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Dr.Surendra Nath Panda, M.S. Professor of Obstetrics & Gynaecology M.K.C.G.Medical College Berhampur, ORISSA, INDIA
11/07/2013
FBD
Pathophysiology
Hormonal basis
Oestrogen & Progesterone
Prolactin Thyroid
11/07/2013
FBD
Pathophysiology
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
Fibrocystic Breast Disease - Prof.S.N.Panda 4
11/07/2013
FBD
Pathophysiology
Thyroid
Suboptimal levels sensitize mammary epithelium to
Prolactin stimulation
FBD
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.
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11/07/2013
FBD
Pathomorphology
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.
FBD
Pathomorphology
Histopathological sections of breast showing FBD
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FBD
Clinical Course
FBD represents a clinical problem in approximately 30% of patients. Predominantly afflicted are
women with menstrual abnormalities nulliparous women patients with a history of spontaneous abortions nonusers of oral contraceptives and
Early fibrocystic manifestations may occur between the age of 20 and 25 years, but most patients (70% to 75%) are in their mid 30s and 40s.
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11/07/2013
FBD
Clinical Course
Incidence of FBD
FBD
Clinical Course
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
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FBD
Diagnosis
Symptoms and Signs
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
FBD
Diagnosis
Symptoms and Signs
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.
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11/07/2013
FBD
Diagnosis
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
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FBD
Diagnosis
Mammography
Patients with early fibrocystic change show small areas of increased density on the mammographic film.These are irregular and scattered, with varying degrees of density. As disease progresses, dark areas may occur along with the whitish grey areas, and microcalcifications may also become prominent. These calcifications can be single or multiple small flecks located in intraductal or periductal stroma or in entire lobules.
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FBD
Diagnosis
Mammography
Nodular changes are reflected in the mammogram by darker specks amid dense white areas appear- ing as "buckshot" breast". Wolfel ob- served a dense pattern in approximately 20% of women between age 39 and 49, in 5% between age 50 and 59 and in 0.5% of patients of age 60 or above.
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FBD
Diagnosis
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.
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FBD
Diagnosis
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.
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FBD
Treatment
MedicalGoal 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
Surgical
Intervention indicated when Fibroadenoma is increasing in size Serous / Serosanguineous / bloody discharge occurs Patients are pshychologicaly disturbed
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FBD
Treatment
MedicalIneffective 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 AntioestrogensTamoxifen AndrogensDanazol
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FBD
Treatment
Medical- Hormones
OC pills Users are protected from
Danazol
Remains the most
phase for 9-12 months About 80% get relief but 40% require restart of therapy
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FBD
Treatment
75% 47%
81.40%
90%
400mg
100-800mg 200-400mg
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FBD
% use 75 21 18 18 15 13 10 9 3
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A
THANK YOU
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