12/16/2023 0 Comments Fibrocystic breast changes mriBased on the number of mutations required for cancer, current opinion suggests that breast cancer is a process that takes many years to develop with the age of menarche as the earliest factor influencing this process. Recent specific genetic data suggests that an average of 11 “driver” mutations and 100 bystander mutations are present in established invasive breast cancer (10). This originally was suggested by loss of heterozygosity studies. This orderly progression depends upon the number of acquired genetic mutations accumulated by clonal cells in the breast. The linear pathway illustrated in Figure 3 depicts this progression but, while considered by some to be overly simplistic, provides a useful framework. With progression of the HELUs, atypical ductal or lobular hyperplasia, or ductal carcinoma in situ (DCIS) may ensue. Further proliferative changes result in lobules approaching 100µ in diameter and called hyperplastic elongated lobular units (HELUs). This change, when associated with a 2% or greater prevalence of Ki67 positive cells, is associated with an approximately two fold increase of subsequent breast cancer (9). Ductal tissue also may undergo hyperplastic change with an increase in number of ductal cells but without alterations in their appearance. The hyperplastic glandular lesions may progress to palpable or mammographically detectable abnormalities requiring biopsy. In the late reproductive period, glandular tissue may become hyperplastic with sclerosing adenosis or lobular hyperplasia. Ductal changes remain uncommon while stromal hyperplasia may occur resulting in areas of ill-defined fullness (“lumpy-bumpy” consistency) on physical exam or in firm areas requiring biopsy.įigure 2 Simplified anatomy of the female breast illustrating the major structural components of the breast, the anatomic location of various lesions, and the histology of those lesions and corresponding sites of origin of potential lesions. In the middle reproductive years, glandular breast tissue continues to undergo changes in response to cyclic increments in plasma levels of estradiol and progesterone and, if substantial, is called adenosis. Changes in glandular and ductal tissue occur uncommonly. During the early reproductive years, stromal hyperplasia may occur and produces juvenile breast hypertrophy (7) or rarely, the more significant problems of unilateral or bilateral macromastia (enlargement of breast tissue beyond what is considered normal) (8). Specific changes in the breast, relating to stromal, ductal and glandular tissue occur as a function of age. Importantly, fibrocystic changes detected clinically incur no increased risk of breast cancer. This new term implies that women with lumpy breasts or non-discrete nodules do not have breast disease. The term “fibrocystic changes” is now preferred since up to 50 to 60 percent of normal women may have this pattern histologically (6). The normal histologic appearance represents a spectrum ranging from a predominance of ducts, lobules, and intra- and inter-lobular stroma to patterns with a predominance of fibrous change and cyst formation, a process formerly called fibrocystic disease ( Figure 2). Anatomic and histologic structures of the breast undergo substantial change during the period from early adolescence to menopause (5).
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