Evaluation F Histiopatlogical Diagnosis In The Treatment And Management Of Fibrocystic Disease Of The Breast

SUMMARY

Fibrocystic disease of the breast occurs when at the onset of menses, hormone levels decrease and the fluid responsible for the breast edema is removed by the lymphatic system. All the fluid in the breast may not be removed , eventually the fluids accumulates in the small glands and ducts of the breast, allowing cyst formation.

A case reported of a 49 years old woman presented with a three months history of a sharp constant pain arising from the back of her left breast and radiating to her left nipple and arm. This pain kept her awake at night and she was anxious that it might be caused by breast cancer. There was no significant past medical or drug history. The pain was cyclical[menstrually related].

On examination findings reveals no skin discolouration, palpable 2cm round, soft, tender immobile lump at the upper quadrant of the breast, consistent with a cyst , vital signs were normal. The breast was tender to palpation and there was no nipple discharge. Estradiol [32pg/ml] was elevated and serum progesterone [3.00nmol/l] was reduced. white blood cell count [3.2ul]was reduced, red blood cell count was normal and packed cell volume [41%]was normal .There was no patches of microbiological organisms. Despite the multiple cases in this case report, with correct diagnosis and right treatment the patient was fully recovered after 2 months of therapy.

 CHAPTER ONE              `

INTRODUCTION

Fibrocystic disease can be defined as the development of fibrous tissues and cystic spaces typically in the pancreas, glands or the breast.

Fibrocystic disease of the breast which is also known as fibrocystic breast change [FBC] is the most common type of benign breast disorder.it is a catch-all diagnosis used to describe the presence of multiple ,often painful benign breast nodules. this breast nodules vary in size and blend into surrounding tissue.

However, the histological changes responsible for the changes responsible for the breast nodules could belong to one of  several categories.

Women with a fibrocystic breast condition often have a history of spontaneous abortion shortened menstrual cycle, early menarche and late menopause. cyclic premenstrual breast pain and tenderness that last about a week are the most common  symptoms .with time,the severity of the pain increases and onset occurs 2 to 3 weeks before menstruation.

In advanced cases, the breast pain can be constant rather than cyclic. Fibrocystic breast changes usually occur bilaterally and in the upper outer quadrant of the breast. The abnormality may be described as a hardness or a thickening in the breast. The areas are usually tender, and change in size relative to the menstrual cycle[becoming more pronounced before menstruation and decreasing or the disappearing by day 4or 5 of the cycle].

GENETIC CONSIDERATION                              

Having a family history of cyst formation is common among women with fibrocystic breast disease.

GENDER AND LIFE SPAN CONSIDERATION     

Fibrocystic changes that cause premenstrual pain ,tenderness and increased tissue density usually begin when a woman reaches her mid 20s to their early 30s. Cyst occurs most frequently in women in their 30s,40s and early 50s. Advanced stages can occur during the mid to late 40s.Symptoms and cyst disappears once menopause is complete.

However, symptoms may persist in women who are taking hormone replacement therapy for menopausal discomfort. Breast cysts are uncommon in women who are 5years postmenopause and are not under going hormone replacement therapy. Therefore, the possibility of a more serious breast problem in any woman who presents with a breast mass should be carefully investigated. Birth control pills may also reduce the symptoms of fibrocystic breast disease.fibrocystic disease of the breast can make it more difficult for one or the doctor to identify potentially cancerous lumps during breast exams and on mammograms. Most fibrocystic breast diseases are either discovered clinically or brought to the attention of a family physician because of breast symptoms a woman notices herself.

TYPES OF FIBROCYSTIC BREAST DISEASE.

The different types of fibrocystic breast changes are often categorized as ;

(A)   Proliferative

(B)   Non proliferative.

PROLIFERATIVE BREAST CHANGE

This involves the growth of new cells, and that makes this category of fibrocystic diseases a little more worrisome, at least initially for the possibility of under lying breast cancer.

NON PROLIFERATIVE BREAST CHANGE   

These are those changes in which the problem has not been caused by new or unexpected cell growth. This is a type of breast problem that can occur from imbalances in secretions and infections.

ANATOMY OF THE BREAST

The breast is the tissue overlying the chest [pectoral] muscles. Womens breasts are made up of specialized tissue that produce milk (glandular tissue) as well as fatty tissue. The amount fat determines the size of the breast. The milk producing part of the breast is organized into 15 to 20 sections called LOBES. Within each lobes are smaller structure called LOBULES, where milk is produced. The milk travels through a network of tiny tubes called DUCT. The duct connect and come together into large ducts, which eventually exit the skin in the nipple is called the AREOLA.

Connective tissue and ligaments provide support to the breast and give it its shape. Nerves provide sensation to the breast also contains blood vessel, lymph vessels, and lymph nodes. (The areola contains small glands that lubricate. The nipple during breast feeding.) lymph is a fluid that travel through a network of channels called the lymphatic system and carries cells that help the body fight inflection. The lymph vessel lead to the limp node which are small bean shaped glands that are part of the inflection fighting lymphatic system. Lymph node are located in the armpit above the cover bone and in many other parts of the body including inside the chest. Lymph nodes are also found in many other parts of the body including inside the chest, abdominal cavity and the groin. Breast development and function depend on hormones produced by the ovaries, namely estrogen and progesterone. Estrogen  elongates the ducts and causes them to create side branches. Progesterone increases the number and size of the lobules in order to prepare the breast for nourishing a baby. After  ovulation, progesterone makes the breast cells grow and blood vessels enlarge and fill with blood.at this time, the breast often become engorged with fluid and may be tender and swollen.

MICROSCOPIC FEATURES.

(1)  Fluid-filled round or oval sacs (cyst)

(2)   A prominence of scara like fibrous tissue(fibrosis)

(3)   Over growth of cells (hyperplasia) linnig the milk producing tissues (lobules) of the breast.

(4)   Enlarged breast lobules (adenosis).

Pages:  27

Category: Seminar

Format:  Word & PDF

Chapters: 1-5

Material contains Table of Content, Abstract and References