Fibrocystic change (breast)

Fibrocystic change of the breast (also known as diffuse cystic mastopathy) is a benign alteration in the terminal ductal lobular unit of the breast with or without associated fibrosis. It is seen as a wide spectrum of altered morphology in the female breast from innocuous to those associated with risk of carcinoma.

Epidemiology

Very common entity (observed clinically in up to 50% and histologically in 90% of women ⁶). Fibrocystic change is unusual before adolescence. These are most often diagnosed between the ages of 20 and 40 with the peak before or at menopause.

As compared to the general population, women with nonproliferative lesions have no significant elevation in risk of developing a breast carcinoma, while those with the proliferative disease have a greater risk.

Clinical presentation

• breast pain that worsens during ovulation
• tender nodular swellings
• most often multifocal and bilateral

Pathology

Hormonal alterations with estrogen dominance over progesterone are considered to be an important factor. The alterations seen are subdivided into:

• non-proliferative (simple) FCC that includes simple breast cyst and/or fibrosis (most common)
• proliferative that includes
  • atypical epithelial cell hyperplasias of the ducts or ductules 
  • sclerosing adenosis

Aberrations in Normal Development and Involution of the breast (ANDI) encompasses all the changes associated with normal variations in breast parenchyma associated with changes in hormone levels and aging, thus it is better to classify fibrocystic changes under ANDI and it is not to be treated as a pathology per se.

Radiographic features

Mammography

• breasts show heterogeneous and usually dense parenchyma 
• partially circumscribed masses may be present reflecting cysts
• tea-cup, low-density round calcifications in multiple lobes

Ultrasound

On ultrasound, findings may show:

• prominent fibroglandular tissue in the area of a palpable nodule; however, no discernible mass 
• small cysts in the mammary zone