Fibrocystic Changes PDF

FIBROCYSTIC CHANGES INTRODUCTION A group of changes in the female breast that range from innocent to patterns associated with an increased risk of breast carcinoma. Some of these alterations produce palpable "lumps.“ It is widely accepted that this range of changes is the consequence of an exaggerat...

FIBROCYSTIC CHANGES INTRODUCTION A group of changes in the female breast that range from innocent to patterns associated with an increased risk of breast carcinoma. Some of these alterations produce palpable "lumps.“ It is widely accepted that this range of changes is the consequence of an exaggeration and distortion of the cyclic breast changes that occur normally in the menstrual cycle. Estrogenic therapy and oral contraceptives do not seem to increase the incidence of these alterations; indeed, oral contraceptives may decrease the risk. these breast alterations have been called fibrocystic disease; Most of the changes have little clinical significance except that they cause nodularity; the "lumps" produced by the various patterns of fibrocystic change must be distinguished from cancer, the distinction can be made by examination of fine-needle aspiration material or more definitively by biopsy and histologic evaluation. fibrocystic changes are here subdivided into : nonproliferative patterns. : Include cysts and/or fibrosis without epithelial cell hyperplasia, known as simple fibrocystic change. proliferative patterns. include : 1. Typical duct or ductular epithelial cell hyperplasias 2. Atypical duct or ductular epithelial cell hyperplasias 3. sclerosing adenosis. All tend to arise during reproductive period of life but may persist after menopause. so common, being found at autopsy in 60% to 80% of women, Some are mild and carry little risk of carcinoma Others are more atypical hyperplasias that carry a significantly greater risk, Epithelial hyperplasia does not often produce a clinically discrete breast mass. Occasionally, it produces microcalcifications on mammography, raising fears about cancer. may be associated with a serous or serosanguineous nipple discharge Relationship of Fibrocystic Changes to Breast Carcinoma is controversial. Minimal or no increased risk of breast carcinoma: fibrosis, cystic changes (microscopic or macroscopic), apocrine metaplasia, mild hyperplasia, fibroadenoma. Slightly increased risk (1.5-2 times): moderate to florid hyperplasia (without atypia), ductal papillomatosis, sclerosing adenosis. Significantly increased risk (5 times): atypical hyperplasia, ductular or lobular (seen in 15% of biopsies). family history of breast cancer may increase the risk in all categories Lesion NONPROLIFERATIVE BREAST CHANGES (Fibrocystic changes) Duct ectasia Cysts Apocrine change Mild hyperplasia Adenosis Fibroadenoma w/o complex features PROLIFERATIVE DISEASE WITHOUT ATYPIA Moderate or florid hyperplasia Sclerosing adenosis Papilloma Complex sclerosing lesion (radial scar) Fibroadenoma with complex features PROLIFERATIVE DISEASE WITH ATYPIA Atypical ductal hyperplasia (ADH) Atypical lobular hyperplasia (ALH) CARCINOMA IN SITU Lobular carcinoma in situ (LCIS) Ductal carcinoma in situ (DCIS) Relative Risk (Absolute Lifetime Risk)[*] 1.0 (3%) 1.5 to 2.0 (5% to 7%) 4.0 to 5.0 (13% to 17%) 8.0 to 10.0 (25% to 30%)