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Breast Cyst

A breast cyst is defined as a fluid-filled sacs present in tissue of a breast, which is usually benign in nature.


Presentation

Based on the size reached, the cysts can be then classified into two groups, microcysts, if they are too small to be identified with imagining techniques, and macrocysts, with an average diameters of 3-4 centimeters. Breast cysts appear as lumps protruding from the surface of the breast, which might be painful and surrounded by a adjacent tender area. They might go undetected during physical examination, but the larger cysts can be quite visible and easily felt at touch. Breast cysts too follow the menstrual cycle, which cause them to increase in size before the period and decrease soon after it. Although they are usually begin in nature, the appearance of a new breast cyst should always be brought to the attention of a specialist. Many breast cysts remain stable even after many years, whereas others might resolve spontaneously after a relatively brief period of time [9]. The number of cysts in a breast does not increase the risk of malignancy, which means that the appearance of one single cyst might already be indicative of a tumor in preparation.

Breast Mass
  • The present case report clearly demonstrates that cyst aspiration plays a vital role in the evaluation of cystic breast masses.[ncbi.nlm.nih.gov]
  • Abstract The breast mass is a clinical problem commonly encountered by family physicians. Fine-needle and core biopsy techniques require training and cytopathologist support.[ncbi.nlm.nih.gov]
  • Cysts constitute 15% of all discrete breast masses, and represent fluid filled, distended involuted lobules. Links: clinical features and diagnosis management Aberations in the Normal Development and Involution of the breast (ANDI)[gpnotebook.co.uk]
  • Adjacent breast masses: one a debris-filled cyst, the other a simple cyst. Panoramic view of a simple breast cyst within the glandular layer of breast tissue.[imaginis.com]
  • mass with the following features: oval or round shape circumscribed margins Multiple round masses in both breasts is suggestive.[radiopaedia.org]
Excitement
  • The presence of endogenous substances in breast cyst fluid which inhibit oestrone sulphatase activity in the MCF-7 cell line is exciting because of the therapeutic potential of oestrone sulphatase inhibition in hormone-dependent breast cancers.[ncbi.nlm.nih.gov]

Workup

There are three major methodologies to diagnose breast cyst: ultrasound examination, needle aspiration [10] and mammography. Ultrasound examination is the best option, as it is almost 100% accurate and can distinguish between fluid-filled sacs and solid lumps and nodules, which might suggest the presence of precancerous and cancerous lesions. Needle aspiration instead, provides the physician with aspirated fluids which can be later used to diagnose malignancies. Mammography provides with very clear images, even though it is not sufficient to determine whether a mass is a solid lump or a cyst. Therefore, it has to be integrated with the medical history and the physical examination of the patient, to collect as much information as possible regarding the symptoms and the presence of other abnormalities.

Treatment

The majority of breast cysts cause no trouble at all and tend resolve after a certain period of time. However, in a few cases cysts become large enough to provoke pain and discomfort and require treatment. There are two major methodologies to treat breast cysts: needle aspiration biopsy and surgery.

Needle aspiration biopsy is a well known diagnostic procedure used to take samples from superficial lumps and masses, which after collection can be used to perform other types of examinations. This methodology is employed when the breast cyst tends to recur frequently but shows no major issue, thus can easily be cured by draining the fluid contained in it. After aspiration, there is no need of other medical procedures, apart from a close follow up to make sure the cyst does not reappear again. In certain cases, the rate of cyst reoccurrence might be decreased by hormone therapy thought oral contraceptives, which has the further advantage of regulating the menstrual cycle and avoid breast tissue overgrowth. In this regard, the most used drug is danazol, a derivate of the synthetic steroid ethisterone which inhibits gonadotrophin production and has weak androgenic effects [10].

Surgery is used only in a few circumstances, especially in severe cases, like the cyst recurring every month and showing blood-stained fluids, which might indicate the presence of another major medical issue still waiting to be detected.

Prognosis

As previously said, the appearance of a breast cyst is usually begin in nature, although it is quite frequent and affects a great part of the female population. Recurrent complications related to breast cysts occurrence are frequently connected with the aftermath of medical procedures, such as scarring, lost of breast size, breast asymmetry, infections and especially fluid leakage, which might trigger aseptic inflammations in the surrounding tissues [8].

Etiology

A brief overview of breast structure might help understand the development of cysts. A breast is formed by several lobes of granular tissue arranged in a way that resembles the disposition of the petals of a daisy. These lobes are further subdivided in smaller lobules which are responsible for the production of milk during pregnancy and breast-feeding. These lobules are in turn connected with ducts which bring the milk to the nipples and the outside of the woman's body. This internal part is then surrounded by a support layer of fatty and connective tissue which gives the breast its rounded shape and sinuous appearance.

A cyst develops when there is an overgrowth of glands and connective tissue in some part of the breast, in what is called a fibrocystic change. This structural modification blocks the nearby milk ducts, which in turn begin to fill up with fluids and widen out. However, the reason why a cyst develops remains unknown, even though many studies appear to suggest the excess of estrogens as responsible of an overstimulation of breast tissue growth. That is perhaps why they frequently develop during lobular development, menstrual cyclic changes, and lobular involution [2].

Epidemiology

It has been estimated that around 7% of the women in the western world are affected by breast cysts [3], especially in the 35-50 years range [4]. Many studies appear to confirm an epidemiological correlation between the appearance of macrocysts and the increased risk of breast cancer. Microcysts are more common in young premenopausal women [5].

Sex distribution
Age distribution

Pathophysiology

A better overview of the breast structure provides with further important details to comprehend the breast cysts pathophysiology. The mammary glands are at the base of the breast, where they form glandular units called breast lobules. Each breast contains from 15 to 25 glandular units. The breast lobules then drain into the lactiferous ducts which continue until the external surface of the nipple. This last stretch is characterized by two structural elements: the ampulla traversing the nipple and the lactiferous sinus underneath it, an enlarged dilatation which serves as milk reservoir during lactation [6]. The keratin overproduction that often takes place during epidermalization of lactiferous sinus might result in the appearance of a abscess formation [7], which prevents milk from spilling outside. To date, no one knows exactly the factors responsible for this overproduction.

Prevention

Unfortunately, many breast cysts cannot be prevented, because they are the consequence of hormonal changes which are simply out of the patient’s control. They have no major symptom that might help detect their growth, and tend to become evident only when they are well on the way of their full development, therefore painful and uncomfortable for the patient. This is the reason why many doctors suggest to regularly check the breast, and to become aware of it by learning to know its lineaments and details: this “awareness” helps the patient recognize the smallest breast changes and notify them to the doctor, so as to follow on time the appropriate course of action and avoid further complications.

As general measures to prevent breast cyst formation, doctors recommend to maintain a healthy life style, which means to follow a balanced and healthful diet, practice physical exercises on a daily basis, limit alcohol consumption, avoid smoking and secondhand smoke, advert certain drugs and ensure an appropriate intake of vitamins and other supplements. Stress might also be a cause of breast cyst development and should thus be avoided.

There are a number of other substances that seem to have a correlation with breast cyst appearance. The best known example of these substances is undoubtedly caffeine, whose consumption appears to be correlated with the worsening of breast cysts symptoms. If fact, many are the patients that claim to experience a symptoms relief by avoiding caffeine and its derivatives. In any case, this correlation has never been scientifically proved.

Summary

A breast cyst is a fluid-filled mass in the breast tissue. A breast might have more than one cyst, that usually appears as round or oval structure with distinct edges when observed using imaging techniques. Their size is variable, varying from a diameter of around 1 cm, the dimension of a little pea, to a diameter of 4-5 cm, the dimension of a ping-pong ball, but many can be so small to remain unidentified during physical examination. To the touch they appear as soft grapes or water-filled balloons, rarely as firm globules, which generally create no problem. However, sometime they might cause pain and discomfort, even though they are normally benign in nature.

Breast cysts are common in adolescents [1] or pre-menopausal women in their 30s and 40s, and disappear after menopause and in advanced age. They are not to be confused with milk cysts, a typical complication which affects women during weaning.

Patient Information

A breast cyst is a fluid-filled sacs present in the tissue of a breast, which is usually benign in nature. Their size is variable, varying from a diameter of around 1 cm, the dimension of a little pea, to a diameter of 4-5 cm, the dimension of a ping-pong ball, but many can be so small to remain unidentified during physical examination. To the touch they appear as soft grapes or water-filled balloons, rarely as firm globules, which generally create no problem. However, sometime they might cause pain and discomfort, even though they remain normally benign in nature.

A cyst develops when there is an overgrowth of glands and connective tissue in some part of the breast, in what is called a fibrocystic change. This structural modification blocks the nearby milk ducts, which in turn begin to fill up with fluids and widen out. However, the reason why a cyst develops remains unknown, even though many studies appear to suggest the excess of estrogens as responsible of an overstimulation of breast tissues growth. It has been estimated that around the 7% of the women in the western world are affected by breast cysts, especially in the 35-50 years range.

There are three major methodologies to diagnose breast cyst, ultrasound examination, needle aspiration and mammography, and two principal medical techniques to treat breast cysts, needle aspiration biopsy and surgery. As there is no effective way to prevent breast cysts development, and neither are there early symptoms that might help detect them, many doctors suggest to regularly check the breast, and to become aware of it by learning to know its lineaments and details. This “awareness” helps the patient recognize the smallest breast changes and notify them to the doctor, so as to follow on time the appropriate course of action and avoid further complications. As general measures, it is strongly recommended to follow a balanced and healthful diet, practice physical exercises on a daily basis, limit alcohol consumption, avoid smoking and secondhand smoke, advert certain drugs, ensure an appropriate intake of vitamins and other supplements and avoid stress as much as possible.

References

Article

  1. Strasburger VC. Adolescent Medicine: A Handbook for Primary Care. Lippincott Williams & Wilkins. p. 228. 2006
  2. Hughes LE, Mansel RE, Webster DJ. Aberrations of normal development and involution (ANDI): a new perspective on pathogenesis and nomenclature of benign breast disorders. Lancet 1987; 2:1316.
  3. Dixon JM, McDonald C, Elton RA, Miller WR. Risk of breast cancer in women with palpable breast cysts: a prospective study. Edinburgh Breast Group. Lancet 1999 353 (9166): 1742–5.
  4. Berg WA, Sechtin AG, Marques H, Zhang Z. Cystic breast masses and the ACRIN 6666 experience. Radiol Clin North Am 2010; 48:931.
  5. Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 2003; 227:183.
  6. Whitaker-Worth DL, Carlone V, Susser WS, et al. Dermatologic diseases of the breast and nipple. J Am Acad Dermatol. Nov 2000;43(5 Pt 1):733-51; quiz 752-4.
  7. Bland KI, Copeland EM, eds. The Breast: Comprehensive Management of Benign and Malignant Disorders. 3rd ed. Saunders; 2004.
  8. Dronkers DJ, Hendriks JHCL, et al. Practice of Mammography: Pathology - Technique - Interpretation - Adjunct Modalities. Thieme. p. 130. 2011
  9. Chowdhury V, Gupta AK, Khandelwal N Anju Garg A. Diagnostic Radiology: Musculoskeletal and Breast Imaging. JP Medical Ltd. p. 484. 2012
  10. Daly CP, Bailey JE, Klein KA, Helvie MA. Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy?. Acad Radiol 2008 15 (5): 610–7.

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Last updated: 2017-08-09 17:35