changes present include epitheliosis, particularly atypical epitheliosis, i.e. cases in which there is nuclear atypia of the proliferating duct lining cells. The increased risk of malignancy in cases with epitheliosis is approximately 2.5 times normal.