What is Fibrocystic change of the breast

Representation of fibrocystic change in comparison with a normal breast.
Representation of fibrocystic change in comparison with a normal breast.
Microscopic picture of fibrocystic change: A benign breast neoplasm showing proliferating ducts and ductules some of them cystically dilated.
Microscopic picture of fibrocystic change: A benign breast neoplasm showing proliferating ducts and ductules some of them cystically dilated.

Benign Breast Lesions

*Clinical Manifestations:

It affects approximately 30-35% of women between the ages of 20 and 45 years.

75% of affected women between the ages of 35 and 40 y/o.

Usually multifocal and bilateral

Women who have a history of taking OCPs are less likely to develop fibrocystic changes.

After menopause, fibrocystic changes and symptoms gradually disappear (e.g. Breast pain and tenderness)

Estrogens stimulate proliferation of connective tissue with the development of fibrosis; the fibrosis causes obstruction of ductules that gradually dilate and become cystic as a result of persistent cyclic epithelial secretion.

*Grossly, the specimen or breast tissue contains several, small, randomly distributed blue-domed or clear cysts. Large cysts (greater than 2.0cm) are less frequent.

*Microscopically, they are characterized by cystically dilated round to oval spaces lined by slightly attenuated epithelial and myoepithelial cell layers. The stroma in between lobules are frequently sclerotic. As cystic changes progress, smaller cysts coalesce, and form large cysts that continue to be lined by  native, attenuated, epithelial, and myoepithelial cells; metaplastic apocrine cells may be present. When cysts rupture, an inflammatory response results and subsequent reparative changes cause additional  fibrosis.

*Immunohistochemical stains are not helpful in fibrocystic change.

*Differential Diagnosis include the following:

Cystic lobular involution and Duct ectasia

*Treatment:

Oral contraceptives, danazol and tamoxifen are all effective in reducing the progression and symptoms of disease.

Women with intractable systems and dense nodular breasts may be considered for bilateral subcutaneous mastectomy.

*Prognosis

They generally involute and symptoms disappear with menopause.

***On the final note, women aged 35 years old and above who presents with a tender or painful, round to ovoid, well-circumscribed, movable/mobile breast mass either unilateral (involves only one breast) or bilateral (both) are generally associated with fibrocystic change. Palpable axillary lymph nodes may be present, however may not be 100% indicative of a malignant process.

Diagnosis is confirmed either by mammography. Where microcalcifications would point more to a malignant process. Gold standard is still through biopsy, either through core-needle biopsy, incisional biopsy or excision biopsy.

If diagnosis is confirmed, there is no need to worry since fibrocystic change has no malignant potential meaning it is not precursor lesion for cancer.

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