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Fibromatosis of the mammary gland
Last reviewed: 23.04.2024
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When a woman develops a pathological process of glandular or connective tissue growth in the breast, caused by an increase in the proliferative activity of their cells, and various lumps and nodes develop, this is called breast fibromatosis.
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Causes of the fibromatosis of the mammary gland
Disruption of tissue development, which doctors also call dysplasia, can occur at almost any point in the human body. Intensively proliferating "extra" cells of some tissues are able to penetrate into the structure of the surrounding tissues, forming neoplasms in the form of tumor-like conglomerates, dense nodes or cysts. The result of this process in the mammary glands is mastopathy - that is, breast pathology. Its main clinical and morphological manifestations, many experts define as breast fibromatosis, but more often - as various forms of nodular mastopathy.
Fibromatosis of the mammary gland - a pathological change in its parenchyma and stroma - leads to nodular mastopathy with clear contours or diffuse mastopathy, that is, diffuse fibromatosis, in which anomalous cell division affects the entire gland.
In clinical mammology, diffuse fibromatosis of the mammary glands or diffuse mastopathy is divided into glandular, cystic or fibrous, according to the predominant type of affected tissue. There is a mixed type of mastopathy, in which there are signs of both nodular and diffuse mastopathy. Also diagnosed fibrocystic mastopathy.
In addition, this disease is manifested by such types of nodular mastopathy as fibroadenoma (or adenofibroma), phylloid (leaf-shaped) fibroadenoma, cyst or intraductal papilloma.
The causes of breast fibromatosis lie in the fact that all these pathological transformations occur as a result of disturbances in the balance of hormones in a woman’s body. The level of estradiol, estrogen, testosterone, progesterone, prolactin cyclically varies due to sexual development, menstruation, pregnancy, menopause. And in this system work not only the ovaries that produce estrogen, but also the pituitary gland, which synthesizes luteotropic hormone and prolactin. The thyroid gland, which is responsible for the production of thyroxine and triiodothyronine, which regulate the state of metabolism, is also involved in it. So a decrease in thyroid function (hypothyroidism) can significantly increase the likelihood of developing breast fibromatosis.
The emergence of this pathology can also "contribute" to the malfunction of the pancreas that produces insulin. Therefore, various formations in the chest are often diagnosed in women with type II diabetes and obesity. And in women with diabetes mellitus type I, often there is a special - autoimmune diabetic mastopathy.
Why in the body of women fails in the hormonal system? In addition to the above physiological cyclical factors destabilize the normal hormonal background, genetic predisposition and many hereditary diseases, diseases of the uterus (fibroids, endometriosis), inflammation of the ovaries, etc. Destructive factors also include: repeated artificial interruptions of pregnancy, operations for gynecological diseases, the use of certain medications (hormonal contraception first of all), bad habits, stresses, drastic weight loss Does weight gain. All this leads to excessive levels of some hormones (estrogen) and a clear deficit of others (progesterone). And the causes of breast fibromatosis are precisely this.
Symptoms of the fibromatosis of the mammary gland
With all the variety of forms of fibromatosis of the mammary gland, its main clinical manifestations are reduced to the fact that a nodule (or nodules) is felt in the soft tissues of the breast - in the form of a round "pea" or oval "bean" the size of a few millimeters or centimeters. If the nodule is dense, with clear contours, quite mobile, but even with its palpation, there is no pain, then this is most likely pericanalicular fibroadenoma. If the formation is softer and does not have the exact outlines, then it is intracanalicular fibroadenoma. Their difference is only in structure, but in both cases during menstruation a woman may feel discomfort in the breast.
The signs by which doctors recognize nodular mastopathies include dense strands, and elastic round formations of a tumor-like structure, not connected to the skin of the mammary gland; aching chest pains; sensations of engorgement, distention, or heaviness in the glands. These symptoms become more pronounced before menstruation.
Similar symptoms have diffuse fibromatosis of the mammary glands (more precisely, diffuse fibroadenomatosis), only a few nodules in the breast. In some cases, there is a slight pain, which before the onset of menstruation can become more intense and even irradiate to the shoulder, armpit or shoulder blade. But with enough rare phylloid fibroadenoma neoplasia grows to gigantic size and causes severe pain in the mammary gland.
The presence of a small cyst in the mammary gland (which is most often found in nulliparous women after 35 years of age) - as and in most cases with fibroadenoma - does not manifest itself and is also detected by chance. With a larger size of the cystic formation possible pain before the onset of menstruation. A constant pain (regardless of the cycle) cause large cysts. In addition, they can not only deform the natural shape of the breast, but also cause inflammation with reddening of the skin on the chest and fever.
Symptoms of mammary gland fibromatosis, which is diagnosed by breast cancer specialists as intraductal (intraductional) papilloma, appear as clear or bloody nipple discharge. When examining patients, the rounded papillary proliferation node of the intraductal tissue is found inside the ductus, which is not very dense, moderately painful. This node can injure the duct and cause local inflammation.
Where does it hurt?
Diagnostics of the fibromatosis of the mammary gland
In the diagnosis of breast fibromatosis, the following methods are used:
- history taking, physical examination (palpation of the mammary glands and regional lymph nodes);
- X-ray mammography (allows you to identify education size even 1mm);
- a blood test for hormone levels;
- ultrasound examination (ultrasound) of the breast;
- X-ray computed tomography (CT);
- Doppler ultrasound (allows you to assess the state of blood flow in the breast);
- MRI (if necessary - MRI with dynamic contrast);
- ductography (radiography with the introduction of a contrast agent into the milk ducts
- to identify their pathology);
- pneumocystography (to determine the content of fibrocystic dysplasia);
- puncture biopsy of the glands with subsequent histological examination of a sample of tumor tissues.
What do need to examine?
Who to contact?
Treatment of the fibromatosis of the mammary gland
When prescribing the treatment of fibromatosis of the mammary gland, the doctor takes into account the age, features of the menstrual cycle and the prospects of the patient's reproductive function; her gynecological, endocrine and other diseases.
Drug therapy of almost all the varieties of fibromatosis of the mammary gland is not symptomatic, but etiological in nature. Therefore, it is widely used hormonal drugs, as well as vitamins and enzymes.
Drug treatment of breast fibromatosis
Among the hormonal drugs used in the treatment of fibromatosis of the mammary gland, doctors often prescribe the use of such drugs as Duphaston, Bromocriptine, Provera, Goselerin, Letrozole, Prozhestogel, Mastodinon.
Duphaston (Dydrogesterone, Duphaston) belongs to the pharmacological group of gestagens (preparations based on female sex hormones produced by the corpus luteum of the ovary and the adrenal cortex) and is used only in the case of laboratory-confirmed deficiency of endogenous progesterone. The active substance of Duphaston is a synthetic analogue of progesterone didrogesterone. Taking the drug compensates for the deficiency of progesterone and neutralizes the proliferative effects of estrogen. For long-term treatment, one tablet (10 mg) is prescribed for 14 days of each menstrual cycle. This remedy is contraindicated in liver diseases.
The drug Bromocriptine (Parlodel) is a derivative of ergot alkaloid ergocriptine. It stimulates the dopamine receptors of the hypothalamus and thereby reduces the production of prolactin and somatropin. Women of childbearing age are advised to take this drug at 1.25–2.5 mg in the second phase of the cycle - for 3-4 months. Among the side effects of bromocriptine are headache and dizziness, weakness, nausea and vomiting. You can not take this medicine with high blood pressure and cardiovascular and gastrointestinal diseases.
In breast fibromatosis, Provera is used (Klinovir, Vadezin, Tsikrin, Ora-guest, Farlutal, Methylgesten, Sedometril, etc.). The drug contains medroxyprogesterone acetate, which inhibits the synthesis of gonadotropins in the pituitary and thereby stops the growth of hormone-dependent tumors of the uterus and mammary glands. The dosage is determined by the doctor depending on the diagnosis and an average of 1-3 tablets of 500 mg per day (orally, after meals). The drug has a lot of side effects, ranging from allergies, headaches and depression, ending with alopecia, thromboembolism and cerebrovascular disorders.
To reduce the effect of estrogen on the pathological proliferation of breast tissue, the drug Goselerin (Zoladex), which is a synthetic analogue of the natural luteinizing hormone releasing factor, may be prescribed. After the introduction of this tool, the production of this hormone in the pituitary gland is reduced, and the level of estradiol in the blood is reduced. Method of its use: the capsule of the drug (3.6 mg) is injected subcutaneously into the anterior abdominal wall with the help of the supplied syringe applicator every 28 days. The maximum duration of treatment is 6 months.
Side effects of this drug can manifest as a skin rash, lowering blood pressure, hot flashes, excessive sweating.
The drug Letrozole (Femara) belongs to the pharmacological group of aromatase inhibitors and is used to treat breast fibromatosis in postmenopausal women. At this age, estrogens are formed mainly with the participation of the enzyme aromatase. This drug is aimed at inhibiting the activity of this enzyme, as a result of which estrogen biosynthesis in tissues is suppressed. The standard dosage is one tablet (contains 2.5 mg of active substance) once a day (daily). Side effects are possible, but they are quite rare and are manifested by headache and joint pain, weakness, nausea, swelling and flushing.
In the treatment of various forms of fibromatosis of the breast, in particular fibrocystic neoplasias, the drug based on vegetable progesterone Progestogel is used - 1% gel for external use. It is recommended to apply it on each mammary gland - 2.5 g of the drug, for at least 4 months in a row. Then you need to take a break for two months. In the instructions of the drug indicated that a positive result can be achieved after one or two courses of therapy. Prozestzhel does not have side effects.
Treatments for the treatment of diffuse fibromatosis of the mammary glands and nodal mastopathy include the homeopathic preparation Mastodinon, often recommended by doctors. This is an alcohol extract from medicinal plants (cyclamen, chilibuchs, iris and tiger lilies), which should be taken twice a day, 30 drops each (for three months).
In the treatment of fibromatosis of the mammary gland, vitamins (A, C, B6, E, P) are prescribed, which have a positive effect on the breast tissue and activate microcirculation in them. Successfully used in the treatment of this pathology Wobenzym - an enzyme preparation based on proteolytic enzymes of plant and animal origin. This drug has an immunomodulatory, anti-inflammatory and fibrinolytic effect.
Wobenzym accelerates the removal of toxins from the body and the resorption of hematomas and edema, improves the supply of tissues with oxygen and nutrients. The standard dosage of Wobenzin - 3-5 pills 3 times a day (without chewing and always drinking 200 ml of water), half an hour before meals. Side effects of this drug are absent, and among the contraindications - hemophilia, thrombocytopenia and other pathologies of blood clotting.
Surgical treatment of breast fibromatosis
The surgical way to solve the problems of breast fibromatosis is chosen in two cases. The first is when the size of hyperplasias is very significant already at the stage of their detection. The second is when the undertaken conservative treatment has not given positive results. However, it should be borne in mind that the diagnosis of phylloid fibroadenoma and intraductal papilloma shows only surgical intervention.
All forms of breast fibromatosis can be removed in two ways. The first is sectoral resection (lumpectomy), in which the affected breast is excised as a sector, with a portion of healthy tissue. The second method is nucleation (or enucleation), which consists in exfoliating only the pathological formation, without affecting the normal tissues of the gland.
There is another method of surgical treatment of breast fibromatosis - laser (laser-induced thermotherapy).
More information of the treatment
Forecast
Given that the proliferative activity of the cells of the tissues of the mammary glands in 85% of cases is benign in nature, the prognosis of breast fibromatosis can be considered positive. But it all depends on the specific type of dysplasia.
If degeneration into cancer (malignancy) of fibroadenoma is observed in only 3% of cases, then this type of breast fibromatosis, like phylloid fibroadenoma, is considered by most mammologists as a precancerous tumor: it is reborn in connective tissue sarcoma in almost 10% of cases.
The probability of malignancy of fibrocystic mastopathy with a significantly pronounced growth of tissue, according to research, is 31%.
In addition, the role of hormones in the functioning of the mammary glands is so great that, under the negative influence of their imbalance, even operated on breast fibromatosis recurs in 15% of cases. But it comforts that at least 10% of benign tumors that appear in the chest during menopause (that is, when the hormonal background changes) dissolve on their own.