Masses in the breast

Formations in the mammary gland are part of a large cluster of proliferative processes occurring in tissues, which in clinical practice are called mastopathy or benign hyperplastic diseases.

Adenoma, fibroma, fibroadenoma, fibrocystic disease, lipoma... All these pathological formations in the mammary gland are associated with hormonal disorders and occur in women of different ages.

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Causes breast masses

The key causes of breast formations, recognized in modern mammology, are abnormal proliferation (cell division) of breast tissue, and this pathological process is the result of hormonal disorders. Deviations from the level of estrogen, progesterone, prolactin programmed by nature, which directly affect breast tissue, as well as the male hormone testosterone, together with malfunctions in the hypothalamic-pituitary system of the body, negatively affect the cellular structure of the parenchyma and stroma of the mammary glands. As a result, there is an "unplanned" increase in the number of cells, causing hyperplasia, or their pathological development - dysplasia.

Clinical studies of recent years provide every reason to include iodine deficiency in the body, which increases the sensitivity of mammary gland tissue to estrogen, among the causes of hormone-dependent formations in the mammary gland.

Experts consider the following to be the main factors that increase the likelihood of formations in the mammary gland:

• stable menstrual cycle disorders, premature onset of menstruation in girls (before 12 years of age), late onset of menopause in adult women;
• reproductive factors (multiple artificial terminations of pregnancy, late first pregnancy, refusal of natural breastfeeding, absence of pregnancies and births, infertility);
• gynecological diseases (endometriosis, uterine fibromatosis, ovarian inflammation and cysts);
• violation of general metabolism (in obesity, diabetes, pathologies of the thyroid and pancreas);
• stress and psychotic conditions;
• abuse of hormonal drugs, in particular contraceptives;
• the presence of various forms of mastopathy in the family history on the female side.

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Symptoms breast masses

The nature of the development of breast pathologies in women has individual characteristics, but there are also typical symptoms of formations in the mammary gland.

Among such signs are:

• a palpable oval or round formation in the mammary gland of varying density, mobile or strictly fixed in the thickness of the tissue;
• discomfort in the chest and swelling (engorgement) before the start of the next menstruation;
• burning sensation in the mammary gland;
• noticeable increase and decrease in the size of the mammary gland during the menstrual cycle;
• pain of varying intensity before and during menstruation;
• pain in the mammary gland not associated with menstruation (with a number of hyperplastic pathologies, pain is absent even when palpating the formation);
• enlarged lymph nodes in the armpit area;
• distinct changes in the skin of the mammary gland (in color and structure);
• the appearance of discharge from the nipple (transparent, greenish-yellow or with bloody elements).

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Forms

There is a clinical classification according to which a benign formation in the mammary gland can be nodular, diffuse or lobular. There is also a histological classification of mammary gland tumors, which was developed by WHO and includes all formations in the mammary gland. This international classification differentiates formations into epithelial (these include more than two dozen cancerous tumors of the mammary gland, as well as non-cancerous formations - adenomas), myoepithelial, mesenchymal, fibroepithelial, etc.

Nodular, diffuse and lobular formations

Nodular formations in the mammary gland or, as they are also called, focal formations in the mammary gland are a single, elastic to the touch or dense formation in the mammary gland, having the appearance of a node with clear boundaries and localization, that is, not spreading throughout the gland. Nodular formations can arise from glandular and fibrous tissue, can be mobile or fused with surrounding tissues. In shape, a round formation in the mammary gland very often may not manifest itself in any way and not cause the slightest discomfort, or it may be painful when palpated. Such nodes in most cases form in one mammary gland.

Experts classify fibroadenoma (focal fibrosis, nodular or localized fibroadenomatosis), phylloid (or leaf-shaped) fibroadenoma, cysts and lipoma as this type.

Next come diffuse formations in the mammary gland. Among them, a fibrous formation in the mammary gland is distinguished, which is manifested by multiple seals throughout the breast, formed as a result of the proliferation of fibrous tissue cells, as well as adenosis of the glandular lobules. Diffuse fibroadenoma is diagnosed when formations in the mammary gland consist of fibrous and glandular tissue. In this case, a formation may be found in the right mammary gland, or a formation in the left mammary gland, or both breasts may be affected at the same time.

Lobular formations are characterized by damage to fibrous tissue in the lobules of the gland. And with this type of formation, mammologists diagnose pericanalicular or intracanalicular fibroadenoma, sclerosing adenosis of the milk ducts of the mammary gland, or sclerosing lymphocytic lobular mastitis. Sclerosing pathologies are the lot of many elderly women, this is a benign formation in the mammary gland, but with this disease, the formation of calcifications in the mammary gland is observed.

It should also be noted that the most voluminous formation in the mammary gland, which can occupy most of the gland, occurs with leaf-shaped fibroadenoma and lipoma.

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Glandular, fibrous, cystic, fatty formations

In many cases, a single glandular formation in the mammary gland (adenoma) may appear, which consists, accordingly, of glandular tissue - parenchyma. All adenomas, as well as intraductal papilloma, are epithelial hyperplasias.

Fibrous formation in the mammary gland is the proliferation of fibrous connective tissue. Fibrosis, that is, the reorganization of the cytoskeleton of epithelial tissues and their transformation into fibrous (which can be observed in any organ) usually occurs where it is necessary to isolate some inflammation focus from surrounding structures. And this process is regulated not by sex hormones, but by anti-inflammatory hormone-like proteins cytokines (which are produced by macrophages, granulocytes, reticular fibroblasts) and the renin-angiotensin-aldosterone system of the body, which synthesizes biologically active substances. But today in mammology the mechanism of fibrogenesis in the etiology of fibrous formations in the mammary gland is not taken into account.

A fibrous formation in the mammary gland is diagnosed as fibroadenoma, adenofibroma, fibrocystic disease, etc. And this is true, since with rare exceptions the composition of such tissue conglomerates is mixed. A classic example of mixed fibrous-epithelial hyperplasia is a nodular heterogeneous formation in the mammary gland in the form of fibroadenoma, which is characterized by the presence of abnormally overgrown cells of both fibrous tissue and parenchymal epithelium, as well as fibrocystic disease or dysplasia of the mammary gland.

A cystic formation in the mammary gland, based on the pathogenesis of cysts, most likely does not fall into the category of hormone-dependent proliferative pathologies, since it is a cystic cavity, and often these are liquid formations in the mammary gland.

If the encapsulated cavity appeared in the last stages of pregnancy or during lactation due to blockage of the milk duct and retention of colostrum or breast milk, then this is a retention cyst. Such a cystic formation in the mammary gland is called a lactocele (or galactocele). A ramolitic cyst is a benign but quite painful formation in the mammary gland that occurs as a result of injury to soft tissues, for example, after a chest contusion. The cyst is a fixed dense formation in the mammary gland - it has a round shape, the sizes are different, there can be multiple, and it can provoke the formation of calcifications in the mammary gland.

Mesenchymal formations are tumors of various tissues, as well as vessels and membranes (serous and synovial). In the everyday diagnostic terminology of domestic mammologists, this definition is often not used, although this type includes chondroma, which is similar to fibroadenoma - a benign formation in the mammary gland, growing from cartilage or bone into the soft tissues of the breast. Chondroma can also cause the formation of calcifications in the mammary gland.

The main thing in the clinical picture of congenital vascular formations is hemangiomas - a red or bluish-purple soft tumor in the superficial layer of the skin of the mammary gland. This formation has clear boundaries and can slightly rise on the skin.

Fatty formation in the mammary gland is represented by atheroma and lipoma. Due to the obstruction of the sebaceous gland duct, a cystic formation in the mammary gland - atheroma - can develop in the thickness of the skin. These cysts of the sebaceous gland of the skin, which have a capsule and viscous contents, are a dermatological problem, despite the fact that atheroma of the mammary gland can reach impressive sizes. The occurrence of atheromas is associated with increased secretion of male sex hormones and a deficiency of thyroid hormones. These formations have a tendency to inflammation (if an infection occurs) and the formation of abscesses.

But such a fatty benign formation in the mammary gland as a lipoma is classified as a nodular mesenchymal formation, its increased growth leads to an increase in the affected breast and deformation of its shape. In addition, when the nerve endings are compressed, the lipoma can be very painful.

Diagnostics breast masses

Diagnosis of formations in the mammary gland is based on:

• visual examination of the mammary glands and their palpation;
• palpation of regional lymph nodes;
• collecting anamnesis, including family history;
• general blood test;
• blood test for levels of sex hormones;
• mammography (X-ray examination of the mammary glands);
• ultrasound examination (ultrasound) of the mammary glands;
• ductography (X-ray examination with the introduction of a contrast agent into the milk ducts);
• elastography (ultrasound scanning of the mammary gland to study the density of the formation);
• aspiration biopsy and histological examination of the structure of the tissue formation.

Ultrasound examination of formations in the mammary gland is based on the degree of their echogenicity, which changes depending on the density of the tissue. Thus, a cyst looks like an anechoic formation in the mammary gland; a nodular adenoma - as an isoechoic formation in the mammary gland; a cyst with liquid contents, fibroadenoma, fibrocystic formations - as a hypoechoic formation in the mammary gland.

A hyperechoic formation in the mammary gland is visualized in the case of a lipoma, as well as when a fibrous or cystic formation in the breast gland is voluminous or quite dense.

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Treatment breast masses

Treatment of formations in the mammary gland involves taking vitamins A, E and group B, as well as iodine preparations (Potassium iodide, Iodomarin, Microiodide, Iodex, etc.).

Treatment of breast lesions with hormone-containing drugs is carried out only based on the results of a blood test for hormone levels in the body. The prescription of such drugs is individual in each specific case and is aimed at normalizing the patient's hormonal background. Among the most commonly used hormonal drugs are Mastodinone, Parlodel, Diphereline, Provera, Letrozole, etc.

The homeopathic herbal remedy Mastodinon is recommended to be taken 30 drops twice a day for a three-month course of treatment. The hormonal drug Parlodel (Bromocriptine) helps suppress prolactin production due to the ergot alkaloids ergotoxine, ergotamine and ergotamine. This drug is prescribed to be taken orally at 1.25–2.5 mg; its contraindications include high blood pressure and cardiovascular insufficiency.

An analogue of endogenous gonadotropin - the drug Diphereline - is used for injection therapy of breast tumors caused by increased synthesis of estrogen. The drug inhibits the synthesis of estrogen in the ovaries, however, it has many side effects (nausea, vomiting, increased blood pressure, bone fragility, ureteral obstruction, uterine bleeding, etc.).

Fibrous formation in the mammary gland caused by excess estrogen is treated with Provera (Clinovir, Ora-Gest) or Femara (Letrozole). Both drugs affect (each in its own way) the synthesis of steroid hormones and lead to a decrease in the level of estrogen, progesterone and testosterone. Side effects when taking Provera are allergic reactions, alopecia, insomnia, depression, etc. The use of Femara can cause headaches, joint pain, nausea and hot flashes.

For fibrocystic formations in the mammary gland, doctors very often prescribe the gel for external use Progestogel, which is applied to the skin of the chest (2.5 g once a day), the duration of one course of treatment is 4 months.

Surgical treatment

Surgical treatment of breast tumors is carried out strictly according to indications, in the absence of an effect from drug therapy, but - most often - if there is a suspicion of a malignant nature of the tumor.

First of all, this applies to such glandular focal formations as rapidly progressing phyllodes (leaf-shaped) fibroadenoma, which has a high risk (up to 10%) of degeneration into oncology. In relation to adenoma and fibroadenoma, the decision on surgery (sectoral excision or node nucleation) is made when the nodular formations in the mammary gland steadily increase in size. If the size of the node is no more than 1-1.5 cm, then it is enough to take the prescribed medications and periodically undergo examination - mammography.

Treatment of fatty formations in the mammary gland - atheroma and lipoma - is carried out exclusively by surgical methods. And cystic formations in the mammary gland are treated by sclerosing the cyst cavity, for which a fine-needle aspiration puncture is performed with pumping out part of its contents and introducing 96% ethyl alcohol.

Prevention

Today, the main prevention of breast formations is systematic self-examination of women's mammary glands. And if blood relatives have serious problems with their breasts, then a preventive measure for women after 35-40 years is an annual visit to a mammologist and preventive X-ray examination of the mammary glands (mammography).

Treatment of existing gynecological diseases (uterus, ovaries, appendages) and diseases of the thyroid and pancreas will also help to avoid hormone-dependent formations in the mammary gland.

Mandatory conditions for the prevention of these diseases, and doctors never tire of repeating this, are weight loss and a balanced diet.

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Forecast

The prognosis for breast formations depends on the specific type of pathology, but is generally favorable: the degeneration of these benign formations into cancerous tumors does not exceed an average of 3.5-3.8%.

The greatest risk of malignancy is with leaf-shaped fibroadenoma. There is also a possibility of malignancy of lobular and ductal formations, in particular, intraductal papilloma. Oncologists do not exclude the possibility of cancerous mutations of large fibroadenoma cells and multiple cystic formations. But at the same time, we must not forget that hormonal disorders that cause formations in the mammary gland do not directly lead to oncological consequences.

But this is not a reason to take breast growths lightly and not seek medical help.

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