Types of Fibrocystic Change

by Carlo Raj, MD

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    00:01 Here, we have fibrocystic change in a very important table that you need to make sure that you go over in greater detail.

    00:08 Every single one of the histologic changes, you must know in greater detail and I’ll walk you through these.

    00:13 And why? That’s because it is the most common cause of breast lumps in a female of reproductive age.

    00:21 You need to also know this so that you do not order unnecessary tests.

    00:26 And you need to know as to how to then examine your patients.

    00:29 Presents with premenstrual breast pain, okay? Premenstrual.

    00:34 Remember this is estrogen responsive.

    00:37 There might be multiple lesions.

    00:39 Notice that I did not say tumors.

    00:41 Lesions.

    00:43 Very specific about terminology here.

    00:45 Often will be bilateral.

    00:47 Fluctuation in size, estrogen responsive.

    00:50 May be painful or painless.

    00:53 Usually does not indicate increased risk of carcinoma.

    00:58 I will give you an exception, okay? But luckily, these females that have the lump, there’s no increase in carcinoma, but you still always have to keep your eyes open.

    01:11 Fibrosis is the first histologic change.

    01:14 As the name implies, there’s going to be fibrosis.

    01:18 You do no find cysts here and you will not find your blue dome.

    01:23 Where the fibrosis will be taking place will be with the stroma.

    01:27 Fibrosis.

    01:28 Cystic, second type of histologic change.

    01:32 Take a look at the name.

    01:34 Fibro-, cystic.

    01:35 There you have two of the four histologic changes.

    01:39 Would you please tell me as to what kind of metaplasia has taken place where it’s secreting fluid into the cyst? Can you remember apocrine metaplasia? Good.

    01:50 Why do well it blue dome? Because this cyst, if you were to then assess it with your naked eye, it would appear as being blue.

    01:58 "Hey, doc, I have a 'bruise' on my breast." Ductal dilation.

    02:04 Cystic.

    02:05 The next one is called sclerosing adenosis.

    02:09 Sclerosing means what? Narrowing.

    02:12 Adenosis and glandular.

    02:14 Pretty much given you what you need to know.

    02:16 Increased acini and there would be intralobular fibrosis.

    02:22 Stop here for one second and understand that in greater detail.

    02:25 The adenosis part would be the acini.

    02:28 What does an acini mean? Can you think of a pipette? A pipette.

    02:32 Meaning to say the proximal portion would be the bulb, the aprocrine.

    02:36 Where we’ve seen this before with acini would be the pancreatic duct and salivary duct, right? In physiology, we’ve talked about the ducts in greater detail.

    02:46 Here, the acini will be affected.

    02:49 What’s happening? Where are we? The lobule.

    02:52 Where is the lobule located in your breast apparatus? If you know it, fantastic.

    02:56 If you don’t, that’s okay.

    02:57 As I told you, I’ll go through the clinical markings and anatomy of your breast apparatus.

    03:02 The lobule will be right in front of the stroma, just above, so pretty deep, pretty deep.

    03:08 And here, you would find your fibrosis.

    03:09 So you we have narrowing, sclerosing adenosis, acini.

    03:14 Associated with calcifications.

    03:16 Remember that we do not have breast cancer per se here.

    03:20 Calcification could to you mean, “Is it concerning?” But if it’s fibrocystic change, you can take – You can sigh because chances are this is not breast cancer.

    03:32 But just keep that in mind.

    03:35 I told you there would be an exception for perhaps the increased risk of cancer of the breast.

    03:39 Here it is.

    03:40 Anytime that you have hyperplasia, you can take two routes.

    03:44 Hyperplasia, as the name implies, means that there’s going to be increased number and here, it will be the breast epithelium.

    03:52 Anytime that you have hyperplasia, do you remember? Your next step of management of endometrial hyperplasia of this subtype would be removal of the uterus.

    04:04 Hysterectomy.

    04:06 What then did you see that determined the next step of management to remove the uterus? Nuclear atypia.

    04:15 Same thing here as well.

    04:16 So epithelial hyperplasia, you follow up and make sure that you do a proper biopsy in which you then look for nuclear atypia.

    04:24 If there is nuclear atypia, then you start thinking about maybe perhaps my patient may be at risk for breast cancer.

    04:32 Epithelial hyperplasia, increased number of epithelial cells over more or less in the terminal duct in the lobules.

    04:39 So you’re moving towards the deep portion.

    04:42 There is an increased risk for carcinoma with atypical cells, that is the most important statement in this particular histologic picture.

    04:52 Once again, your female here is in her reproductive age and she is young, 30 and above.

    05:00 Fibrocystic change, dilation of duct, producing microcysts.

    05:04 Remember once again the four histologic pictures, would be your fibrosis, your cystic, sclerosing adenosis, more so associated with calcification than epithelial hyperplasia.

    About the Lecture

    The lecture Types of Fibrocystic Change by Carlo Raj, MD is from the course Breast Disease.

    Included Quiz Questions

    1. Solid mass near the stroma
    2. Premenstrual pain
    3. Estrogen-responsive size fluctuation
    4. Bilateral lesions
    5. Multiple lesions
    1. Sclerosing adenosis
    2. Cystic
    3. None are associated with calcifications
    4. Epithelial hyperplasia
    5. Fibrosis
    1. Lobules
    2. Lactiferous sinus
    3. Nipple
    4. Apocrine cells
    5. Cooper's ligaments
    1. Epithelial hyperplasia
    2. Cystic
    3. No type increases the risk of carcinoma
    4. Fibrosis
    5. Sclerosing adenosis

    Author of lecture Types of Fibrocystic Change

     Carlo Raj, MD

    Carlo Raj, MD

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