Breast adenoma

Adenoma of the breast 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 has a benign character.

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

Causes of the adenomas of the mammary gland

Adenosis, that is, an abnormal division of parenchyma cells and its proliferation, is diagnosed in young women aged 20-30 years, when not only the most intensive development of lobules, lactations and intralobular ducts of the mammary glands occurs, but also their maximum functional load (in connection with childbirth and lactation). Later, after forty years, the glandular tissue in the breast begins to be replaced by fatty and connective (fibrous) tissue. Therefore, the adenoma of the breast - the pathology of women of active childbearing age and after menopause is rare.

The fact that the main causes of mammary adenoma (and most dysplasia of breast tissue) are a violation of the production of sex hormones and their disproportion in the female body, is scientifically proven and is virtually undeniable. All the morphological and cyclic physiological processes that occur in the 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 is estrogen.

With a violation of the ratio of these hormones with the prevalence of progesterone, mammary adenoma develops. And in the case of excess estrogen - fibrotic adenoma of the breast or fibroadenoma. By the way, this pathology often happens with obesity, as fatty tissue is able to accumulate estrogens.

In addition, the causes of mammary 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 hormone of the pancreas insulin (with diabetes). The etiology of adenoma does not exclude the connection with liver diseases, which with bile leads off excess hormones, and in case of violations in the work of the hepatobiliary system it simply does not cope with this function.

Experts argue that the causes of breast adenoma can be covered in the stresses that women suffer. After all, during stress, the production of corticosteroids multiplies many times, which leads to violations of normal metabolism.

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

Risk factors

Factors contributing to the development of a benign neoplasm include birth, abortion, lactation, and painful periods.

[10], [11], [12]

Symptoms of the adenomas of the mammary gland

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

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

An adenoma can form in one or both mammary glands, and in two cases out of ten adenoma have a multiple character.

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

Forms

The adenoma of the breast consists of the glandular tissue of the organ. This type of benign breast tumor can be observed much less often than fibroadenoma. Fibrous adenoma of the breast is a simultaneous excess growth of glandular and connective tissues, usually resulting from mastopathy.

Fibrous breast tumors are divided into nodal and leaf-like variants:

• nodal formations are clearly separated from the nearest tissues;
• leaflike neoplasms are distinguished by a large number of layers and relatively rapid growth.

During routine examination, it is extremely difficult to distinguish fibrous and usual adenomas, this requires additional diagnostics.

In addition to the above options for the development of a benign breast tumor, there are also tubular and lactating adenomas:

• Tubular adenoma is a nodal densification that is composed of closely adhering tubular structures bounded by epithelial and myoepithelial cells. Such structures have much in common with the structure of the milky canals;
• lactating adenoma is a tumor with active secretion, as during the lactation period.

In addition, adenomas of the nipple and the nasal zone are isolated, when other nearby tissues are not involved in the pathological process. A similar tumor develops inside the milky canals. Visually, the disease can be seen by the presence of a nodule on the nipple: pathology is sometimes accompanied by the appearance of transparent secretions, the formation of sores.

[17], [18], [19]

Diagnostics of the adenomas of the mammary gland

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

Self-examination is an independent examination and a woman's feeling of her mammary glands. Typically, 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 a deep massing of tissues. If everything is done correctly, then if there is a tumor, it can be easily probed and promptly seek medical help.

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

However, in the blood plasma there is only a third of the steroid hormones, so it is problematic to establish exactly the degree of their negative impact on the processes in the mammary glands.

Correct diagnosis of breast adenoma is impossible without such hardware examination methods as breast x-ray (mammography) and ultrasound. An x-ray study can be used with the introduction of a contrast medium into the milk ducts (doptography).

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

Special diagnostic methods include the use of instrumental procedures:

• MRI is a visualization of the layered picture of the tumor, which makes it possible to see its structure;
• contrast radiography is the acquisition of an X-ray image after the introduction of a contrast medium into the milk channels, which makes it possible to assess the condition and patency of the channels;
• radioisotope scanning is a method used to determine the etiology of a tumor and the possibility of metastasis;

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

• a blood test for the level of progesterone, estradiol and other hormones;
• the analysis of blood on onkomarkery (allows to diagnose a propensity of the patient to development of malignant tumors).

[20], [21], [22], [23], [24], [25], [26]

Treatment of the adenomas of the mammary gland

As experts note, treatment of adenoma of the breast should be complex. At the same time, many of them believe that medicines (including hormones) can not cure this disease, and they recommend taking vitamins A, C, B ₆, E and R. And also a preparation from kelamin kelamin (tablets or capsules ). Organic iodine, which contains this remedy, is needed for normal functioning of the thyroid gland. Three tablets of this drug provide a daily dose of a person in iodine and improve not only lipid metabolism, but also the condition of mammary glands in women.

If the size of the node-neoplasia does not exceed 10 mm, continuous monitoring at the mammalian doctor and periodic ultrasound of the mammary glands are shown. Being in the chest for a long time, the adenoma of the breast does not affect the health of many patients and does not affect the function of other systems and organs. Moreover, in clinical practice there are many cases when this benign formation disappeared by itself. And in some women with mammary adenoma that have passed the menopause period, the size of education decreases, although, as a rule, they do not completely disappear.

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

So, the hormonal drug based on ergot alkaloid Parlodel (Bromocriptine), activating the 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 medication can be accompanied by headaches, weakness, nausea, vomiting. It is contraindicated in arterial hypertension, as well as diseases of the cardiovascular system and the gastrointestinal tract.

Preparation Diferelin (synthetic analogue of natural gonadotropin) inhibits the function of the ovaries, that is, reduces the production of both estrogen and progesterone. Intramuscular injection of Dipherylin is done every 4 weeks for three months. The use of this drug is fraught with increased fragility of bones, obstruction of the ureter, uterine bleeding, increased blood pressure and tachycardia, headache, nausea and vomiting, swelling, alopecia, weight gain and a decrease in the size of the mammary glands.

In fibrotic adenoma of the breast, the drug Provera (Klinovir, Ora-gest, Methylgesten, etc.), which depresses gonadotropin production , can be prescribed . The dose is determined only on an individual basis. This drug has side effects such as allergies, baldness, sleep disorders, depression, blood clots, cerebral circulation, etc.

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

Removal of adenoma of the breast is recommended only when there was concern about the good quality of education, when the node in the parenchyma of the gland is constantly growing, and when its size leads to a clear defect in the appearance of the patient.

Operation with adenoma of the breast is made by the method of sectoral resection (excision). And fibrotic adenoma of the mammary gland is removed both by resection and with the help of nucleation - excision of the pathological node. But the most sparing way to get rid of fibrous adenoma is laser-induced thermal therapy.

The operation can be assigned in the following situations:

• with rapid growth of the tumor;
• when the appearance of the mammary gland is distorted (asymmetry, convexity, etc.);
• with a tendency to malignancy;
• if the adenoma interferes with the natural function of the mammary gland (with an internal tumor, fibroadenoma).

Removal of adenoma of the breast can be carried out in different ways:

• The enucleation method is the excision of areas with excess tissue growth, without the involvement of healthy zones. Such an operation is performed under local anesthesia. At small volumes of a tumor scar, as a rule, is absent;
• The method of sectoral resection is an intervention with complete excision of tumor tissues, as well as the nearest sites within a few centimeters (one to three). Sectoral resection is prescribed if there is a suspicion of a malignant degeneration of the adenoma. This type of surgery is usually accompanied by further chemotherapy or radiation therapy. After sectoral removal on the skin can remain a trace - a small scar from the cut.

Prevention

The main prevention of mammary adenoma is an attentive attitude towards one's health, which in this case means systematic examination of the mammary glands by each woman, especially if the genus has a tendency to the pathologies of the breast and the entire sexual sphere. This is within the power of every woman: once a month, while taking a shower, examine and feel the right and left breasts to make sure there are no seals and new growths. In addition, neobyodimo timely treatment of diseases of the ovaries, uterus, thyroid and pancreas. An important role in the prevention of all hormone-dependent pathologies is getting rid of excess kilos and rational nutrition.

The slightest signs of the disease should alert the woman and become an occasion for an early appeal to a medical specialist, be it a mammologist or an obstetrician-gynecologist.

Also, you should periodically visit these doctors for a planned ultrasound or mammogram. Sometimes the decisive preventive role is played by timely treatment of diseases of other reproductive organs: appendages, uterus, and thyroid gland. It is important to maintain a stable metabolism and body weight, because slow metabolism and excess fat deposits also negatively affect the hormonal balance in the body.

Such simple measures will save the health and attractiveness of the breast.

[27], [28], [29], [30]

Forecast

The prognosis of mammary adenoma, considering that its degeneration into oncology is considered unlikely, favorable, and not even an obstacle to pregnancy and breastfeeding.

In the case of fibrotic adenoma of the breast, the risk of malignancy exists, so the prognosis is considered conditionally favorable.

It should be remembered that the adenoma of the breast is a consequence of hormonal disorders, and not the precursor of the development of breast cancer.

It must be remembered that any pathological formation, including the adenoma of the breast, is an occasion for compulsory consultation of the doctor. Only a competent specialist will be able to determine the nature of the tumor and the degree of its danger, and also decide on what treatment can be applied in each specific case.

[31], [32], [33], [34]