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Breast-nonmalignant

Fibrocystic disease

Cystic hypersecretory hyperplasia

 

Editor: Hind Nassar, M.D., Johns Hopkins Medical Institute (see Reviewers page)

Revised: 6 October 2012, last major update May 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Cystically dilated ducts of various sizes with colloid-like material

● Ducts are lined by flat, orderly, bland columnar epithelial cells

● Not included in WHO classification of breast lesions

 

Terminology

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● Cystic hypersecretory carcinoma: lesions that resemble cystic hypersecretory hyperplasia but with proliferative atypical epithelium

 

Epidemiology

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● Rare

 

Etiology

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● Unknown

 

Clinical features

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● Palpable mass or occasionally asymptomatic with mammographic abnormality

● Benign lesion with good prognosis when not associated with atypia or carcinoma

 

Case reports

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● 48 year old woman with mass exhibiting atypia (Arch Pathol Lab Med 2003;127:e389)

 

Treatment

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● Wide excision (Cancer 1988;61:1611)

● If atypia present at core biopsy, excise entire lesion because DCIS can be present (Am J Surg Pathol 2004;28:789)

 

Gross description (Macroscopy)

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● Resembles juvenile papillomatosis

● Large, ill-defined, firm to rubbery, spongy mass of fibrous tissue containing multiple small cysts

● Also abundant thick, sticky mucin within the cysts; resembles thyroid colloid

● May coexist with atypia or DCIS of cystic hypersecretory type, so sample generously

 

Micro description (Histopathology)

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● Cystically dilated ducts of various sizes with colloid-like material, often with parallel fracture lines, retraction halo and overlapping due to processing

● Ducts are lined by flat, orderly, columnar epithelial cells with eosinophilic cytoplasm; nuclei are round/oval, vesicular, bland

● Atypical features are epithelial crowding, enlarged nuclei lacking normal polarization, hyperchromasia and rare mitotic figures

● Can be associated with pregnancy-like (pseudolactational) hyperplasia (Am J Surg Pathol 2000;24:1670)

 

Micro images

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Cysts lined by flat cuboidal epithelium contain eosinophilic material

 

 

Intraluminal secretions show fine, parallel cracks and shrinkage

of the cyst content with peripheral scalloping

 

 

  

Atypia - focal atypical epithelium between cysts (AFIP) 

 

 

Fig A: MRI shows 5 cm mass

Fig B: dilated epithelial cysts with colloid-like material

Fig C: epithelium is flat or cuboidal

Fig D: focal areas of cellular atypia and mitotic figures

 

Cytology description

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● Secretory material (same as histology) with isolated or clusters of epithelial cells

 

Positive stains

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● PR in a small subset

 

Negative stains

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● ER

 

Differential Diagnosis

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Cystic hypersecretory DCIS

 

End of Breast-nonmalignant > Fibrocystic disease > Cystic hypersecretory hyperplasia

 

 

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