Fibrocystic Disease
·
A „catch-all‟ category for gross
and micro cysts
·
Don‟t call it mammary dysplasia
·
Commonest disease of the breast
·
Cause obscure – unopposed
oestrogen a known factor. Women on combined pill get less fibrocystic disease
·
Classification by size:
o Gross cysts: very easy to diagnose on US. 40s.
Drain with FNA
o Micro cysts: usually 30‟s and 40‟s.
May have cyclical pain. Resolves
after menopause
o Galactocoele – milk filled cyst, usually with lactation
·
5 components (either separately
or together):
o Cysts:
§ Dilated ducts containing cloudy serous fluid (sometimes bloody or
infected)
§ All breasts contain microcysts during childbearing years. Abnormal when > ~ 2mm
§ Histology: epithelium may be flattened, cuboidal, columnar, piled up or
show apocrine metaplasia. Surrounding stroma likely to be fibrous
o Fibrosis:
§ Dense collagenisation distorting/compressing epithelial structures
§ Most common in upper outer quadrants, patient‟s in 30s
o Sclerosing adenosis:
§ Usually a tender lump in the upper outer quadrant, patient around 40
§ Benign proliferation of small ductules in a fibrous stroma, but
histologically circumscribed
§ Lining cells proliferate to fill the ducts
§ Increased risk of cancer with florid (2*) and atypical (4*) hyperplasia
§ Mimics cancer both clinically and microscopically
o Apocrine Metaplasia: Benign metaplastic change to tall cells with eosinophilic cytoplasm resembling those of secretory glands
(eg lactation, sweat, etc)
o Duct (and sometimes lobular) epithelial hyperplasia
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