MEDizzy - During a routine breast self-examination, a 35-year-old

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Reproductive Systems and Skin

During a routine breast self-examination, a 35-year-old woman is concerned because her breasts feel “lumpy.” She consults you as her primary care physician. After performing an examination, you reassure her that no masses are present and that the “lumpiness” is due to fibrocystic changes. Which of the following pathologic findings is a type of nonproliferative fibrocystic change?

ExplanationFibrocystic change of the breast is one of the most common features seen in the female breast. It is most likely associated with an endocrine imbalance that causes an abnormality of the normal monthly cyclic events within the breast. These fibrocystic changes are subdivided into nonproliferative and proliferative changes. Nonproliferative changes include fibrosis of the stroma and cystic dilation of the terminal ducts, which when large may form blue-domed cysts. A common feature of the ducts in nonproliferative changes is apocrine metaplasia, which refers to epithelial cells with abundant eosinophilic cytoplasm with apical snouts. Proliferative changes include epithelial hyperplasia of the ducts. This hyperplastic epithelium may form papillary structures (papillomatosis when pronounced) or may be quite abnormal (atypical hyperplasia). Two benign, but clinically important, forms of proliferative fibrocystic change include sclerosing adenosis and radial scar. Both of these may be mistaken histologically for infiltrating ductal carcinoma, but the presence of myoepithelial cells is a helpful sign that points to the benign nature of the proliferation. Sclerosing adenosis is a disease of the terminal lobules that is typically seen in patients 35 to 45 years old. It produces a firm mass, most often located in the upper outer quadrant. Microscopically there is florid proliferation of small ductal structures in a fibrous stroma, which on low power is stellate in appearance and somewhat maintains the normal lobular architecture. A radial scar refers to ductal proliferation around a central fibrotic area.