Breast cysts are the most common cause of solitary breast mass in women older than 30 years. Cystic masses are included in the context of fibrocystic disease of the breast.
We speak of fibrocystic breast changes to refer to an increase in cysts and fibrous tissue in a breast that is completely normal.
As explained by Dr. Nuria Garrido, assistant doctor of the Obstetrics and Gynecology Service of the Mammary Pathology Unit of the University Hospital of Alcalá de Henares, benign tumors of the breast, among which are included Breast cysts constitute about 20% of the consultations that appear in a specialized breast pathology unit. They tend to change with menstrual cycles, recur during childbearing years, and improve with menopause.
“There are no ways to avoid its appearance as it is part of the mammary constitution of some women”, says the doctor. breast cysts may be asymptomatic or present with pain breast (mastodynia) when they reach a size due to distension of the cyst capsule.
“the cyst it can fluctuate in size with the menstrual cycle. If the woman has regular periods, the cysts are characteristically more painful when they reach their maximum diameter, that is, just before the onset of menstruation,” explains Dr. Garrido.
Solid and cystic benign tumors may appear in the breast. Solid tumors are caused by the non-cancerous proliferation of any of its components.
So, heTumors may be cystic (breast cysts, maximum expression of fibrocystic breast disease) or solid, in which depending on the element that proliferates, be it stroma, epithelium, vascular tissue, neural tissue or adipose tissue, we will talk about:
· Fibroadenomas (mixed proliferation of stroma and epithelium).
· Phyllodes tumor (mixed proliferation of stroma and epithelium, especially the stroma).
· Hamartoma (disordered and encapsulated proliferation of all the components of the breast).
· Adenoma (only epithelial proliferation).
· Lipoma (proliferation of adipose tissue).
· Hemangioma (vascular proliferation).
Leiomyoma (proliferation of smooth muscle tissue).
Neurofibroma (proliferation of neural tissue).
Asymptomatic simple cysts do not require any treatment. In very symptomatic and painful cysts, a puncture-aspiration can be performed to evacuate content. If they do not disappear after aspiration or a residual solid component persists, a biopsy is performed.
“In the presence of clinical signs of inflammation or if the existence of bacteria is demonstrated in the culture, antibiotic treatment may be indicated. The most frequently implicated microorganism is Staphylococcus,” says Garridos.
Differences in physical examination and ultrasound
In the examination, the breasts are initially inspected with the patient semi-sitting and then in a horizontal position. Possible retractions of the nipple-areola complex are then assessed and the characteristics of the skin are inspected.
The systematic examination begins with the upper quadrants of one breast and later the lower quadrants are assessed to then explore the contralateral breast. Finally, mammary secretions are assessed through the nipple and the axillary, clavicular, and cervical nodes are palpated.
On physical examination, the cysts are palpable as a soft, more or less delimited mass that is not very mobile. The cysts may bulge the skin, but they are not adherent to it or deep and are often multiple and bilateral.
On the contrary, heMalignant tumors are palpable as hard, irregular, ill-defined nodules that retract the nipple-areola complex and may be adherent to pectoral muscles and other structures. They are often single and unilateral and may be accompanied by axillary lymphadenopathy.
Cysts can be confused with benign breast nodules, among which the most frequent are fibroadenomas, which on physical examination are hard to palpation, firm and very mobile, can bulge the skin as it grows but not retract the nipple. They are not usually accompanied by axillary nodes.
“Diagnostic confirmation is made with breast ultrasound and in some cases fine-needle aspiration puncture. Content analysis is performed in the cytology laboratory. If the aspirated fluid is purulent, it is sent to Microbiology for staining and culture. Infection normally is secondary to the rupture of the cyst in the mammary parenchyma”, the doctor clarifies.
According to Dr. Garridos, on breast ultrasound, a simple cyst can be differentiated from a complicated cyst. “Simple cysts are regular, oval, lobulated, and anechoic, with well-defined borders. Complex cysts have irregular or undifferentiated walls and may contain solid parts inside, therefore they are more likely to be associated with cancer,” he points out.
Can a benign cyst become malignant?
Most progress satisfactorily, unless there is a secondary infection or the beginning of a malignant process. When the cyst is benign, it continues its course without becoming malignant, but intracystic carcinomas do evolve into infiltrating tumors.
“In most cases, cysts are benign and will never become malignant, only a very low percentage of breast cancers exist that develop within a cyst (they are diagnosed as complex processes), from the beginning are malignant and over time evolve into tumors that infiltrate the neighboring mammary parenchyma”, explains Dr. Garrido.