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Fibrocystic Breast Disease

08/09/2012. Fibrocystic Breast Disease - Prof.S.N.Panda. 2. Fibrocystic Breast Disease (FBD). Most benign breast conditionIncidence-varying, related to ageMenstruating years-200-50% in premenopausal yearsSynonyms-Mammary dysplasia, Cystic disease, Cyclic Mastopathy, Cystic Hyperplasia. 08/

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Fibrocystic Breast Disease

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    1. Fibrocystic Breast Disease Dr.Surendra Nath Panda, M.S. Professor of Obstetrics & Gynaecology M.K.C.G.Medical College Berhampur, ORISSA, INDIA

    2. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 2 Fibrocystic Breast Disease (FBD) Most benign breast condition Incidence-varying, related to age Menstruating years-20% 30-50% in premenopausal years Synonyms- Mammary dysplasia, Cystic disease, Cyclic Mastopathy, Cystic Hyperplasia

    3. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 3 Pathophysiology Hormonal basis Oestrogen & Progesterone Prolactin Thyroid Methylexanthiones Trauma- NOT A CAUSE

    4. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 4 Oestrogen & Progesterone Oestrogen predominance over progesterone is considered causative Serum levels of Oestrogen > Luteal phase is shortened Progesterone level decreased to 1/3 normal Corp. Lut. Deficiency / Anovulation in 70% Patients with Pre Menstrual Tension syndrome more likely to develop FBD Women with progesterone deficiency carry a five fold risk of premenopausal breast cancer

    5. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 5 Prolactin- levels are increased in 1/3 of women with FDB Probably due to Oestrogen dominance on pituitary Thyroid – Suboptimal levels sensitize mammary epithelium to Prolactin stimulation Methylexanthiones- Increased intake of coffee, tea, cold drinks chocolate is associated with development of FDP

    6. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 6 Pathomorphology Oestrogens stimulate proliferation of connective and epithelial tissues.' The polymorphism of fibroeystic disease is documented by fibrosis, cyst formation, epithelial proliferation, and lobular-alveolar atrophy. FBD entails simultaneous progressive and regressive change. Ductular branching, intraductal epithelial proliferation(papillomatosis), lobular hyperplasia, and proliferation of intralobular connective tissue may undergo regressive changes such as. adenofibrosis, srlerosing adenosis, duct dilation, cyst formation, and calcification. Loss of parenchymal elements (ductules, alveoli) with intra-lobular and periductal fibrosis is encountered in chronic disease.

    7. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 7 Cyst formation as a consequence of obstruction by stromal fibrosis and per- sisting ductular alveolar secretion, whereby material is retained, leading to dilation of terminal ducts (duct ectasia) and alveoli with cyst formation. In 20% to 40% of patients with fibroeystic dis- ease, gross cyst formation is observed. Macrocysts (>1 em in diameter) rep- resent an advanced form of fibrocystic disease. They develop in women mainly in their forties and, depending on the degree of fluid filling and pericystic fi- brosis, appear softer or harder. Pathomorphology

    8. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 8 Histopathological sections of breast showing FBD Pathomorphology

    9. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 9 Clinical Course

    10. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 10 Clinical Course

    11. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 11 Clinically, three phases of fibrocystic disease can be recognized- Phase I-Moderate stromal fibrosis, beginning hardness of breast tissue and premenstrual breast tenderness Phase II- Progressive fibrosis leading to increased hardening and tenderness, cyst formation, moderate modularity Phase III- Pronounced fibrosis and tenderness, macrocyst formation Clinical Course

    12. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 12 Diagnosis Fibroeystic disease has a history of many months to several years. Fibroeystic disease is rare in ovulating women, multiparous women, and patients using oral contraceptives. Breast pain (mastodynia) and/or tenderness is observed in the majority of patients. In 40% to 60% of patients these are associated with irregular menses, dysmenorrhea, menometrorrhagia, or ovarian cysts.

    13. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 13 Breast pain (mastodynia) and/or tenderness is observed in the majority of patients. Mastodynia may start a few days or 1 to 2 weeks before menstruation; it usually eases or subsides with the onset of or during menses. In more than half of the patients with mazoplasia, pre- menstrual breast swelling, mastodynia, and irregular menses, are observed. In approximately 20% of patients, axillary tenderness and enlarged lymph nodes are observed. Diagnosis

    14. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 14 Nipple secretion- In one third of patients with FBD, discharge is spontaneous or secretion can be expelled from the nipple. The cytological features may include amorphous material (fat, proteins), ductal cells, erythrocytes, andlor foam cells. 7he fluid is straw yellow, green- ish, or bluish. In 2-3% carcinoma is diagnosed Bloody Nipple secretion- when present 50-60% due to intra ductal proliferation (Papilloma) 30-40% due to carcinoma ( 64% after age 50). Diagnosis

    15. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 15 Mammography –

    16. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 16 Mammography –

    17. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 17 Ultrasonography - Particularly useful in delineating solid from cystic breast masses. Ultrasound of cystic masses characteristically defines a mass with a uniform outer margin demonstrating no asymmetry or unusual thickness of the wall. The central part of the mass shows no echoes, and there is posterior wall enhancement.

    18. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 18 Needle aspiration biopsy – Indicated in patients with breast mass, a lump like structure,, a hard dense area or any abnormal tissue areas, as defined by clinical examination, mammography or USG. In patients at high risk of breast cancer, needle aspiration should be performed when the slightest suspicion arises. In women with fibrocystic disease, ductal epithelium consists of cohesive cells with a scant rim of cytoplasm and round or oval small, slightly hyper chromatic nuclei. Connective (fibrous) tissue is usually predominant.

    19. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 19 Treatment Goal- To stop progression To relieve pain To reverse changes Soften breast tissue Indicated when- Fibroadenoma is not increasing in size No nipple discharge No psychological effect Intervention indicated when- Fibroadenoma is increasing in size Serous / Serosanguineous / bloody discharge occurs Patients are pshychologicaly disturbed

    20. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 20 Ineffective modalities Diet therapy-Caffeine restriction Diuretics Iodine containing agents Thyroid hormone Evening Primrose oil Vitamin E & B6 Dihydroergotamine Antiprolactin drugs Analgesics Hormones- Low Oestrogen Combined OC pills Progestogens in the luteal phase Antioestrogens- Tamoxifen Androgens-Danazol

    21. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 21 OC pills- Users are protected from FBD Progestogen potency should be high Progestogens - To be given in the luteal phase for 9-12 months About 80% get relief but 40% require restart of therapy Danazol Remains the most effective therapy Basis- ovarian supression Dose-200-600mg/day

    22. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 22

    23. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 23 Treatment Preferences of 276 Consultants (UK) – BeLieu RM,1994

    24. 08/09/2012 Fibrocystic Breast Disease - Prof.S.N.Panda 24 THANK YOU

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