Breast - nonmalignant
Fibrocystic disease
General

Author: Hind Nassar, M.D. (see Authors page)

Revised: 28 July 2017, last major update March 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Fibrocystic disease [title] breast [title]

Cite this page: Fibrocystic disease - general. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastfcc.html. Accessed October 22nd, 2017.
Definition / general
  • A general category for numerous entities, described separately
  • Cystic features are usually prominent but there may not be fibrosis
  • Not necessarily a disease that requires treatment but Rosai favors "fibrocystic disease" over “fibrocystic change” because the constellation of findings fulfills the criteria for a disease, similar to nodular hyperplasia of the prostate
Terminology
  • Also called fibrocystic change, diffuse cystic mastopathy
Epidemiology
  • Common (50% incidence) in women ages 25 - 45 years, more common in Americans / Europeans than Japanese or South American women
  • Reduced incidence in postmenopausal women due to reduced serum estrogens but is maintained by estrogen replacement therapy or estrones in adipose tissue in obese women
  • More common in women with polycystic ovaries (Minerva Ginecol 2000;52:321, Arch Gynecol Obstet 2009;280:249)
  • Also associated with Cowden syndrome (multiple hamartomas including trichilemmomas, high risk of breast, uterine and nonmedullary thyroid cancer)
Etiology
  • Associated with hormonal imbalance (increased estrogen to progesterone ratio); decreased risk with oral contraceptives, perhaps due to balanced supply of estrogens and progesterone
Diagrams / tables

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Breast tissue with cysts

Clinical features
  • Benign, not neoplastic but may be confused with malignancy
  • Usually bilateral although one breast may be affected more than the other
  • Either proliferative (adenosis, hyperplasia) or nonproliferative (cysts)
Prognostic factors
  • The specific proliferative disease present (if any) determines the relative risk for subsequent carcinoma, varying from 1x (no increased risk) to 5x for atypical ductal hyperplasia (Am J Surg Pathol 2003;27:836)
Gross description
  • Clear or blue domed cysts, usually 1 - 2 mm but also up to 2 cm
  • Variable soft white fibrous tissue
Gross images

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Cysts surrounded by fibrous tissue

Irregular fibrosis and small cysts

Fibrosis and dilated ducts

Microscopic (histologic) description
  • Primarily affects the terminal duct lobular unit, not the large ducts; see also specific types described separately
Microscopic (histologic) images

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Cysts in fibrocystic disease

Virtual slides

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Fibrocystic change