- Painful, often multiple, usually bilateral masses in the
- Rapid fluctuation in the size of the masses is common.
- Frequently, pain occurs or worsens and size increases during
premenstrual phase of cycle.
- Most common age is 30–50. Rare in postmenopausal
women not receiving hormonal replacement.
Fibrocystic condition is the most frequent lesion of the breast. Although
commonly referred to as “fibrocystic disease,” it does
not, in fact, represent a pathologic or anatomic disorder. It is
common in women 30–50 years of age but rare in postmenopausal
women who are not taking hormonal replacement. Estrogen is considered
a causative factor. There may be an increased risk in women who
drink alcohol, especially women between 18 and 22 years of age.
Fibrocystic condition encompasses a wide variety of benign histologic
changes in the breast epithelium, some of which are found so commonly
in normal breasts that they are probably variants of normal but
have nonetheless been termed a “condition” or “disease.”
The microscopic findings of fibrocystic condition include cysts
(gross and microscopic), papillomatosis, adenosis, fibrosis, and
ductal epithelial hyperplasia. Although fibrocystic condition has
generally been considered to increase the risk of subsequent breast
cancer, only the variants with a component of epithelial proliferation
(especially with atypia) represent true risk factors.
Fibrocystic condition may produce an asymptomatic mass in the
breast that is discovered by accident, but pain or tenderness often
calls attention to it. Discomfort often occurs or worsens during the
premenstrual phase of the cycle, at which time the cysts tend to
enlarge. Fluctuations in size and rapid appearance or disappearance
of a breast mass are common with this condition as are multiple
or bilateral masses and serous nipple discharge. Patients will give
a history of a transient lump in the breast or cyclic breast pain.
Mammography and ultrasonography should be used to evaluate a
mass in a patient with fibrocystic condition. Ultrasonography alone
may be used in women under 30 years of age. Because a mass due to
fibrocystic condition is difficult to distinguish from carcinoma
on the basis of clinical findings, suspicious lesions should be
biopsied. Fine-needle aspiration (FNA) cytology may be used, but
if a suspicious mass that is nonmalignant on cytologic examination
does not resolve over several months, it should be excised. Surgery
should be conservative, since the primary objective is to exclude cancer.
Occasionally, core needle biopsy or FNA cytology will suffice. Simple
mastectomy or extensive removal of breast tissue is rarely, if ever,
indicated for fibrocystic condition.
Pain, fluctuation in size, and multiplicity of lesions are the
features most helpful in differentiating fibrocystic condition from carcinoma.
If a dominant mass is present, the ...