Updated: 4/30/2015

Fibrocystic Change

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  • A 28-year-old female recently discovered a lump in her right breast. She has no family history of breast cancer, and her menstrual cycle began at 13 years of age. On exam you find a 1-cm movable mass in the right outer/upper quadrant. There is no skin dimpling. A mammogram is shown.
  • Most common cause of benign breast masses in premenopausal women
  • Caused by exaggerated response to hormones and fluctuations in mass size
  • Not typically associated with progression to cancer
  • Several histologic types
    • fibrosis
      • breast stromal hyperplasia
    • cystic
      • may show large or small cysts
        • "blue domed"
      • ductal dilation
    • sclerosing adenosis
      • acini proliferation with intralobular fibrosis
      • associated with calcifications
      • commonly mistaken for infiltrating ductal cancer
    • ductal/epithelial hyperplasia
      • epithelial cell proliferation in terminal duct lobule
      • ↑ risk of carcinoma with atypical cells secondary to estrogen stimulation
  • Symptoms
    • bilateral breast pain or tenderness
      • size/pain varies with the menstrual cycle

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