Fibrocystic Change

Overview

Definition

• A non-specific term without a universally agreed upon definition
• Refers to benign Benign Fibroadenoma changes in the breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy, particularly fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans and cysts
• Not associated with an increased risk of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer

Classification of benign Benign Fibroadenoma breast lesions

• Non-proliferative lesions 
  • Classic fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast
  • Examples:
    • Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans
    • Cysts
    • Adenosis (↑ number of acini per lobule)
• Proliferative lesions without atypia 
  • Generally not included in the term fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast
  • Associated with a slight ↑ risk for cancer
  • Examples: 
    • Sclerosing adenosis Sclerosing Adenosis Fibroadenoma
    • Epithelial hyperplasia Hyperplasia An increase in the number of cells in a tissue or organ without tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. Cellular Adaptation
• Atypical hyperplasias
  • Not considered fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast
  • Associated with an ↑↑ risk for cancer 
  • Often incidental findings on mammogram
  • Histologically similar to carcinoma in situ Carcinoma in situ A lesion with cytological characteristics associated with invasive carcinoma but the tumor cells are confined to the epithelium of origin, without invasion of the basement membrane. Leukoplakia
  • Examples: 
    • Atypical ductal hyperplasia Atypical Ductal Hyperplasia Benign Breast Conditions
    • Atypical lobular hyperplasia Atypical Lobular Hyperplasia Benign Breast Conditions

Epidemiology

• Most frequent benign Benign Fibroadenoma breast lesion
• Affects up to 50–60% of women
• Most common in women reproductive-age women, 30–50 years of age 
• Changes decrease (or resolve) with menopause Menopause Menopause is a physiologic process in women characterized by the permanent cessation of menstruation that occurs after the loss of ovarian activity. Menopause can only be diagnosed retrospectively, after 12 months without menstrual bleeding. Menopause.

Etiology

• Tied to estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy and progesterone Progesterone The major progestational steroid that is secreted primarily by the corpus luteum and the placenta. Progesterone acts on the uterus, the mammary glands and the brain. It is required in embryo implantation; pregnancy maintenance, and the development of mammary tissue for milk production. Progesterone, converted from pregnenolone, also serves as an intermediate in the biosynthesis of gonadal steroid hormones and adrenal corticosteroids. Gonadal Hormones levels
• Risk factors:
  • Nulliparity
  • First live birth at age > 30 years old
  • Early menarche Menarche The first menstrual cycle marked by the initiation of menstruation. Menstrual Cycle

Pathophysiology

Anatomy

• Breast tissue consists of: 
  • Epithelial components → glands and ducts
  • Stroma → adipose and fibrous connective tissue Connective tissue Connective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix. Connective Tissue: Histology
• Lobules Lobules Breasts: Anatomy are functional units (milk-producing sacs), separated by Cooper ligaments Cooper ligaments Breasts: Anatomy
  • Each contains multiple acini (tubuloalveolar glands) and adipose tissue Adipose tissue Adipose tissue is a specialized type of connective tissue that has both structural and highly complex metabolic functions, including energy storage, glucose homeostasis, and a multitude of endocrine capabilities. There are three types of adipose tissue, white adipose tissue, brown adipose tissue, and beige or “brite” adipose tissue, which is a transitional form. Adipose Tissue: Histology.
  • Acini empty into the lactiferous ducts Lactiferous ducts Breasts: Anatomy.

Pathophysiology

• The pathogenesis is incompletely understood, but appears to be associated with hormone levels.
  • Estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy stimulates ductal elements (including adenosis).
  • Progesterone Progesterone The major progestational steroid that is secreted primarily by the corpus luteum and the placenta. Progesterone acts on the uterus, the mammary glands and the brain. It is required in embryo implantation; pregnancy maintenance, and the development of mammary tissue for milk production. Progesterone, converted from pregnenolone, also serves as an intermediate in the biosynthesis of gonadal steroid hormones and adrenal corticosteroids. Gonadal Hormones stimulates stromal elements.
• Classic fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast:
  • Cystic lesions: 
    • Derived from the terminal duct lobular unit
    • Form by dilation and obstruction of the efferent Efferent Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology duct
    • Often associated with apocrine metaplasia Metaplasia A condition in which there is a change of one adult cell type to another similar adult cell type. Cellular Adaptation
    • Grow and shrink cyclically as estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy levels fluctuate → cyclic mastalgia
    • Blue-dome cysts: fluid-filled blue-brown unopened breast cysts
  • Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans:
    • Ruptured cysts → chronic stromal inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation → ↑ stromal fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans
    • Results in palpable firmness on exam
• Comparison with proliferative lesions without atypia:
  • Sclerosing adenosis Sclerosing Adenosis Fibroadenoma
    • ↑ acini and intralobular fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans → enlarged and distorted lobules Lobules Breasts: Anatomy
    • Associated stromal fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans and interspersed glandular cells
  • Epithelial hyperplasia Hyperplasia An increase in the number of cells in a tissue or organ without tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. Cellular Adaptation:↑ in number of epithelial cell layers in the ductal space or lobule

Clinical Presentation

Fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast typically present in reproductive-aged women as either “lumpy breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy,” a discrete breast mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast, or mammographic abnormalities found on routine screening Screening Preoperative Care. 

• Ill-defined, diffuse ↑ in breast consistency Consistency Dermatologic Examination (firmness)
• Palpable breast lumps
  • Single mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast or multifocal Multifocal Retinoblastoma (more common)
  • Discrete, well-circumscribed, mobile, and compressible
  • May be tender or nontender
  • Size and number of lesions can fluctuate throughout the menstrual cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation
• Cyclic breast pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
  • Generally mid-cycle
  • Fullness or heaviness
• Findings are often similar in both breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy.

Diagnosis and Management

Diagnosis

The most important thing is to differentiate benign Benign Fibroadenoma fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast from malignant conditions. 

• Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening:
  • Recommended for all women ≥ 30 years old with a breast mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast
  • Reveals round or oval-shaped masses with defined boundaries 
  • May contain densities or dispersed calcifications
• Breast ultrasound:
  • Recommended for all women with a breast mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast (including those < 30 years old)
  • Findings: 
    • Anechoic Anechoic A structure that produces no echo at all (looks completely black) Ultrasound (Sonography), well circumscribed, compressible lesions
    • Posterior wall enhancement
    • Thickened parenchyma
    • Increased echongenicity
  • Findings suspicious for cancer (these would be lacking in fibrocystic changes Fibrocystic changes A common and benign breast disease characterized by varying degree of fibrocystic changes in the breast tissue. There are three major patterns of morphological changes, including fibrosis, formation of cysts, and proliferation of glandular tissue (adenosis). The fibrocystic breast has a dense irregular, lumpy, bumpy consistency. Examination of the Breast):
    • Thickened walls
    • Septa
    • Vascular flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure
    • Solid or other echogenic components
    • Absence of posterior wall enhancement
• Core needle biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma (CNB): 
  • Histologic evaluation of suspicious imaging findings
  • Possible benign Benign Fibroadenoma findings include:
    • Cystic structures
    • Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans of stromal tissue
    • Epithelial hyperplasia Hyperplasia An increase in the number of cells in a tissue or organ without tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. Cellular Adaptation
    • Apocrine metaplasia Metaplasia A condition in which there is a change of one adult cell type to another similar adult cell type. Cellular Adaptation

Management

• Observation:
  • For patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship without significant discomfort 
  • Provide reassurance Reassurance Clinician–Patient Relationship.
  • Routine breast screening Screening Preoperative Care based on age
• Treat pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:
  • Supportive bra
  • Warm compresses Warm Compresses Chalazion
  • Avoid caffeine Caffeine A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine’s most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. Stimulants (limited evidence)
  • Non-steroidal anti-inflammatory drugs ( NSAIDs NSAIDS Primary vs Secondary Headaches) or acetaminophen Acetaminophen Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen
• Hormonal issues:
  • ↓ or discontinue postmenopausal hormone replacement therapy Hormone Replacement Therapy Hormone replacement therapy (HRT) is used to treat symptoms associated with female menopause and in combination to suppress ovulation. Risks and side effects include uterine bleeding, predisposition to cancer, breast tenderness, hyperpigmentation, migraine headaches, hypertension, bloating, and mood changes. Noncontraceptive Estrogen and Progestins
  • Oral contraceptive Oral contraceptive Compounds, usually hormonal, taken orally in order to block ovulation and prevent the occurrence of pregnancy. The hormones are generally estrogen or progesterone or both. Benign Liver Tumors pills (OCPs)
    • Can help with cyclic pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways
    • Produces negative feedback Negative feedback Hypothalamic and Pituitary Hormones for endogenous estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy production
    • May need to ↓ estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy component in some patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship
• For severe symptoms:
  • Danazol Danazol A synthetic steroid with antigonadotropic and anti-estrogenic activities that acts as an anterior pituitary suppressant by inhibiting the pituitary output of gonadotropins. It possesses some androgenic properties. Danazol has been used in the treatment of endometriosis and some benign breast disorders. Antiestrogens (androgen)
  • Tamoxifen Tamoxifen One of the selective estrogen receptor modulators with tissue-specific activities. Tamoxifen acts as an anti-estrogen (inhibiting agent) in the mammary tissue, but as an estrogen (stimulating agent) in cholesterol metabolism, bone density, and cell proliferation in the endometrium. Antiestrogens ( estrogen Estrogen Compounds that interact with estrogen receptors in target tissues to bring about the effects similar to those of estradiol. Estrogens stimulate the female reproductive organs, and the development of secondary female sex characteristics. Estrogenic chemicals include natural, synthetic, steroidal, or non-steroidal compounds. Ovaries: Anatomy receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors antagonist)
  • Bromocriptine Bromocriptine A semisynthetic ergotamine alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion. Parkinson’s Disease Drugs ( dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS agonist)
  • Fine needle aspiration Fine Needle Aspiration Fibroadenoma of cysts

Differential Diagnosis

• Fibroadenoma Fibroadenoma Fibroadenomas are the most common benign tumor of the female breast and the most common breast tumor in adolescent and young women. The tumors are well-circumscribed, mobile, and unencapsulated, with a rubbery or firm consistency. Fibroadenoma: a benign Benign Fibroadenoma, solid breast mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast composed of fibrous and glandular tissue. This presents as a small, well-defined, mobile mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast with a rubbery or firm consistency Consistency Dermatologic Examination. The exact etiology is unknown. Diagnosis is confirmed with a CNB. Management is either excision or observation.
• Phyllodes tumor Phyllodes Tumor A type of connective tissue neoplasm typically arising from intralobular stroma of the breast. It is characterized by the rapid enlargement of an asymmetric firm mobile mass. Histologically, its leaf-like stromal clefts are lined by epithelial cells. Rare phyllodes tumor of the prostate is also known. Benign Breast Conditions: a fibroepithelial tumor Tumor Inflammation similar to fibroadenomas, usually characterized by rapid growth. They may behave like benign Benign Fibroadenoma fibroadenomas, or they may become malignant and metastasize. Phyllodes tumors are associated with Li-Fraumeni syndrome. Diagnosis is by CNB and management involves complete resection, with adjuvant Adjuvant Substances that augment, stimulate, activate, potentiate, or modulate the immune response at either the cellular or humoral level. The classical agents (freund’s adjuvant, bcg, corynebacterium parvum, et al.) contain bacterial antigens. Some are endogenous (e.g., histamine, interferon, transfer factor, tuftsin, interleukin-1). Their mode of action is either non-specific, resulting in increased immune responsiveness to a wide variety of antigens, or antigen-specific, i.e., affecting a restricted type of immune response to a narrow group of antigens. The therapeutic efficacy of many biological response modifiers is related to their antigen-specific immunoadjuvanticity. Vaccination radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma in malignant cases.
• Galactocele Galactocele Benign Breast Conditions: a cystic collection of fluid usually caused by an obstructed milk duct. They present as a palpable, firm mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast in the subareolar region, and may show a classic fat-fluid level Fat-Fluid Level Imaging of the Mediastinum on imaging. Diagnosis is based on history and aspiration, yielding milky fluid. These lesions do not require excision, but this may be considered for significant discomfort.
• Mastitis Mastitis Mastitis is inflammation of the breast tissue with or without infection. The most common form of mastitis is associated with lactation in the first few weeks after birth. Non-lactational mastitis includes periductal mastitis and idiopathic granulomatous mastitis (IGM). Mastitis or breast abscess Breast Abscess Benign Breast Conditions: inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the breast tissue, most commonly due to infection with skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions or oral flora introduced during breastfeeding Breastfeeding Breastfeeding is often the primary source of nutrition for the newborn. During pregnancy, hormonal stimulation causes the number and size of mammary glands in the breast to significantly increase. After delivery, prolactin stimulates milk production, while oxytocin stimulates milk expulsion through the lactiferous ducts, where it is sucked out through the nipple by the infant. Breastfeeding. A purulent abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease may form. Occasionally non-lactational mastitis Non-Lactational Mastitis Mastitis and abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease are also possible. Cases usually present with a fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, breast pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion, edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema, and a possible tender, fluctuant Fluctuant Dermatologic Examination abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease. The diagnosis is clinical. Management involves antibiotics, continued expression of breast milk if lactating, and incision and drainage Incision And Drainage Chalazion of an abscess Abscess Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. Chronic Granulomatous Disease.
• Fat necrosis of the breast Fat necrosis of the breast Fat necrosis of the breast is an inflammatory, benign condition resulting from injury to the breast tissue. Forms of injury include blunt traumatic injury as well as trauma from surgical procedures, biopsies, and radiation therapy. Fat Necrosis of the Breast: usually due to breast injury resulting in liquefactive necrosis Liquefactive Necrosis Cell Injury and Death of the adipose tissue Adipose tissue Adipose tissue is a specialized type of connective tissue that has both structural and highly complex metabolic functions, including energy storage, glucose homeostasis, and a multitude of endocrine capabilities. There are three types of adipose tissue, white adipose tissue, brown adipose tissue, and beige or “brite” adipose tissue, which is a transitional form. Adipose Tissue: Histology. As the damaged breast tissue is repaired, there is progressive fibroblastic proliferation resulting in scar Scar Dermatologic Examination tissue. Calcifications may appear and can be difficult to distinguish from a malignant mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast. Management involves supportive measures for pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways control, but this condition is usually self-limited and does require further treatment.
• Malignant breast lesions: the most common types of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer are invasive ductal carcinoma and lobular carcinoma. Most patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship are asymptomatic, and a breast mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast may be picked up on standard cancer screening Screening Preoperative Care ( mammography Mammography Radiographic examination of the breast. Breast Cancer Screening). Diagnosis is made with a core needle biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma. Management may involve surgery, chemotherapy Chemotherapy Osteosarcoma, radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma, and hormonal treatment.