ESSENTIALS OF DIAGNOSIS
Painful breast masses; often multiple and bilateral.
Rapid fluctuation in mass size is common.
Pain often worsens during premenstrual phase of cycle.
Most common age is 30–50 years. 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 it has been thought that a fibrocystic condition increases the risk of breast cancer, only the variants with a component of epithelial proliferation (especially with atypia), papillomatosis, or increased breast density on mammogram 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, 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; mammography may be helpful, but the breast tissue in young women is usually too radiodense to permit a worthwhile study. Ultrasonography is useful in differentiating a cystic mass from a solid mass, especially in women with dense breasts. Simple cysts are not worrisome and require no treatment or follow-up unless they are symptomatic and causing pain, in which case they may be aspirated. Ultrasonography can reliably distinguish fibroadenoma from carcinoma but not from a phyllodes tumor. Because a mass due to fibrocystic condition may nonetheless be difficult to distinguish from carcinoma on the basis of clinical findings and imaging studies, suspicious lesions should be biopsied. Core needle biopsy, rather than fine-needle aspiration (FNA), is the preferable technique. If the lesion is cystic, needle aspiration ...