Education in the mammary gland

The formation in the mammary gland is part of a large cluster of proliferative processes in the tissues, which in clinical practice are referred to as 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.

[1], [2]

Causes of the formations in the mammary gland

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

Clinical studies of recent years give all grounds to enroll in the causes of formations in the mammary gland hormone-dependent etiology deficiency of iodine in the body, which increases the sensitivity of breast tissue to estrogen.

The main factors that increase the likelihood of formation in the breast, experts say:

• stable violation of the menstrual cycle, premature start of menstruation in girls (before 12 years), later onset of menopause in adult women;
• reproductive factors (multiple artificial abortions, late first pregnancy, rejection of breastfeeding, lack of pregnancy and childbirth, infertility);
• gynecological diseases (endometriosis, uterine fibromatosis, inflammation and ovarian cyst);
• violation of the general metabolism (with obesity, diabetes, thyroid and pancreatic pathologies);
• stress and psychotic states;
• abuse of hormonal drugs, in particular, by contraception;
• the presence of various forms of mastopathy in the family history of the female line.

[3], [4], [5], [6], [7]

Symptoms of the formations in the mammary gland

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

Among such signs are noted:

• palpable oval or rounded formation in the mammary gland of varying density, mobile or strictly fixed in the thickness of the tissues;
• unpleasant sensations in the chest and her swelling (engorgement) before the next menstruation;
• burning in the mammary gland;
• a noticeable increase and decrease in the size of the mammary gland during the menstrual cycle;
• soreness of various 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 palpation of education);
• enlarged lymph nodes in the axillary region;
• a distinct change in the skin of the breast (in color and structure);
• the appearance of discharge from the nipple (transparent, greenish-yellow or with bloody elements).

[8], [9], [10]

Forms

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

Nodal, diffuse and lobular formations

Nodal formations in the mammary gland or, as they are still determined, focal lesions in the mammary gland are a single, elastic to the touch or dense formation in the mammary gland, which looks like a node with clear boundaries and localization, that is, it does not spread throughout the gland. Nodal formations can arise from glandular and fibrous tissue, can be mobile or else welded to surrounding tissues. In the form of rounded formation in the mammary gland very often can not show itself and cause no discomfort, and can be painful when probed. Such nodes in most cases are formed in one breast gland.

To this kind of specialists include  fibroadenoma  (focal fibrosis, nodular or localized fibroadenomatosis), phylloid (or leaf-shaped) fibroadenoma, cysts and lipoma.

Diffuse formations in the mammary gland follow. Among them, fibrotic formation in the mammary gland is distinguished, which is manifested by a number of seals throughout the breast that are formed due to proliferation of fibrous tissue cells, as well as adenosis of glandular lobules. Diffuse fibroadenoma is diagnosed when the mammary gland consists of fibrous and glandular tissue. In this case, formation in the right mammary gland, or formation in the left mammary gland, can be detected, or both breasts can be affected simultaneously.

For lobular lesions, the lesion of fibrous tissue in the lobules of the gland is characteristic. And with such a variety of formations mammologists diagnose perikanalikulyarnaya or intrakanalikulyarnaya fibroadenoma, sclerosing adenosis of the milk ducts of the breast or sclerosing lymphocytic lobular mastitis. Sclerosing pathologies are the lot of many older women, this is a benign formation in the mammary gland, but with this disease, calcification 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.

[11], [12], [13], [14]

Glandular, fibrous, cystic, fatty formations

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

Fibrous formation in the mammary gland is a proliferation of fibrous connective (fibrous) tissue. Fibrosis, that is, the reorganization of the cytoskeleton of epithelial tissues and their transformation into fibrous tissue (which can be observed in any organ) usually occurs where it is necessary to isolate from any surrounding structures any inflammatory focus. 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 that synthesizes biologically active substances. But to date in mammology the mechanism of fibrogenesis in the etiology of fibrous formations in the mammary gland is not taken into account.

Fibrous formation in the mammary gland is diagnosed as fibroadenoma, adenofibroma, fibrocystic disease, etc. And this corresponds to reality, since with rare exceptions the composition of such tissue conglomerates is mixed. A classic example of mixed fibrotic epithelial hyperplasias is a nodal non-uniform formation in the mammary gland in the form of a fibroadenoma, which is characterized by the presence of abnormally expanded cells of both fibrous tissue and epithelium of the parenchyma, as well as fibrocystic disease or mammary dysplasia.

Cystic education in the mammary gland, based on the pathogenesis of cysts, most likely does not enter into the category of hormone-dependent proliferative pathologies, since it is a cystic cavity, and often it is fluid formations in the mammary gland.

If the encapsulated cavity appeared on the last days of pregnancy or during lactation due to the overlapping of the milk duct and the delay of the colostrum or breast milk, it is a retention cyst. Such a cystic formation in the mammary gland is called lactocele (or galactocele). The cyst is a benign, but painful, formation in the mammary gland, which is caused by the injury of soft tissues, for example, after a chest injury. Cyst - immovable dense formation in the mammary gland - has a rounded shape, the sizes are different, it can be plural, it can provoke formation of calcinates in the mammary gland.

Mesenchal formations are tumors of various tissues, as well as vessels and membranes (serous and synovial). In the everyday diagnostic terminology of domestic mammalogists, this definition often does not figure, although this type refers to a similar chondroma fibroadenoma - a benign formation in the mammary gland that grows from cartilage or bone to the soft tissue of the breast. Chondroma can also cause calcification in the mammary gland.

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

Fat formation in the mammary gland is represented by atheroma and lipoma. Because of the violation of the patency of the duct of the sebaceous gland in the thickness of the skin, cystic formation in the mammary gland, atheroma, can develop. These capsules and viscous contents of the sebaceous gland cyst are a dermatological problem, despite the fact that atheroma of the breast can reach impressive sizes. The onset of athere is associated with increased secretion of male sex hormones and a deficiency of thyroid hormones. These formations have a tendency to inflammation (with infection) and the formation of abscesses.

But such a fat benign formation in the mammary gland, like a lipoma, is related to the nodal mesenchal formations, its increased growth leads to an increase in the affected breast and deformation of its shape. In addition, when squeezing the nerve endings, the lipoma can be very painful.

Diagnostics of the formations in the mammary gland

Diagnosis of lesions in the mammary gland is based on:

• visual examination of mammary glands and their palpation;
• palpation of regional lymph nodes;
• collection of anamnesis, including family history;
• a general blood test;
• analysis of blood levels of sex hormones;
• mammography (fluoroscopy of mammary glands);
• ultrasound examination of the mammary glands;
• doktografii (X-ray examination with introduction into the milk ducts of contrast medium);
• Elastography (ultrasound scan of the breast to study the density of education);
• aspiration biopsy and a histological study of the structure of tissue education.

Ultrasound examination of lesions in the mammary gland is based on the degree of their echogenicity, which varies depending on the density of the tissues. So, the cyst looks like an anechoic formation in the mammary gland; nodular adenoma - as isoechoic formation in the mammary gland; cyst with liquid contents, fibroadenoma, fibro-cystic formations - as a hypoechoic formation in the mammary gland.

The hyperechoic formation in the mammary gland with lipoma is visualized, and also when the fibrous or cystic formation in the breast of the gland is voluminous or sufficiently dense.

[15], [16], [17]

Treatment of the formations in the mammary gland

Treatment of the formations in the mammary gland involves the intake of vitamins A, E and Group B, as well as iodine preparations (Potassium iodide, Iodomarine, Mikroiodid, Yodex, etc.).

Preparations containing hormones, the treatment of formations in the mammary gland is carried out only by the results of a blood test for the content of hormones in the body. The purpose of such medications is individually in each case and is aimed at normalizing the patient's hormonal background. Among the most commonly used hormonal drugs are Mastodinone, Parlodel, Diferelin, Provera, Letrozol, and others.

The homeopathic medicine Mastodinon on the basis of medicinal plants is recommended to take 30 drops twice a day, the course of treatment - three months. The hormonal drug Parlodel (Bromocriptine) due to the maintenance of ergot alkaloids ergotoxin, ergotamine and ergotamine contributes to the inhibition of prolactin production. This drug is prescribed to take internally at 1.25-2.5 mg; to its contraindications include high blood pressure and cardiovascular insufficiency.

An analogue of endogenous gonadotropin - the drug Diferelin - is injected with the therapy of neoplasms of the breast 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, brittle bones, ureteral obstruction, uterine bleeding, etc.).

Fibrous formation in the mammary gland caused by excess estrogen is attempted to be treated with Provera (Clinovir, Ora-gestom) or Femara (Letrozole). Both drugs affect (each in their own way) the synthesis of steroid hormones and lead to a decrease in the levels of estrogen, progesterone and testosterone. Adverse effects during admission Provera - allergic reaction, alopecia, insomnia, depression, etc. The use of the drug may cause headaches, joint pain, nausea and hot flashes.

In fibro-cystic formations in the mammary gland, doctors often prescribe a gel for external use. The Progestogen, which is applied to the skin of the breast (once a day for 2.5 grams), the duration of one course of treatment is 4 months.

Surgery

Treatment of lesions in the mammary gland surgically performed strictly according to indications, with no effect from drug therapy, but - most often - with a suspicion of a malignant nature of the tumor.

First of all, this refers to such glandular focal formations as the rapidly progressing phyloid (leaf-like) fibroadenoma, which has a high degree of risk (up to 10%) of degeneration into oncology. With respect to adenoma and fibroadenoma, the decision on surgery (sectoral excision or node nucleation) is taken when the nodal formations in the mammary gland are steadily increasing in size. If the size of the node is not more than 1-1.5 cm, then it is enough to take the prescribed medications and periodically undergo a survey - mammography.

Treatment of fat formation in the mammary gland - atheromas and lipomas - is performed exclusively by the surgical method. A cystic formation in the mammary gland is treated by sclerosing the cavity of the cyst, for which a fine needle aspiration puncture is performed, pumping out a part of its contents and introducing 96% ethyl alcohol.

Prevention

To date, the main prevention of lesions in the mammary gland is the systematic self-examination by women of their mammary glands. And if the blood relatives have serious problems with the breast, a preventive measure for women after 35-40 years is an annual visit to the mammalog and prophylactic fluoroscopy of the mammary glands (mammography).

Also helps to avoid hormone-dependent formations in the mammary gland treatment of existing gynecological diseases (uterus, ovaries, appendages) and diseases of the thyroid and pancreas.

Obligatory conditions for the prevention of these diseases, and doctors do not get tired of repeating it, are weight loss and a balanced diet.

[18], [19], [20], [21], [22], [23]

Forecast

The prognosis of the formations in the mammary gland depends on the specific type of pathology, but, on the whole, it is favorable: the degeneration of benign formation into cancer tumors does not exceed 3.5-3.8% on average.

The biggest risk of malignancy is with leaf-shaped fibroadenoma. There is also a likelihood of malignancy of lobular and ductal formations, in particular, intrapropatic papilloma. Oncologists do not rule out the possibility of cancer cell mutations by fibroadenomas of large size and multiple cystic formations. But it should not be forgotten that hormonal disorders that cause formation in the mammary gland do not directly lead to oncological consequences.

But this is no reason not to take the education in the mammary gland seriously and not to seek medical help.

[24], [25], [26]