Fibrocystic Changes and Breast Pain

Question 1

previously referred to as fibrocystic disease

Answer 1

• spectrum of clinical, mammographic, and histologic findings
• common during the fourth and fifth decades
• premenstrual cyclic mastalgia, with pain and tenderness to touch

Question 2

Cyclic Vs Non Cyclic

Answer 2

• Normal ovarian hormonal influences on breast glandular elements frequently produce cyclic mastalgia
• Noncyclic mastalgia is more likely idiopathic and difficult to treat

Question 3

Women 30 years and older with noncyclic mastalgia should undergo

Answer 3

> > breast imaging with mammography and ultrasonography in addition to a physical examination.

> > If examination reveals a mass, this should become the focus of subsequent evaluation

Question 4

a simple cyst may cause cyclical or noncyclic breast pain, Tx ?

Answer 4

aspiration of the cyst usually resolves the pain.

Question 5

large cysts Tx ?

Answer 5

> > will quickly recur after aspiration

> > percutaneous excision with a vacuum-assisted device will be definitive

Question 6

complex cysts with solid intracystic components

Answer 6

> > require additional evaluation including biopsy of the solid components

Question 7

Referred pain , what is the reason and location ?

Answer 7

> > the most common source of which is scapulothoracic bursitis.
cyclical Vs noncyclical

> > Shoulder pain can be referred to the axilla, breast, and arm due to shared nerve pathways (intercostal nerves & dorsal horn).

> > Trigger point injection along the medial scapular border helps diagnose and treat scapulothoracic bursitis.

> > Heat + NSAIDs reduce inflammation and pain

Question 8

Fibrocystic changes on mammogram

Answer 8

> > Fibrocystic changes are usually seen on mammography as diffuse or focal radiologically dense tissue.

> > most of these cysts are nonpalpable

Question 9

Solid elements with fibrocystic changes

Answer 9

• including adenosis, sclerosis, apocrine metaplasia, stromal fibrosis, and epithelial metaplasia and hyperplasia
• Depending on the presence of epithelial hyperplasia, fibrocystic changes are classified as
  » nonproliferative
  » proliferative without atypia
  » proliferative with atypia

Question 10

When it is a risk for Cancer ?

Answer 10

> > epithelial atypia
(atypical ductal hyperplasia [ADH]) is a risk factor for the development of breast cancer.

> > Atypical proliferations of ductal epithelial cells confer increased risk for breast cancer

> > however, fibrocystic change is not itself a risk factor for the development of breast malignancy