![]() Besides menstrual hormonal change, other endogenous or exogenous hormonal stimuli, such as pregnancy, lactation, hormone replacement therapy in post-menopausal women, and hormone therapy in the treatment or prophylaxis of breast cancer, can also affect breast density, fibroglandular tissue volume, and background enhancement on breast imaging. Meanwhile, serum or salivary levels of endogenous hormones are not directly linked to changes in breast density, volume, and enhancement on mammography and MRI during the menstrual cycle rather, cell proliferation observed in the luteal phase may be responsible for these cyclic changes. Breast density on mammography and fibroglandular tissue volume and background parenchymal enhancement on MRI vary according to the phases of the menstrual cycle, all of which are more increased at the luteal phase than the follicular phase. Such histological changes in breast tissue at a cellular level, according to the different phases of the menstrual cycle, can be reflected in imaging studies. Enlargement of the ductal lumens with glandular secretion and vascular congestions also occur at the luteal phase. Toward the luteal phase, histological characteristics such as distinction between epithelial and myoepithelial layers of the acini, basal-layer vacuolation of the acini, stromal edema, and infiltration, apoptosis, and mitosis progressively appear and become more intensified than at the follicular phase. The histological characteristics of breast tissue at cellular level differ between the follicular phase and luteal phase. Besides this long-term modification, breast tissue also varies cyclically within a menstrual cycle in response to endogenous hormonal alteration. ![]() Although she did not undergo follow-up breast imaging, 3 years after the biopsy she did not complain of further progression of breast symptoms or present with clinical evidence of breast cancer.īreast tissue is quite a unique hormonally sensitive organ, which continuously varies throughout a person’s lifetime from pubertal development to menopausal involution under the control of hormonal regulation. Serum level of estradiol or total estrogen was not checked at that time. Microscopic findings of the biopsied breast lesion showed multiple cystically dilated breast ducts located in the terminal duct lobular units in fibrosclerotic background ( Figure 4). This led to a pathological diagnosis of fibrocystic change. Ultrasonography-guided 14-gauge core needle biopsy was performed at the upper inner quadrant of the left breast, and 8 fragments of biopsy specimens were acquired at multiple sites in the quadrant. MRI demonstrated unilateral, diffuse, stippled enhancement at the left breast that began at the periphery of breast tissue during the early phase and gradually propagated centrally in the delayed phase with a persistent kinetic pattern ( Figure 3). ![]() Background echotextures of both breasts were symmetrical and homogeneously fibroglandular ( Figure 2). ![]() Ultrasonography also showed a larger amount of fibroglandular tissue in the left breast than the right breast without discernable abnormality. Both breasts had symmetrical overall densities and were extremely dense ( Figure 1). On mammography, the left breast showed a larger volume of fibroglandular tissue than the right breast with no accompanying sign of malignancy ( Figure 1). She had no past medical history or family history of breast cancer. Simultaneously, she had also developed polymenorrhea with a frequency of twice a month. Assessment revealed focal palpability at the upper inner portion of the left breast. A 38-year-old female presented with a complaint of progressive unilateral enlargement of her left breast over 3 months.
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