7. Fibrocystic disease of the breast

Question 1

Fibrocystic disease of the breast

Answer 1

• Alternative names
• Incidence
• Etiology
• Pathology
• Clinical Picture
• Investigations
• Treatment

Question 2

Alternative names for Fibrocystic disease of the breast

Answer 2

• Mammary dysplasia
• Fibroadenosis
• chronic interstitial mastitis.
• ANDI (aberration of normal development and involuion)

Question 3

Incidence of Fibrocystic disease of the breast

Answer 3

The most frequent disorder of the breast.

Question 4

Etiology ofFibrocystic disease of the breast

Answer 4

• The exact cause is unknown
• ANDI stands for aberration of normal development and involuion due to abnormal response to estrogen with each menstrual cycle

Question 5

Pathology ofFibrocystic disease of the breast

Answer 5

The changes which take place include a mixture of the following with a variable proportion :

• Adenosis
• Epitheliosis
• Fibrosis
• Cyst formation
• Note concerning papilloma and fibroadenoma

Question 6

Adenosis in thePathology of Fibrocystic disease of the breast

Answer 6

• non-neoplastic glandular hyperplasia

* causing multiplication of acini.

Question 7

Epitheliosis in thePathology of Fibrocystic disease of the breast

Answer 7

• Definition
• Papillomatosis
• atypical Epithelial hyperplasia

Question 8

Definition of Epitheliosis in thePathology of Fibrocystic disease of the breast

Answer 8

Epithelial hyperplasia within the small ducts.

Question 9

Papillomatosis in Epitheliosis in thePathology of Fibrocystic disease of the breast

Answer 9

Extensive Epithelial hyperplasia within the small ducts forming intraductal papillary growths

Question 10

atypical Epithelial hyperplasia in epitheliosis in thePathology of Fibrocystic disease of the breast

Answer 10

• in rare cases

* accompanied by a higher possibility of developing breast cancer

Question 11

Fibrosis in thePathology of Fibrocystic disease of the breast

Answer 11

Fibrous tissue replaces the fat and elastic tissue

Question 12

Cyst formation in thePathology of Fibrocystic disease of the breast

Answer 12

a. Microcyst (commonest )

b. Macrocyst

Question 13

Microcyst in Cyst formation in thePathology of Fibrocystic disease of the breast

Answer 13

• Incidence

* Pathogenesis

Question 14

Incidence of Microcyst in Cyst formation in thePathology of Fibrocystic disease of the breast

Answer 14

commonest cyst formation in the Pathology of Fibrocystic disease of the breast

Question 15

Pathogenesis of Microcyst in cyst formation in thePathology of Fibrocystic disease of the breast

Answer 15

Degeneration cysts of the acini.

Question 16

Macrocyst in cyst formation in thePathology of Fibrocystic disease of the breast

Answer 16

• Alternative name

* Pathogenesis

Question 17

Alternative name for Macrocyst in cyst formation in thePathology of Fibrocystic disease of the breast

Answer 17

Blue-domed cyst of Bloodgood

Question 18

Pathogenesis of Macrocyst in cyst formation in thePathology of Fibrocystic disease of the breast

Answer 18

• Retention cyst

* due to obstruction of ducts by fibrosis or epitheliosis

Question 19

Note concerning papilloma and fibroadenoma in thePathology of Fibrocystic disease of the breast

Answer 19

It’s probable that:

• Duct papilloma is a localized form of epitheliosis
• Fibroadenoma is a localized form of adenosis and fibrosis

Question 20

Clinical Picture of Fibrocystic disease of the breast

Answer 20

• Symptoms

* Examination

Question 21

Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 21

1. Completely asymptomatic
2. Mastalgia : Commonest presentation
3. Nipple discharge
4. Painful nodularity
5. Breast lump

Question 22

Mastalgia in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 22

• Incidence
• Character
• Meaning of Mastodynia

Question 23

Incidence of Mastalgia in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 23

The commonest presentation ofFibrocystic disease of the breast

Question 24

Character of Mastalgia in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 24

Usually a cyclical mastalgia

Question 25

Meaning of Mastodynia in Mastalgia in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 25

marked mastalgia

Question 26

Nipple discharge in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 26

* Usually clear or yellow * brown or green * bloody

Question 27

Pathogenesis of bloody Nipple discharge in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 27

Epithelial ulceration

Question 28

Painful nodularity in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 28

* Definition | * Time

Question 29

Definition of Painful nodularity in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 29

* Multiple small painful lumps | * that may be unilateral or bilateral.

Question 30

Time of Painful nodularity in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 30

The lady Usually observes this in relation to her cycles

Question 31

Pathogenesis of Breast lump in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 31

Caused by: * a macro cyst Or * sclerosing adenosis

Question 32

sclerosing adenosis in Pathogenesis of Breast lump in Symptoms in Clinical Picture of Fibrocystic disease of the breast

Answer 32

when fibrosis is extensive )> lump formation )> sclerosing adenosis

Question 33

Examination in Clinical Picture of Fibrocystic disease of the breast

Answer 33

a. Breast | b. Axillary L.N

Question 34

Breast Examination in Clinical Picture of Fibrocystic disease of the breast

Answer 34

1. Tender breast. 2. Tender nodularity 3. Breast lump :

Question 35

Tender nodularity Examination in Breast Examination in Clinical Picture of Fibrocystic disease of the breast

Answer 35

Better felt by the tips of the fingers.

Question 36

Breast lump Examination in Breast Examination in Clinical Picture of Fibrocystic disease of the breast

Answer 36

* May be felt. | * The lump may disappear if the patient is re-examined 1 week after the menstrual cycle

Question 37

Axillary L.N Examination in Clinical Picture of Fibrocystic disease of the breast

Answer 37

* Results | * Pathogenesis of the results

Question 38

Results of Axillary L.N Examination in Clinical Picture of Fibrocystic disease of the breast

Answer 38

May be enlarged, tender & firm.

Question 39

Pathogenesis of the results of Axillary L.N Examination in Clinical Picture of Fibrocystic disease of the breast

Answer 39

due to reactive hyperplasia

Question 40

Investigations of Fibrocystic disease of the breast

Answer 40

Indications Radiological Investigations Laboratory Investigations

Question 41

Indications of Investigations of Fibrocystic disease of the breast

Answer 41

* Investigations are usually not required | * Done to rule out breast cancer in suspected cases.

Question 42

Radiological Investigations of Fibrocystic disease of the breast

Answer 42

1. Mammography & complementary breast ultrasound. | 2. U/S guided aspiration of a cyst

Question 43

U/S guided aspiration of a cyst in Radiological Investigations of Fibrocystic disease of the breast, considered benign if

Answer 43

* The fluid is not blood-stained. * The lump disappears completely after aspiration. * Does not recur within two weeks.

Question 44

Laboratory Investigations of Fibrocystic disease of the breast

Answer 44

1. Cytology of the fluid | 2. Excision biopsy

Question 45

Indications of Excision biopsy in Laboratory Investigations of Fibrocystic disease of the breast

Answer 45

* a solid mass | * a recurrent cyst.

Question 46

Treatment of Fibrocystic disease of the breast

Answer 46

1. Reassurance and follow up. 2. Advise the patient to get pregnant. 3. treatment of Cyclic mastalgia 4. Cysts are treated by aspiration 5. A recurrent cyst is treated by excision biopsy

Question 47

Treatment of Cyclic mastalgia in Treatment of Fibrocystic disease of the breast

Answer 47

a. Supportive brassiere at day time & a soft brassiere at night. b. Avoiding caffeine consumption may be useful. c. Primaleve ( capsules of primrose oil ) for 3 months. d. Treatment of intractable mastalgia

Question 48

Treatment of intractable mastalgia in Treatment of Cyclic mastalgia in Treatment of Fibrocystic disease of the breast

Answer 48

* Prolactin inhibitors | * Tamoxifen

Question 49

Prolactin inhibitors in Treatment of intractable mastalgia in Treatment of Cyclic mastalgia in Treatment of Fibrocystic disease of the breast

Answer 49

* bromocriptine | * 2.5 mg twice daily

Question 50

Tamoxifen in Treatment of intractable mastalgia in Treatment of Cyclic mastalgia in Treatment of Fibrocystic disease of the breast

Answer 50

rarely needed to deprive the breast epithelium of estrogenic drive.