Fibrocystic change of the breast (also known as diffuse cystic mastopathy) is a benign alteration in the terminal ductal lobular unit of the breast with or without associated fibrosis. It is seen as a wide spectrum of altered morphology in the female breast from innocuous to those associated with risk of carcinoma.
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Epidemiology
Very common entity (observed clinically in up to 50% and histologically in 90% of women 6). Fibrocystic change is unusual before adolescence. These are most often diagnosed between the ages of 20 and 40 with the peak before or at menopause.
As compared to the general population, women with nonproliferative lesions have no significant elevation in risk of developing a breast carcinoma, while those with the proliferative disease have a greater risk.
Clinical presentation
breast pain that worsens during ovulation
tender nodular swellings
most often multifocal and bilateral
Pathology
Hormonal alterations with estrogen dominance over progesterone are considered to be an important factor. The alterations seen are subdivided into:
non-proliferative (simple) fibrocystic change that includes simple breast cyst and/or fibrosis (most common)
-
proliferative that includes
atypical epithelial cell hyperplasias of the ducts or ductules
Aberrations in Normal Development and Involution of the breast (ANDI) encompasses all the changes associated with normal variations in breast parenchyma associated with changes in hormone levels and aging, thus it is better to classify fibrocystic changes under ANDI and it is not to be treated as a pathology per se.
Radiographic features
Mammography
breasts show heterogeneous and usually dense parenchyma
partially circumscribed masses may be present reflecting cysts
tea-cup, low-density round calcifications in multiple lobes
Ultrasound
On ultrasound, findings may show:
prominent fibroglandular tissue in the area of a palpable nodule; however, no discernible mass
small cysts in the mammary zone
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