BREAST INTRODUCTION AND FIBROCYSTIC CHANGE

Diagnostic method for breast lesion

1. Clinical breast examination

2. Imaging

• mammography — detect density and calcification - early detection

• Ultrasound - for younger patients, defines lesion edges

3. fine needle aspiration cytology

• needle inserted into lump

• Cells is aspirated

• Fixation→ 95% ethyl alcohol

• Stained → papanicolaou stain

4. Core biopsy / trucut

• tissue sample

• Biopsy under local anesthesia

• Fixation ; 10% formalin

• Stain→ H& E

5. Other methods

• excision biopsy

• Molecular studies

Classification of Benign epithelial lesion

Categories

1. Non - proliferative lesions ( fibrocystic change)

2. Proliferative disease w/o atypia

3. Proliferative disease with atypia

Clinical significance

• discomyand pain

• Mimic malignancy

• Some increase cancer risk

Aetiology

• age : 30-55 y/o (near menopause)

• Hormonal imbalance

• Distorted cyclical breast tissue chnge

Clinical features

Younger women

• pain , tender, nodularity

• Diffuse nodules up to 5mm

Peri menopausal women

• pain, tender, palpable lumps

• Discrete cysts

• Firm masses (fibrosis)

Types of changes in classification of benign epithelial lesion :

1. Non proliferative lesion ( fibrocystic change )

2. Proliferative disease w/o atypia

3. Proliferative disease with atypia

1. Non proliferative lesion ( fibrocystic change )

• Cysts with apocrine metaplasia

• Dilated acini and duct

• Lined by cell resembling sweat gland epithelium

• Turbid fluid - filled “ blue dome cyst”

• fibrosis

• Reactive response to ruptured cysts

• Palpable nodularity

• Adenosis

• Increase number of acini per lobule

• Lobule enlargement

1. Proliferative disease w/o atypia

• epithelial hyperplasia (epitheliosis)

• Proliferation of epithelial and myoepithelial cell in acini / ducts

• sclerosing adenosis

• Increase, compressed, distorted acini

• Fibrosis , calcification

• papillomas

• Grow within dilated ducts

• Multiple branching fibrovascular cores

• May associated epithelial hyperplasia, apocrine metaplasia, fibrosis

1. Proliferative disease with atypia

• atypical ductal hyperplasia (ADH)

• Abnormal cell growth in ducts

• Disordered orientation, nuclear pleomorphism, mitosis

• atypical lobular hyperplasia

• Similar change in lobules

• Monomorphic cells with abnormal architecture