Diffuse breast fibroadenomatosis

Diffuse fibroadenomatosis of the mammary glands has several names: breast dysplasia, mastodynia, fibrocystic mastopathy, fibrocystic disease. But the essence of pathology is the same, and it lies in the fact that proliferative changes occur in the tissues of the mammary gland with the formation of cystic and fibrous seals.

In contrast to the nodular type, in which the fibroepithelial neoplasia in the chest have clear boundaries and localization, diffuse fibroadenomatosis of the mammary glands is manifested by glandular, cystic or fibrous seals dispersed in all breast tissues.

[1], [2], [3], [4]

Causes of the diffuse fibroadenomatosis of mammary glands

The causes of diffuse fibroadenomatosis of the mammary glands are directly related to hormonal disorders in women of any age. And this concerns not only the purely sexual female hormones (estrogen, progesterone, gonadotropes, etc.).

But the reasons why hormonal disorders occur in the female body are much more. Physicians include congenital and genetically determined factors, pathological abnormalities of the menstrual cycle, some infectious diseases, weakening of the immune system, abortions, refusal to breastfeed a child.

Among the causes of hormonal imbalance and, as a result, diffuse fibroadenomatosis of the mammary glands, experts call inflammatory diseases of the ovaries (for example, adnexitis); irregular sex life; thyroid pathology (hypothyroidism); adrenal cortex dysfunction (with increased or insufficient secretion of cortisol); violation of the pancreas (with type II diabetes and obesity).

In a special group of causes of imbalance of female sex hormones, pathologies are distinguished, accompanied by disturbances in the metabolism of hormones, which only after being converted into a water-soluble form are removed from the body. In the liver, female steroid hormones, which are converted to methoxyestrogens, are associated with glucuronic acid, and then excreted from the body with bile. When this process is disrupted, the estrogens can return back (through the intestinal walls), and their content in the body increases. That leads to diseases of the reproductive sphere of women, including pathological fibrocystic tumors in the mammary glands.

Obesity plays an important role in the occurrence of diffuse fibroadenomatosis of the mammary glands, and here's why. The fact is that the excess body fat in a woman's body provokes the accumulation of estrogen by transforming (under the influence of the enzyme arotamase) testosterone formed in the adrenal glands into female sex hormones, causing hyperestrogenism.

[5], [6],

Symptoms of the diffuse fibroadenomatosis of mammary glands

The main symptoms of diffuse fibroadenomatosis of the mammary glands are a feeling of "bursting" and uncomfortable heaviness in the chest, as well as its soreness, especially on the eve of menstruation. These signs may be permanent in the formation of fairly large sizes. In this case, the pain can be given to the nearby parts of the chest.

Doctors mammologists note that if the glandular breast tissue (parenchyma) is involved in the pathological process, then palpable densification most often has clear boundaries. When the disease affects the connective tissues (dividing the mammary gland into lobes) with the help of palpation, continuous compaction is detected and diffuse fibrous fibroadenomatosis of the mammary glands is diagnosed.

In the case of the presence of cysts in the tissues, a significant number of formations are found in the mammary gland, which have clear contours of elastic in consistency nodes of a round or oval shape with a size of up to 2 cm or more. These neoplasias do not have connections with the skin of the breast. And the diagnosis is formulated as diffuse cystic fibroadenomatosis of the mammary glands.

Also, the characteristic symptom of diffuse fibroadenomatosis of the mammary glands at the initial stage of the development of the disease is a slight change in the size of the neoplasms depending on the monthly cycle in women who have not reached menopause.

[7], [8], [9], [10], [11]

Diagnostics of the diffuse fibroadenomatosis of mammary glands

Diagnosis of diffuse fibroadenomatosis of the mammary glands is based on:

• patient complaints and breast examinations by palpation;
• x-ray examination of the breast (mammography);
• ultrasound examination (ultrasound);
• results of analysis of the content of female sex hormones in the serum;
• studies of blood vessels and blood flow in the mammary gland (dopplerosonography);
• magnetic resonance imaging (MRI, including with the introduction of a contrast agent);
• biopsy and histological examination of biopsy specimens of a neoplasm (only a biopsy gives an unequivocal answer to the question of the benign or malignant nature of neoplasia).

[12]

Treatment of the diffuse fibroadenomatosis of mammary glands

Treatment of diffuse fibroadenomatosis of the mammary glands involves drug therapy with a variety of modern pharmacological agents. In the majority of diagnosed cases of this disease, hormone preparations of anti-estrogenic action are prescribed.

Thus, the anti-estrogen drug Toremifene (analogues - Fareston, Tamoxifen, Clomiphene citrate, Droloxifen) - in the form of tablets of 20 and 60 mg each - is a non-steroidal derivative of triphenylethylene. His doctors recommend taking 20 mg per day. But this remedy is contraindicated in hyperplasia of the uterine lining (endometrium) and liver dysfunction. Toremifene can cause unwanted effects in the form of hot flashes, dizziness, excessive sweating, vaginal bleeding, nausea, rash, itching of the genitals, edema, and depression.

Raloxifene (Evista) - a benzothiophene derivative - is similar in action to Toremifene. It is prescribed only to women in the postmenopausal period, 60 mg per day.

The drug Duphaston (Didrogesteron) has the active substance Didrogesterone, which is a synthetic analogue of the hormone progesterone. It is prescribed only in case of deficiency of this hormone; The standard dosage is 10 mg (one tablet) per day, taken two weeks during each monthly cycle.

The basis of the drug effects of the drug Fazlodeks is the ability of its active component fulvestrant to block the trophic effect of estrogens due to the inhibition of estrogen-receptor activity. The drug is available in the form of a solution for intramuscular injection (250 mg, 5 ml syringe). The dosage is determined individually by the attending physician, the standard dose is 250 mg per day - once a month. The drug is not used in the presence of severe forms of liver failure, as well as pregnant and lactating women. The most common side effects of Phaslodex are nausea, vomiting, diarrhea, anorexia, vaginal bleeding, edema, urticaria, and venous thromboembolism.

The drug Parlodel (bromocriptine), being a derivative of the ergot alkaloid, reduces the synthesis of hormones such as prolactin and somatropin. Women of childbearing age are prescribed per day from 1.25 to 2.5 mg of the drug. It is necessary to accept after the termination monthly, course of treatment - till 4 months. Among the side effects of Parlodel include headache, dizziness, weakness, nausea and vomiting. This drug is contraindicated in hypertension, cardiac arrhythmias and gastrointestinal tract pathologies.

In the treatment of diffuse fibroadenomatosis of the mammary glands, Provera is also used (Farlutal, Klinovir, Vadezin, Tsikrin, and other synonyms), which blocks the production of pituitary gonadotropins. The average dose of this drug - from one to three tablets per day, after meals. Among the side effects are headaches, allergic reactions, sleep disturbances, depressive states, cardiac rhythm disturbances, etc.

In diffuse fibroadenomatosis of the mammary glands after the onset of menopause mammology, the drug Femara (Letrozole) is recommended, which inhibits the synthesis of estrogen in fatty tissues. The drug is usually taken on a tablet per day. Some patients may experience side effects such as headache, joint pain, weakness, nausea, and hot flashes.

Surgical intervention for diffuse fibroadenomatosis of the mammary glands is performed only if breast cancer is suspected. However, sectoral resection of the gland, in which a part of the affected tissue is excised (with urgent histological examination of tissues), does not provide a complete cure for the disease. Some time after the operation, the diffuse fibroadenomatosis of the mammary glands can again make itself felt, and new lesions in the breast appear in 15% of the operated patients.

Prevention

In the prevention of all dysplasias of the mammary gland, it is very important to detect pathologists in time. Therefore, women should regularly independently examine their mammary glands. And after forty years of prevention of diffuse fibroadenomatosis of the mammary glands lies in periodic visits to the doctor-mammologist, especially if the next of kin have a similar disease.

[13]

Forecast

The prognosis of diffuse fibroadenomatosis of the mammary glands, with its adequate treatment, is in most cases positive, since these tumors are benign. Nevertheless, the risk that the diffuse fibroadenomatosis of the mammary glands enters into oncology is quite large, and with intensive proliferation of cells can reach up to 25-30%.

[14], [15], [16]