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mammary fibrocystic disease

Tuesday 29 May 2007

fibrocystic disease of the breast; diffuse cystic mastopath; fibrosclerosis of breast; chronic cystic mastitis, fibrocystic mastopathy and mammary dysplasia. Bloodgood’s disease, Cooper’s disease, Phocas’ disease, Reclus’ disease, Reclus’ syndrome (after Paul Reclus), Reclus-Schimmelbusch disease, Schimmelbusch disease and Tillaux-Phocas disease. Fibrocystic change of the breast.

WKP WebPathology

Definition: The importance of fibrocystic disease lies in its ability to mimic clinical, radiographic, gross, and microscopic features of carcinoma. It is seen most frequently between the ages of 25 and 45 years.

Macroscopy

In fibrocystic change, small cysts are surrounded by fibrous stroma. Large cysts can contain brown black fluid.

Microscopy

- mammary cysts

  • numerous variably sized cysts surrounded by foci of adenosis.
  • Some of the larger cysts in fibrocystic disease may have a bluish appearance from outside (blue-domed cysts). The cyst lining is flattened or absent in some cases.
  • Multiple dilated cystic spaces can have occasional papillary projections.

- apocrine metaplasia

  • The cysts can be lined by apocrine epithelium. Apocrine metaplasia is a frequent finding in fibrocystic disease. T
  • he lining cells have abundant eosinophilic granular cytoplasm, prominent nucleolus and apocrine snouts.
  • Apocrine metaplastic cells are characterized by having abundant eosinophilic granular cytoplasm and accumulation of secretory granules in the apical cytoplalsm, so called apocrine snout.
  • Some nuclei contain nucleoli.
  • Immunostain for GCDFP-15 is strongly positive.
  • Presence of cytologic atypia in apocrine metaplasia is not a risk factor for carcinoma.
  • The ducts lined by apocrine metaplastic cells can have focal papillary proliferation.

- microcalcifications

  • Microcalcifications tend to be less common in fibrocystic disease than in carcinoma.
  • They tend to be coarse and irregular.

Digital cases

- JRC:5298 : Mammary fibrocystic disease.
- JRC:5300 : Mammary fibrocystic disease.

Synopsis

- apocrine metaplasia

Cytogenetics

- trisomy 18 (9614905)
- tetrasomy 18 (9614905)

Links

- WebPathology

References

- Staats B, Bonk U, Gohla G, Bartnitzke S, Bullerdiek J. Two cases of fibrocystic breast disease with polysomy 18 as the sole clonal cytogenetic abnormality. Cancer Genet Cytogenet. 1998 Jun;103(2):91-4. PMID: 9614905