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Fibrocystic changes are commonly seen in clinically symptomatic patients and during imaging workup of screening-detected findings. The term "fibrocystic changes" encompasses a broad spectrum of specific benign pathologic entities. Recognition of classically benign findings of fibrocystic changes, including cysts and layering calcifications, can prevent unnecessary follow-ups and biopsies. Imaging findings such as solid masses, nonlayering calcifications, and architectural distortion may require core needle biopsy for diagnosis. In these cases, understanding the varied appearances of fibrocystic change aids determination of radiologic-pathologic concordance. Management of fibrocystic change is typically conservative.

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OBJECTIVES: Tamoxifen is prescribed for chronic mastalgia at a dosage of one 10- or 20-mg tablet for 3-6 months. A topical preparation of this drug has recently been approved. The aim of this study was to meta-analyze the effectiveness of tamoxifen and its different regimens for the treatment of mastalgia. We also sought to summarize the side effects and the follow-up results of these treatments. DATA SOURCES: We searched the databases of PubMed/ MEDLINE, Central, Embase, and EBSCO from August 2021 to September 2021. STUDY SELECTION: Articles on the effects of tamoxifen in mastalgia were searched, and randomized controlled trials were retrieved for inclusion in this study. PRISMA guidelines were followed, and we selected 9 articles for the meta-analysis. DATA EXTRACTION AND SYNTHESIS: A proforma was prepared for data collection. RevMan 5.4 software was used for methodological quality assessment, statistical analysis, and preparation of forest plots. Oral tamoxifen performed better than placebo (risk ratio [RR] 2.04; 95% CI 1.49-2.78, P < 0.001). No significant difference in efficacy was seen between the 10- and 20-mg dosages (RR 1.08; 95% CI 0.97-1.21, P = 0.18) when used for 3 months. CONCLUSION: Oral tamoxifen is helpful in long-standing mastalgia. It is safe and effective at an oral dose of 10 mg.

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This meta-analysis aimed to determine the pooled association between polycystic ovary syndrome (PCOS), hypothyroidism, and fibrocystic breast changes. We searched important databases, including PubMed (Medline), Scopus, Web of Science, and Embase to retrieve all relevant studies published from 1990 to April 2021. The bias risk of selected articles was assessed based on the JBI checklist. Our search strategy yielded a total of 487 articles from the international databases. After screening their full-texts, 6 articles met the inclusion criteria and were considered for meta-analysis. The effect of PCOS on the incidence of fibrocystic breast changes was 2.49 (95% CI 1.85-3.34). Also, the effect of hypothyroidism on the incidence of fibrocystic breast changes was 1.90 (95% CI 0.92-3.93). The results showed that women with PCOS were at higher risks to develop fibrocystic breast changes.

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Malignant neoplasm diagnosed after radiological evaluation of a simple breast cyst is rare. This report described the case of a young patient with an initial simple cystic lesion, whom, in 18-month follow-up examinations, showed a change in the imaging pattern of the cyst, and underwent biopsy, where a triple negative carcinoma was identified. In addition, the diagnosis occurred during pregnancy, which makes the present report even rarer.

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BACKGROUND: Breast adenoid cystic carcinoma (AdCC) is a rare invasive carcinoma composed of epithelial and myoepithelial cells. Microglandular adenosis (MGA) is a rare benign proliferative lesion consisting of small, uniform, and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer. MGA may progress to atypical MGA and carcinoma arising in MGA. Among various invasive carcinomas from MGA, AdCC has been rarely reported. Here, we report a case of AdCC arising in MGA. CASE SUMMARY: A 59-year-old woman was diagnosed with a newly developed density on a routine mammogram. The density was similar to or slightly lower than that of the breast parenchyma. Sonography showed an irregular mass with a slightly higher echo than that of fat. Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma. The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern. Microscopically, the tumor was composed of invasive AdCC, in situ AdCC, and MGA. AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets, or haphazardly scattered small cribriform or tubular glands. MGA showed small glands with a single epithelial lining and retained lumen. S-100 staining was strongly positive in MGA area. The patient underwent breast-conserving surgery with sentinel lymph node biopsy. CONCLUSION: Breast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.

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BACKGROUND: Fibroadenoma (FA) is the most common benign solid breast mass in women, with no definite method of management. Because fibroadenoma is dependent on female sex hormones and comprises hypertrophic changes at cellular levels, we investigated the effects of metformin (MF), a safe hypoglycemic agent with anti-estrogenic and anti-proliferative properties, in the management of fibroadenoma. METHODS: In this randomized clinical trial study, eligible women with fibroadenomas were assigned randomly to the metformin (1000 mg daily for six months) or the placebo group. Breast physical and ultrasound exam was performed before and after the intervention, and the changes in the size of fibroadenomas were compared in the two groups. RESULTS: Overall, 83 patients in the treatment, and 92 in the placebo group completed the study. A statistically significant difference in changing size between the two groups was observed only in the smallest mass. In the largest FAs, the rate of size reduction was higher in the treatment group (60.2 % vs. 43.5 %); while a higher rate of enlargement was observed in the placebo group (38 % vs. 20.5 %). In the smallest FAs, the rate of the masses that got smaller or remained stable was about 90 % in the treatment group and 50 % in the placebo group. We categorized size changes of FAs into < 20 % enlargement and ≥ 20 % enlargement. The odds ratio (OR) for an elargemnt less than 20% was 1.48 (95 % CI = 1.10-1.99) in the treatment group in comparison with the placebo group; the odds for an enlargement less than 20% was higher in women with multiples fibroadenomas (OR = 4.67, 95 % CI: 1.34-16.28). In our study, no serious adverse effect was recorded, and the medicine was well-tolerated by all users. CONCLUSIONS: This is the first study that evaluates the effect of MF on the management of fibroadenoma, and the results suggest a favorable effect. Larger studies using higher doses of MF and including a separate design for patients with single or multiple FAs are suggested in order to confirm this effect. TRIAL REGISTRATION: This trial (IRCT20100706004329N7) was retrospectively registered on 2018-10-07.

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Objective: Primary Sjögren's syndrome (pSS) is characterized by exocrine glandular inflammation; however, the association between preceding mammary-gland-inflammation-related diseases and newly diagnosed pSS remains unexplored. Methods: We used the 2003-2013 data retrieved from Taiwan's National Health Insurance Research Database (NHIRD) to conduct the present population-based study. We identified newly diagnosed pSS female patients during the 2001-2013 period, as well as age-matched (1:20) and propensity-score-matched (1:2) non-SS individuals (as controls). We explored the associations between pSS and a history of mastitis and fibrocystic breast disease by determining adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a conditional logistical regression analysis after controlling for potential confounders. Results: We identified 9,665 patients with pSS and 193,300 age-matched non-SS controls, as well as 9,155 SS cases and 18,310 propensity-score-matched non-SS controls. We found that fibrocystic breast disease (aOR, 1.75; 95% CI, 1.63-1.88) were independently associated with incident SS, whereas mastitis and childbirth-associated breast infections were not associated with incident SS. We also found positive associations between SS and previously reported SS-associated diseases, including cardiovascular diseases, thyroid diseases, pancreatitis, bronchiectasis, infectious diseases, osteoporosis, and ankylosing spondylitis. In the propensity-score-matched populations, the associations between pSS and fibrocystic breast disease (aOR, 1.74; 95% CI, 1.58-1.91) remained consistent. Conclusion: The present population-based study revealed a previously unexplored association between pSS and history of fibrocystic breast disease, and the finding highlights the need to survey pSS in patients with mammary-gland-inflammation-associated diseases.

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Objective:To investigate the routine ultrasonographic findings of fibrinous breast disease lesions , and to provide the basis for the differential diagnosis of fibrocystic breast disease lesions and breast cancer.Methods:The two-dimensional ultrasonography , color doppler flow and elastography of 166 lesions in 144 patients with fibrocystic breast disease confirmed by pathology in Peking University Shenzhen Hospital from January 2015 to February 2021 were retrospectively analyzed.Results:The ultrasonographic characteristics of fibrocystic breast disease lesions were as follows: 74.1%(123/166) lesions were hypoechoic, 57.2%(95/166)lesions were irregular, 49.4%(82/166) lesions were incomplete, 90.4%(150/166) lesions were parallel, 25.9%(43/166) lesions showed small cysts, 24.1%(40/166) lesions showed coarse calcification or fine calcification, 65.1%(108/166) lesions showed no change in posterior echo, 90.4%(150/166) blood flow was poor. The elastography score of 98.2%(162/166) lesions was 2-3 points.Conclusions:The ultrasonographic features of fibrocystic breast tumor are hypoechoic, irregular shape, incomplete edge, with fine or coarse calcification, which are easy to be misdiagnosed as breast malignant tumor. However, the former is characterized by parallel growth, small cyst in the interior, no change in posterior echo, lack of blood supply and soft texture, which provide important basis for clinical differential diagnosis.

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Introduction: Some benign breast diseases (BBD) can determine an increased risk of developing breast cancer. Environmental factors related to lifestyle and family history of breast cancer may be associated with BBD development. However, the effect of family history of breast cancer on the risk of benign breast diseases is still unclear. Objective: To evaluate the association between family history of breast cancer and benign breast diseases. Methods: This is an integrative review that selected observational studies in different databases to analyze the association between BBD and family history of breast cancer, considering the different classification criteria for both benign diseases and family history. All studies were published between 1977 and 2016. A total of 13 studies were selected, among which ten are case-control and case-cohort studies; and three are cohort studies. Most studies received high or moderate quality classification according to the Newcastle-Ottawa assessment scale. Results: Family history of breast cancer was associated with the development of proliferative lesions and the presence of atypia, and it was more closely related to the development of benign diseases in young women, with a tendency to decrease with advancing age. Conclusion: Studies suggest there may be an association between family history of breast cancer and benign breast diseases; nevertheless, no statistically significant results were found in many case-control studies, and more robust prospective research is necessary to further clarify this association.

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Fibroadenomas are common benign tumors of the female breast. Those that present as rapidly growing breast tumors exceeding 5 cm in diameter or 500 g in weight in young female patients are commonly classified as giant juvenile fibroadenomas. These tumors are rare, and due to their excessive growth, they are usually enucleated to clarify a malignant origin, to differentiate from phyllodes tumor and to prevent persisting deformities of the breast. This report details the surgical approach to this clinical problem in a 14-year-old female with functional preservation of the breast and a good esthetic result.

Fibroadenomas são tumores benignos comuns da mama feminina. Aqueles que apresentam rápido crescimento excedendo a 5 centímetros de diâmetro ou que pesam mais que 500 gramas em mulheres jovens são classificados como fibroadenomas gigantes juvenis. Estes tumores são raros e, devido seu excessivo crescimento, são comumente enucleados para descartar uma origem maligna, diferenciar de tumores filóides e para evitar deformidades da mama. Este relato de caso detalha uma abordagem cirúrgica em uma adolescente de 14 anos com preservação da mama e bom resultado estético

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Breast cancer is a multifactorial disease. Benign breast disease (BBD) is one of the most important risk factors for breast cancer. The etiology of BBD is unknown. It is divided into nonproliferative and proliferative diseases. The selection of studies will be based on titles, abstract screening, inclusion and exclusion criteria, and quality assessment. Previous studies have shown that all types of BBD increase the risk of breast cancer, but the risk degree is different for each one. Accurate risk estimation of breast cancer in each category can be very important for proper clinical management. This systematic review and meta-analysis will be conducted on observational studies (traditional case control, nested case control, case cohort, and cohort) published in the Web of Science (ISI), PubMed (MEDLINE), Scopus, Google Scholar, and the key journals of this field such as Breast Cancer Research and Treatment and Cancer Research from January 2000 to June 2015. Reference lists and gray literature will be reviewed too. All the initial retrievals will be performed by 2 researchers independently. The data extraction form will consist of general information concerning the studies, study eligibility, method, risk of bias assessment, and results-including odds ratios, risk ratios, rate ratios, and hazard ratios. The PRISMA and MOOSE guidelines will be used to report our findings. Registration Details: PROSPERO-42016035243.

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- The aim of the study was to assess the role of the estradiol and progesterone relationship during the late luteal phase and the occurrence of fibrocystic breast disease (FBD). The concentration of estradiol/progesterone was measured in the group of women with FBD as study group (n=50) and control group of women without FBD (n=40). All women had regular ovulation cycles. Blood samples for estradiol (E2), progesterone (P) and prolactin determination were obtained in the morning at 8 am on days 21 and 24 of menstrual cycle. Significant mastalgia and mastodynia history in women with FBD was obtained with yes or no questionnaire. FBD diagnosis was confirmed with ultrasound (size and number of simple cysts). In the control group, a reduced E2/P ratio was noticed from day 21 to day 24 of the cycle (from 14.8±11.5 pg/mL to 9.1±6.1 pg/mL; p<0.05), which was not recorded in the group of women with FBD (study group). Even the slightest disturbance of the E2/P ratio may contribute to the occurrence of FBD with clinical manifestations of mastalgia and mastodynia.

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Objective:To observe the clinical effect of lower-reinforcing and upper-reducing acupuncture method for hyperplasia of mammary gland (HMG) and its influence on estradiol (E2) and progesterone (P).Methods:A randomized,single-blinded and controlled trial was conducted.A total of 124 cases conforming to the inclusion criteria were randomized by random number table into a treatment group and a control group,with 62 cases in each group.Patients in both groups received acupuncture therapy at the same acupoints,while patients in the treatment group received lower-reinforcing and upper-reducing method,and patients in the control group received even reinforcing-reducing manipulation.The treatment started around 10 d before menstruation and was conducted every other day.Patients received 5 treatments in each menstruation cycle for consecutive 3 cycles.The levels of E2,P and E2/P and clinical efficacy were measured before and after treatment.Results:After treatment,the breast lump size,pain intensity and concomitant symptoms score in both groups were substantially lower than those before treatment,showing statistical significances (all P＜0.01),and the improvement in the treatment group was higher than that in the control group,and the between-group comparisons showed statistical significances (all P＜0.01).After treatment,the overall effective rate was 91.9％ in the treatment group,higher than 72.6％ in the control group,and the between-group comparison showed a statistical significance (P＜0.01).After treatment,levels of E2,P and E2/P value showed no statistical significance when compared with those before treatment in the two groups (all P＞0.05).Conclusion:Lower-reinforcing and upper-reducing acupuncture method can effectively alleviate clinical symptoms and signs in HMG patients,and produce a better effect than even reinforcing-reducing manipulation.The majority of HMG patients' E2,P level and E2/P value were not beyond the normal ranges;therefore,acupuncture showed no substantial influence on E2 and P levels and E2/P value.

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La mastopatía diabética es una lesión fibroinflamatoria de la mama muy infrecuente, que característicamente se presenta en mujeres premenopáusicas y está fuertemente asociada a diabetes mellitus tipo I. La patogénesis es desconocida, sin embargo, histopatológicamente se ha observado una reacción en el tejido conectivo similar al de algunas enfermedades autoinmunes. La clínica y exámenes complementarios pueden ser sugerentes de neoplasia, por lo que se requiere estudio histopatológico para establecer el diagnóstico definitivo.

Diabetic mastopathy is a very infrequent fibro-inflammatory lesion generally found in pre-menopausal women and is strongly associated with type 1 diabetes mellitus. Its pathogenesis is unknown; however its histopathology shows a connective tissue reaction similar to that of some auto-immune diseases. Its clinical presentation and complementary tests may suggest neoplasm, thus definitive diagnosis requires a histopathological study.

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Microglandular adenosis (MGA) of the breast is a rare, benign proliferative lesion but with a significant rate of associated carcinoma. Herein, we report an unusual case of metaplastic carcinoma with chondroid differentiation associated with typical MGA. Histologically, MGA showed a direct transition to metaplastic carcinoma without an intervening atypical MGA or ductal carcinoma in situ component. The immunohistochemical profile of the metaplastic carcinoma was mostly similar to that of MGA. In both areas, all the epithelial cells were positive for S-100 protein, but negative for estrogen receptor, progesterone receptor, HER2/neu, and epidermal growth factor receptor. An increase in the Ki-67 and p53 labelling index was observed from MGA to invasive carcinoma. To the best of our knowledge, this is the first case of metaplastic carcinoma with chondroid differentiation arising in MGA in Korea. This case supports the hypothesis that a subset of MGA may be a non-obligate morphologic precursor of breast carcinoma, especially the triple-negative subtype.

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Microglandular adenosis (MGA) of the breast is a rare, benign proliferative lesion but with a significant rate of associated carcinoma. Herein, we report an unusual case of metaplastic carcinoma with chondroid differentiation associated with typical MGA. Histologically, MGA showed a direct transition to metaplastic carcinoma without an intervening atypical MGA or ductal carcinoma in situ component. The immunohistochemical profile of the metaplastic carcinoma was mostly similar to that of MGA. In both areas, all the epithelial cells were positive for S-100 protein, but negative for estrogen receptor, progesterone receptor, HER2/neu, and epidermal growth factor receptor. An increase in the Ki-67 and p53 labelling index was observed from MGA to invasive carcinoma. To the best of our knowledge, this is the first case of metaplastic carcinoma with chondroid differentiation arising in MGA in Korea. This case supports the hypothesis that a subset of MGA may be a non-obligate morphologic precursor of breast carcinoma, especially the triple-negative subtype.

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Mucocele-like lesions (MLLs) of the breast are characterized by cystic architecture with stromal mucin and frequent atypia, but it is unknown whether they convey long-term breast cancer risk. We evaluated 102 MLLs that were derived from a single-institution benign breast disease cohort of 13412 women who underwent biopsy from 1967 to 2001. MLLs were histologically characterized by type of lining epithelium, architecture of the lesion, associated atypical hyperplasia (AH), and incidence of breast cancer (14.8-year median follow-up). A relatively large proportion of MLLs (42%) were diagnosed in women older than 55 years. AH was significantly more frequent in MLL patient compared to the cohort overall (27% versus 5%; P < .001). Breast cancer has developed in 13 patients with MLL. This frequency is only slightly higher than population expected rates overall (standardized incidence ratio, 2.28; 95% confidence interval, 1.21-3.91) and not significantly different from women in the cohort with (nonatypical) proliferative breast lesions. Younger women (<45) with MLL had a nonsignificant increase in risk of cancer compared to the general population (standardized incidence ratio, 5.16; 95% confidence interval, 1.41-13.23). We conclude that MLL is an uncommon breast lesion that is often associated with coexisting AH. However, in women older than 45 years, MLLs do not convey additional risk of breast cancer beyond that associated with the presence of proliferative disease.

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