Fibrocystic Change

Snap Shot

• A 28-year-old female recently discovered a lump in her right breast. She has no family history of breast cancer, and her menstrual cycle began at 13 years of age. On exam you find a 1-cm movable mass in the right outer/upper quadrant. There is no skin dimpling. A mammogram is shown.

Introduction

• Most common cause of benign breast masses in premenopausal women
• Caused by exaggerated response to hormones and fluctuations in mass size
• Not typically associated with progression to cancer
• Several histologic types
  • fibrosis
    • breast stromal hyperplasia
  • cystic
    • may show large or small cysts
      • “blue domed”
    • ductal dilation
  • sclerosing adenosis 
    • acini proliferation with intralobular fibrosis
    • associated with calcifications
    • commonly mistaken for infiltrating ductal cancer
  • ductal/epithelial hyperplasia
    • epithelial cell proliferation in terminal duct lobule
• ↑ risk of carcinoma with atypical cells secondary to estrogen stimulation

Presentation

• Symptoms
  • bilateral breast pain or tenderness
    • size/pain varies with the menstrual cycle