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A 30 y.o XX complains of breast tenderness that becomes worse during premenstrual period. Multiple small masses are appreciable on palpation. Cytologic examination of a fine needle aspiration reveals no malignant cells. A subsequent biopsy shows multifocal cyst formation, areas of fibrosis, calcification, and apocrine metaplasia. this condition is associated with increased risk of cancer if

a.-Apocrine metaplasia is marked

b.-Calcification is prominent

c.-Cysts are larger than 0.5 cm

d.-Epithelial hyperplasia is florid

e.-Fibrosis is predominant


D, only epithelial hyperplasia indicates malignant potential



Correct answer: D

Fibrocystic change per se do not increase the risk of invasive cancer unless there is concomitant Epithelial Hyperplasia. This is defined as an increase in the number of epithelial cell layers in the terminal duct-lobular unit.

According to recommendations issued by the College of American Pathologists, patients with fibrocystic changes can be classified into 3 categories with respect to the risk of developing invasive breast cancer carcinoma:

1. Fibrocystic changes with no or mild epithelial hyperplasia (<4cell layers): no increased risk (compared with the normal population)

2.-Moderate or florid epithelial hyperplasia : 1.5-2 times the risk

3.-Atypical ductal or lobular hyperplasia: 5 times the risk.

4.-In situ ductal or lobular carcinoma: 8-10 times the risk.


Apocrine metaplasia( choice A), calcification (Choice B), cysts (choice C) and fibrosis (choice E) do not have any effect on the risk of cancer transformation, no matter how prominent or extensive these features appear.

Such changes are nonetheless important in the diagnosis of fibrocystic changes.The cysts are also primarily responsible for the symptomatology, i.e. tenderness, pain and discomfort often manifesting with cyclical pattern. Aspiration of a large cyst may result in prompt relief of pain.


D..Epithelial hyperplasia has a malignant potential........nodnod


d.-Epithelial hyperplasia is florid

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