Atlas of pathophysiology, 2 Edition

Part II - Disorders

Genital Diseases

Benign Breast Conditions

Also incorrectly known as fibrocystic disease of the breast, this disorder of benign changes in breast tissue is usually bilateral.

Age Alert

Fibrocystic change is the most common benign breast disorder, affecting an estimated 10% of women ages 21 and younger, 25% of women ages 22 and older, and 50% of postmenopausal women.

Although most lesions are benign, some may proliferate and show atypical cellular growth. Fibrocystic change by itself isn't a precursor to breast cancer, but if atypical hyperplasia is present, the risk for breast carcinoma increases.

Causes

Exact cause unknown

Proposed causes

·   Estrogen excess and progesterone deficiency during luteal phase of menstrual cycle

·   Environmental toxins that inhibit cyclic guanosine monophosphate enzymes:

§  Methylxanthines—caffeine (coffee), theophylline (tea), theobromine (chocolate)

§  Tyramine—in cheese, wine, nuts

§  Tobacco

Pathophysiology

Breast tissue appears to respond to hormonal stimulation, although the exact mechanism is unknown. Fibrocystic breast changes involve three types: cystic, fibrous, and epithelial proliferation. Cysts, fluid-filled sacs, are the most common feature, and are easily treated. Fibrous tissue increases progressively until menopause and regresses thereafter. Epithelial proliferation diseases include structurally diverse lesions, such as sclerosing adenosis and the lobular and ductal hyperplasias.

Signs and symptoms

·   Breast pain due to inflammation and nerve root stimulation (most common symptom), beginning 4 to 7 days into the luteal phase of the menstrual cycle and continuing until the onset of menstruation

·   Pain in the upper outer quadrant of both breasts (common site)

·   Palpable lumps that increase in size premenstrually and are freely moveable (about 50% of all menstruating women)

·   Granular feeling of breasts on palpation

·   Occasional greenish-brown to black nipple discharge that contains fat, proteins, ductal cells, and erythrocytes (ductal hyperplasia)

Diagnostic test results

·   Ultrasonography distinguishes cystic (fluid-filled) from solid masses.

·   Tissue biopsy distinguishes benign from malignant changes.

·   Cytologic analysis of bloody aspirate rules out malignancy.

Treatment

·   Symptomatic to relieve pain, including:

·   diet low in caffeine and fat and high in fruits and vegetables

·   support bra.

·   Draining of painful cysts under local anesthesia

·   Synthetic androgens (danazol) for severe pain (occasionally)

·   Oral contraceptives

P.301

BENIGN BREAST CONDITIONS

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BENIGN BREAST TUMORS

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