Benign proliferative diseases of the breast
Fibrocystic change is the most common disorder of the female breast.
This produces clinical symptoms in 10% of all women, being present asymptomatically in about 40%. It is common in the breasts of mature women, with an increasing incidence towards the menopause, after which few cases are seen. This condition has also been known by a variety of other terms including «fibro-adenosis», «cystic mammary dysplasia)), «cystic hyperplasia)), «cystic mastopathy)) and «chronic mastitis)), but these terms are now no longer preferred.
Fibrocystic change is characterized by hyperplastic overgrowth of components of the mammary unit, i.e. lobules, ductules and stroma. There is epithelial overgrowth of lobules and ducts, often termed adenosis or epitheliosis, and fibrous overgrowth of specialized hormone-responsive breast-supporting stroma.
Unequal growth of epithelial and stromal elements occurs, giving rise to a range of solid and cystic nodules within the breast, broadly termed fibroadenomatoid hyperplasia or fibroadenosis. This presents as palpable thickening and nodularity of breast tissue, but may also result in the development of single breast lumps.
The cause of fibrocystic disease is uncertain. Most believe that it is due to disturbances of cyclical ovarian estrogen and progesterone levels, accompanied by altered responsiveness of breast tissues in women approaching the menopause.
Macroscopically, areas of fibrocystic disease appear as firm, rubbery replacement of breast tissue, in which cysts may be visible.
There are many histological variations within fibrocystic disease. In many cases the epithelium lining hyperplastic ducts undergoes metaplasia to a form similar to that of normal apocrine glands apocrine metaplasia. Cysts are a prominent component, increasing in incidence with the approach of the menopause. They range in size from those detectable only by histology to palpable lesions 1—2 cm in diameter. Cysts are lined by flattened epithelium derived from the lobular-ductal unit and are filled with watery fluid. As some carcinomas of the breast may be associated with cysts, it is not safe to assume that a lesion is benign because it has a fluid-filled cyst. Cytological examination of fluid aspirated from breast cysts may be useful in diagnosis. In some cases, there is marked proliferation of specialized hormone-responsive stromal tissue and myoepithelial cells, separating and compressing acinar and ductal structures into narrow ribbons of cells. This change, known as sclerosing adenosis, may be difficult to distinguish, both radiologically and histologically, from some patterns of invasive carcinoma. Despite the potential for confusion, this pattern of disease is not associated with development of carcinoma.
Gynecomastia of male breast is most commonly idiopathic, but may be a sign of underlying endocrine disturbance.
The male breast is normally rudimentary and inactive, consisting of fibroadipose tissue containing atrophic mammary ducts. Enlargement of the male breast, which is termed gynecomastia, may be unilateral (70% of cases) or bilateral. In most cases it is idiopathic. Other causes include: Klinefelter's syndrome, Estrogen excess (cirrhosis, puberty, adrenal tumour, exogenous estrogens), gonadotrophin excess (testicular tumour), prolactin excess (hypothalamic or pituitary disease), drug-related (spironolactone, chlorpromazine, digitalis).
Macroscopically, there is enlargement of the breast as a firm, raised, rubbery mass beneath the nipple.
Fibroadenoma presents as a mobile lump in the breast of young women.
One of the lesions most commonly responsible for causing a lump in the breast is the fibroadenoma, a benign, localized proliferation of breast ducts and stroma. There is debate as to whether this lesion is a true neoplasm or actually represents a nodular form of hyperplasia. Fibroadenomas are seen most frequently in women aged 25—35 years as solitary discrete lesions, but histologically identical areas may
also be a component of fibrocystic disease. The fibroadenoma is therefore best regarded as a form of hormone-dependent nodular hyperplasia, rather than a true benign tumour.
Macroscopically, fibroadenomas are typically 1—4 cm in diameter, appearing as firm, rubbery, well-circumscribed, white lesions that are mobile in the breast. They have a glistening cut surface and a tough texture.
There are two histological components: the epithelial component, which forms gland-like structures lined by duct-type epithelium, and the stromal component, which is a loose, cellular fibrous tissue around the epithelial areas.
A specialized type of fibroadenoma, termed a juvenile fibroadenoma, occurs in adolescents, forming huge masses that are frequently the same size or larger than the original breast. Histologically they resemble normal fibroadenomas.
Carcinoma of the breast (See Epithelial tumors).
Stages of individual work in classStudy and describe the macrospecimens
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