Mammary adenoma

Adenoma of the mammary gland is a form of mastopathy along with other pathological formations in the breast (fibroma, fibroadenoma, lipoma, etc.).

This type of tumor affects only the parenchyma (glandular tissue) of the organ and is benign.

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

Causes mammary adenomas

Adenosis, i.e. abnormal division of parenchyma cells and their proliferation, is diagnosed in young women aged 20-30 years, when not only the most intensive development of lobules, milk ducts and intralobular ducts of the mammary glands occurs, but also their maximum functional load (due to childbirth and lactation). Subsequently, after forty years, glandular tissue in the breast begins to be replaced by fatty and connective (fibrous). Therefore, adenoma of the mammary gland is a pathology of women of active childbearing age and rarely occurs after menopause.

The fact that the main causes of mammary gland adenoma (and most breast tissue dysplasias) are disruptions in the production of sex hormones and their disproportion in the female body has been scientifically proven and is practically indisputable. All morphological and cyclic physiological processes that occur in female mammary glands are caused by the action of steroid hormones - estrogens, progesterone, prolactin, somatropin. Thus, the formation of glandular tissue (the growth of the number of lobules and alveoli) is "controlled" by progesterone, and the development of ducts and connective tissue - by estrogen.

When the ratio of these hormones is disturbed with a predominance of progesterone, adenoma of the mammary gland develops. And in the case of excess estrogens - fibrous adenoma of the mammary gland or fibroadenoma. By the way, this pathology often occurs with obesity, since adipose tissue is capable of accumulating estrogens.

In addition, the causes of mammary gland adenoma in almost a third of clinical cases are associated with a deficiency of thyroid hormones - in the presence of thyroid pathologies in women, as well as the pancreatic hormone insulin (in diabetes). The etiology of adenoma does not exclude a connection with liver diseases, which removes excess hormones with bile, and in case of disorders in the hepatobiliary system, it simply cannot cope with this function.

Experts claim that the causes of mammary gland adenoma may be hidden in the stress that women experience. After all, during stress, the production of corticosteroids increases many times over, which leads to disruptions in normal metabolism.

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Risk factors

Factors that contribute to the development of benign neoplasms may include childbirth, abortions, lactation, and painful periods.

[ 10 ], [ 11 ], [ 12 ]

Symptoms mammary adenomas

Typical symptoms of adenoma of the mammary gland are the presence of a small spherical hardening of approximately 10-20 mm in diameter in the thickness of the glandular tissue of the breast. The adenoma has a smooth surface and a clear outline. The palpable "pea" is mobile, i.e. it can move freely within the glandular tissue of the breast. At the same time, the formation is completely painless, and the skin of the mammary gland remains unchanged. Before menstruation, the adenoma may increase in size somewhat, but after its completion, the tumor takes on its original parameters.

In the presence of unfavorable factors, the size of the neoplasm can grow to 30 mm in diameter or more and become painful - due to pressure on the nerve endings. When pregnancy occurs, during which a full-scale hormonal restructuring of the body occurs, in 25% of cases, so-called physiological adenosis is observed. And if it is a fibrous adenoma of the mammary gland (that is, not only glandular tissue is involved in the process, but also connective tissue), then a burning sensation in the mammary gland can be felt, and when pressed - pain.

An adenoma can form in one or both mammary glands, and in two cases out of ten adenomas are multiple.

[ 13 ], [ 14 ], [ 15 ], [ 16 ]

Forms

Adenoma of the mammary gland consists of glandular tissue of the organ. This type of benign breast tumor can be observed much less often than fibroadenoma. Fibrous adenoma of the mammary gland is a simultaneous excessive growth of glandular and connective tissues, usually arising as a result of mastopathy.

Fibrous tumors of the breast are divided into nodular and leaf-shaped variants:

• nodular formations are clearly separated from nearby tissues;
• Leaf-shaped neoplasms are characterized by a large number of layers and relatively rapid growth.

During a routine examination, it is extremely difficult to distinguish between fibrous and normal adenoma; this requires additional diagnostics.

In addition to the above-mentioned variants of development of benign breast tumors, there are also tubular and lactating adenomas:

• tubular adenoma is a nodular compaction that consists of closely adjacent tubular structures, limited by epithelial and myoepithelial cells. Such structures have much in common with the structure of milk ducts;
• Lactating adenoma is a tumor with active secretion, as during the lactation period.

In addition, adenoma of the nipple and areola is distinguished when other nearby tissues are not involved in the pathological process. Such a tumor develops inside the milk ducts. Visually, the disease can be noticed by the presence of a nodule on the nipple: the pathology is sometimes accompanied by the appearance of transparent discharge, the formation of an ulcer.

[ 17 ], [ 18 ], [ 19 ]

Diagnostics mammary adenomas

Diagnosis of mammary gland adenoma begins with listening to the patient’s complaints and examining (palpating) her glands.

Self-examination is a woman's independent examination and palpation of her mammary glands. As a rule, this procedure is carried out monthly, after the end of menstruation, on the same day of the month. Each gland should be examined clockwise, with deep tissue massage. If everything is done correctly, then if there is a tumor, it can be easily palpated and promptly seek medical help.

A mammologist must prescribe a general blood test and a biochemical study of blood serum for the content of steroid hormones, as well as hormone-like compounds that precede them.

However, only a third of steroid hormones are found in blood plasma, so it is difficult to accurately determine the extent of their negative impact on processes in the mammary glands.

Correct diagnostics of mammary gland adenoma is impossible without such hardware examination methods as X-ray of the mammary gland (mammography) and ultrasound. X-ray examination with the introduction of a contrast agent into the milk ducts (ductography) can be used.

And in case of the slightest suspicion of malignancy of the adenoma, an aspiration biopsy and subsequent histological examination of the tumor cells are performed.

Special diagnostic methods involve the use of instrumental procedures:

• MRI is a visualization of a layer-by-layer image of a neoplasm, which makes it possible to see its structure;
• Contrast radiography is the production of an X-ray image after the introduction of a contrast agent into the milk ducts, which allows one to assess the condition and patency of the ducts;
• radioisotope scanning is a method used to determine the etiology of a tumor and the possibility of metastasis;

Sometimes, to clarify the characteristics of the adenoma and to determine the treatment regimen, additional tests and studies may be prescribed:

• blood test for levels of progesterone, estradiol and other hormones;
• blood test for tumor markers (allows to diagnose the patient’s predisposition to developing malignant tumors).

[ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ]

Treatment mammary adenomas

As experts note, treatment of mammary gland adenoma should be comprehensive. At the same time, many of them believe that medications (including those containing hormones) are unable to cure this disease, and recommend taking vitamins - A, C, B ₆, E and P. As well as a preparation from kelp Klamin (tablets or capsules). Organic iodine, which this product contains, is necessary for the normal functioning of the thyroid gland. Three tablets of this drug provide a person's daily dose of iodine and improve not only lipid metabolism, but also the condition of the mammary glands in women.

If the size of the neoplastic node does not exceed 10 mm, constant monitoring by a mammologist and periodic ultrasound of the mammary glands are indicated. Being in the chest for a long time, adenoma of the mammary gland does not worsen the health of many patients and does not negatively affect the functions of other systems and organs. Moreover, in clinical practice, there are many cases when this benign formation disappeared on its own. And in some women with adenoma of the mammary gland, who have passed the menopause period, the size of the formation decreases, although, as a rule, it does not disappear completely.

Treatment of mammary gland adenoma with hormonal drugs is aimed at reducing the level of estrogens, progestin, prolactin or somatropin - depending on the individual hormonal background of each patient.

Thus, the hormonal drug based on the ergot alkaloid Parlodel (Bromocriptine), by activating dopamine receptors of the hypothalamus, reduces the synthesis of such steroid hormones as prolactin and somatropin. Parlodel is prescribed at 1.25-2.5 mg in the second phase of the cycle; the minimum course of therapy is three months. Taking this drug may be accompanied by headaches, weakness, nausea, vomiting. It is contraindicated in arterial hypertension, as well as diseases of the cardiovascular system and gastrointestinal tract.

The drug Diphereline (a synthetic analogue of natural gonadotropin) inhibits ovarian function, i.e. reduces the production of both estrogen and progestin. Intramuscular injection of Diphereline is done every 4 weeks for three months. The use of this drug is fraught with increased bone fragility, ureteral obstruction, uterine bleeding, increased blood pressure and tachycardia, headache, nausea and vomiting, edema, alopecia, weight gain and decreased breast size.

In case of fibrous adenoma of the mammary gland, the drug Provera (Klinovir, Ora-gest, Methylgesten, etc.) can be prescribed, which inhibits the production of gonadotropins. The dose is determined only on an individual basis. This drug has side effects such as allergies, baldness, sleep disorders, depression, blood clots, cerebrovascular accidents, etc.

If the adenoma is recognized as a non-hormone-dependent tumor, dynamic control over the development of the process can be established. Sometimes the tumor increases, and it is necessary to resort to its removal. Less often, the adenoma regresses on its own: in some cases, this occurs after the onset of menopause, when the level of estrogens in the woman's blood decreases.

Removal of a breast adenoma is recommended only when there is concern about the benign nature of the formation, when the node in the parenchyma of the gland is constantly growing, and also when its size leads to an obvious defect in the patient's appearance.

Surgery for mammary gland adenoma is performed by the method of sectoral resection (excision). And fibrous adenoma of the mammary gland is removed both by resection and by nucleation - enucleation of the pathological node. But the most gentle way to get rid of fibrous adenoma is laser-induced thermotherapy.

The operation may be prescribed in the following situations:

• in case of rapid tumor growth;
• in case of distortion of the appearance of the mammary gland (asymmetry, bulge, etc.);
• with a tendency to malignancy;
• if the adenoma interferes with the natural function of the mammary gland (with intraductal tumor, fibroadenoma).

Removal of mammary gland adenoma can be performed in different ways:

• the enucleation method is the excision of areas with excessive tissue growth, without involving healthy areas. This operation is performed under local anesthesia. With small tumor volumes, there is usually no scar;
• The sectoral resection method is an intervention with complete excision of tumor tissue, as well as nearby areas within a few centimeters (from one to three). Sectoral resection is prescribed if there is a suspicion of malignant degeneration of the adenoma. This type of surgery is usually accompanied by further chemotherapy or radiation therapy. After sectoral removal, a trace may remain on the skin - a small scar from the incision.

Prevention

The main prevention of mammary gland adenoma is a careful attitude to your health, which in this case means a systematic examination of the mammary glands by each woman, especially if there is a tendency to breast pathologies and the entire genital area in the family. Every woman can do this: once a month, while taking a shower, examine and feel the right and left breasts to make sure there are no lumps or neoplasms. In addition, timely treatment of diseases of the ovaries, uterus, thyroid and pancreas is necessary. An important role in the prevention of all hormone-dependent pathologies is getting rid of extra pounds and a balanced diet.

The slightest signs of illness should alert a woman and become a reason for a quick visit to a medical specialist, be it a mammologist or an obstetrician-gynecologist.

You should also periodically visit the above-mentioned doctors for a routine ultrasound or mammography. Sometimes, timely treatment of diseases of other reproductive organs: appendages, uterus, and thyroid gland plays a decisive preventive role. It is also important to maintain a stable metabolism and body weight, because a slow metabolism and excess fat deposits also negatively affect the hormonal balance in the body.

Such simple measures will help you maintain the health and attractiveness of your breasts.

[ 26 ], [ 27 ], [ 28 ], [ 29 ]

Forecast

The prognosis for breast adenoma, given that its degeneration into oncology is considered unlikely, is favorable, and is not even an obstacle to pregnancy and breastfeeding.

In the case of fibrous adenoma of the mammary gland, the risk of malignancy exists, so the prognosis is considered conditionally favorable.

It should be remembered that mammary gland adenoma is a consequence of hormonal imbalances and not a precursor to the development of breast cancer.

It is important to remember that any pathological formation, including breast adenoma, is a reason for a mandatory consultation with a doctor. Only a competent specialist can determine the nature of the tumor and the degree of its danger, as well as decide what treatment can be used in each specific case.

[ 30 ], [ 31 ], [ 32 ], [ 33 ]