Sclerosing adenosis of the mammary gland

There are several forms of adenosis of the breast, which are usually localized in the glandular components of the breast. With sclerosing adenosis, the lobes expand, while the layers of internal and external tissue are preserved.

The first stage of dyshormonal diseases of the breast develops mainly at the age of 30 - 40 years, but pathology is possible at a younger age and after 50 years.

Adenosis refers to the simplest forms of dyshormonal pathologies. With sclerosing form, the change in glandular tissues practically does not occur, the basal membranes are preserved, structures are limited.

Sclerosing adenosis consists of small seals, which are associated with an increase in lobules. Usually, the seals are very sensitive, in some cases are characterized by soreness. Due to distorted forms on mammography, adenosis can be mistaken for a cancerous tumor, but it should be noted that pathology refers to benign conditions.

The disease can be detected against a background of pathological proliferation of breast tissue, which leads to a change in shape, carcinoma (ductal or lobular).

ICD-10 code

In ICD-10 sclerosing adenosis of the breast belongs to the class of diseases of the breast (N60-64).

Causes of sclerosing adenosis of the breast

The main cause of the pathology are the hormonal disorders that occur in the body of a woman (a frequent cause of this are constant stresses, a weak immune system).

Imbalance of sex hormones in a woman can be associated with puberty, pregnancy, in this case the level of estrogen and prolactin in the blood increases, progesterone - decreases. Such hormonal changes cause the development of various forms of mastopathy, but usually lead to prolonged hormonal disorders to the sclerosing adenosis.

To determine the cause of the disease, a blood test for the hormonal ratio is often prescribed.

In a number of cases, sclerosing adenosis of the mammary gland is associated with hyperplastic processes in the small pelvis (excessive overgrowth of the endometrium, ovarian dysfunction, ovarian cystic disease, thyroid pathology, excess weight associated with thyroid gland pathologies or consumption of foods high in fat and digestible carbohydrates).

[1]

Pathogenesis

Adenosis increases the risk of developing breast cancer by several times, in comparison with other types of mastopathy. Sclerosing adenosis of the breast is diagnosed in women 20 to 40 years (note: 5% of all cases of mastopathy).

The disease is characterized by proliferation of connective cells in the epithelial tissue and their fibrous degeneration. In the process of tissue replacement, calcinates are formed, which on mammography are often confused with an invasive form of breast cancer.

Sclerosing adenosis occurs in two forms - limited (single nodules) and diffuse (multiple foci).

Symptoms

A common symptom of pathology is frequent drawing pains, intensifying before menstruation. In the chest appears palpable condensation of the correct form (in the entire gland or in a separate area), which can pass to surrounding tissues.

Sclerosing adenosis of the mammary gland can affect the ducts of the mammary gland, which causes the formation of papillomas (benign tumors in the form of a nipple-like growth).

Diffuse sclerosing adenosis of the mammary gland

The diffuse form of sclerosing adenosis is caused by a violation of neurohumoral regulation, which leads to increased production of estrogen or a shortage in the body of progesterone. Also, the disease can provoke bad habits (alcohol, smoking), ecology (especially in large cities), harmful production (ionizing radiation), infatuation with sunburn (sunbeds, beaches, etc.). Reduce the risk of pathology will help delivery (20 to 25 years), breastfeeding, oral contraception (within reasonable limits), all these factors represent a kind of protection against diseases caused by dyshormonal pathologies.

Diffuse sclerosing adenosis of the breast is associated with the phase of the menstrual cycle and provokes severe pain in the second half or middle of the cycle.

The pains in the mammary gland differ in character in each individual case and can be aching, spasming, pricking, giving to the neck, shoulder, back.

Perhaps swelling or thickening of the breast tissue, the appearance of palpable granular structures of small size, clear discharge from the nipples (or in the form of colostrum), while before menstruation, the intensity of such secretions increases.

Treatment of a diffuse form of sclerosing adenosis is basically conservative, while the specialist should observe the state of the woman in dynamics.

In case of diffuse adenosis, it is recommended to change the diet and increase the amount of dairy and sour-milk products, vegetable fiber, and limit animal fats.

With the existing problems with digestion, which violate the absorption of nutrients, a consultation of the gastroenterologist is recommended.

In some cases, vitamin and mineral supplements are prescribed.

Recently, experts recommend that adenoses use homeopathic remedies (Mastodion), phytopreparations (phytolone), sedatives, diuretics and enzyme preparations.

When diffuse adenosis recommended therapeutic exercise.

[2]

Proliferation without atypia

Benign breast lesions are divided into three categories according to the type of cells: without proliferation (tissue proliferation is not observed), with proliferation without atypia and atypical growths of the glandular component of the mammary gland.

Pathologies without proliferation usually do not degenerate into cancerous tumors.

Sclerosing adenosis of the mammary gland is characterized by growth (proliferation) of glandular tissue in the center of the lobule of the breast, while the cells can retain their structure, i.e. The disease develops without atypia.

With atypical hyperplasia, the risk of transformation into a cancerous tumor increases 4-5 times.

First signs

Sclerosing adenosis of the breast can not be manifested for a long time, the main symptom may be pain in the mammary glands before menstruation, which usually does not cause anxiety in many women. Pain in most cases is pulling and is amplified in the phase of the yellow body.

To indicate the development of adenosis can the appearance in the mammary gland of a movable seal, which can be palpated.

[3], [4]

Effects

In detecting sclerosing adenosis, specialists, in most cases, do not rush to prescribe treatment, especially hormonal drugs.

Hormones can harm women's health, especially at a young age, as hormonal surges in this period occur most often and pathology can pass without special intervention.

If there is a need, a specialist can prescribe a minimum hormonal therapy, operations with this form of mastopathy are very rare.

Despite the fact that doctors are in no hurry to treat sclerosing adenosis of the breast, the risk of degeneration into a cancerous tumor is high enough and constant monitoring of a woman's condition is required.

[5], [6], [7]

Complications

Sclerosing adenosis of the mammary gland usually requires minimal treatment, which includes changing the nutrition and treatment of diseases that provoked hormonal disorders.

Usually this form of mastopathy does not cause an atypical process, but a woman is recommended to have a regular checkup with a mammologist.

[8], [9]

Diagnosis of sclerosing adenosis of the breast

If there is a suspicion of dyshormonal diseases of the breast, after a preliminary examination of a specialist, mammography and ultrasound are prescribed.

The examination helps to identify the pathological focus, determine the shape and boundaries of the tumor.

With the proliferation of adenosis and lesion of the milk ducts, the likelihood of developing a malignant process increases significantly. For the timely detection of pathology, cytological, histological and immunological studies are prescribed.

[10], [11], [12]

Analyzes

Sclerosing adenosis of the mammary gland is considered a hormone-dependent disease, and an analysis for determining hormones is used to identify the causes.

The analysis on the level of progesterone, luteonizing hormone (LH), folliculating stimulating hormone (FSH), estrogen, testosterone, etc. Makes it possible to determine if there are hormonal disorders in the woman's body.

Estrogen produce the ovaries (a small part - the adrenal glands), these hormones are responsible for the development of secondary sexual characteristics, and also feel in the system of procreation.

Especially active in biological activity is estradiol, which is responsible for cyclic changes in the body, helps reduce the risk of heart and vascular disease, prevents the development of osteoporosis.

Progesterone is produced mainly by the ovaries (insignificant part - by the adrenal glands). This hormone also is called a hormone of pregnancy, as in the "interesting" position the level of the hormone increases, it helps to prepare the inner layer of the uterus for implantation of the embryo, prevents rejection of the embryo, reduces uterine contraction.

FSH, LH refer to gonadotropic hormones, for the production of which the pituitary gland is responsible. They are responsible for the maturation of the follicles, the formation of the yellow body and the production of progesterone and estrogen.

In addition to determining the level of hormones, the importance of the ratio of hormones in the body.

[13], [14], [15]

Instrumental diagnostics

Instrumental diagnostic methods are needed to establish an accurate diagnosis.

This type of diagnosis can be invasive (with violation of the integrity of the skin) and non-invasive. Sclerosing adenosis of the mammary gland

Invasive include a biopsy, which allows you to study tissue samples under a microscope.

Fine needle aspiration biopsy is used for palpable neoplasms in the chest. The procedure is performed without anesthesia, using a syringe and a thin long needle.

The needle is inserted into the mammary gland and the glandular tissue is drawn into the syringe, which is sent for laboratory testing.

A thick-needle biopsy allows you to get more breast tissue for examination. A thick needle with a cutting device is required for analysis.

The advantage of the method is that due to a larger area of tissue, after a histology the doctor will be able to make a more accurate diagnosis.

Non-invasive, i.e. Not violating the integrity of the skin, methods of instrumental diagnosis include mammography, ultrasound, computed tomography.

Mammograms are recommended to be given to women every year after 35 years. The purpose of this study is the early detection of pathological changes in the mammary gland. On a mammogram, each breast disease has its own characteristic pattern.

Ultrasound examination allows us to clarify the nature of changes in the mammary glands. The method is simple and safe, the advantage is the identification of differences of hollow (cyst) from continuous formations (tumors).

Differential diagnostics

Differential diagnosis is considered the most important in the diagnosis. This method of diagnosis makes it possible to distinguish diseases from each other, since the same symptoms can be associated with different diseases.

In the course of the examination, the specialist gradually excludes diseases that do not fit in any of the symptoms, which as a result allows the final definitive diagnosis to be made.

Sclerosing adenosis of the breast, usually the doctor reveals on examination, palpation reveals dense nodes of the correct form. Complaints of the patient for pain (character, during which period of the cycle is manifested, etc.) are also taken into account. To confirm the diagnosis, ultrasound is usually given, since mammography has a high risk of a wrong result (adenosis can be mistaken for breast cancer).

[16], [17], [18], [19], [20], [21]

Treatment of sclerosing adenosis of the breast

The features of treatment depend on the stage, age and overall health of the patient. In most cases sclerosing adenosis of the breast is not treated, and a woman should perform ultrasound and visit a doctor every year.

In some cases, multivitamin preparations, sedatives, combined oral contraceptives or hormones, drugs to improve the work of immunity, diuretics can be prescribed.

With dyshormonal pathologies, oral combined contraceptives may be prescribed (Lindineth 30). Such drugs contain a certain level of hormones that smooth the hormonal background and interfere with the monthly hormonal fluctuations in the body.

Lindineth 30 contains a synthetic analogue of estradiol, which regulates the menstrual cycle, as well as Gestodene (progesterone analog). The drug helps prevent a number of gynecological diseases, including the growth of tumors. 1 tablets are taken. Daily (preferably at the same time) for 21 days, then after a weekly break the course is repeated.

Gestagens (Dyufaston, Norkolut) - steroid hormones that suppress the production of luteinizing hormone, have antiestrogenic, gestagenic, androgenic and antiandrogenic effects.

After taking, you may be worried about swelling, nausea, high blood pressure. With violations of the liver and a tendency to thrombosis, such drugs are contraindicated.

Duphaston contains dydrogesterone, in properties close to natural progesterone, the drug does not have side effects inherent in most synthetic analogues of progesterone.

Take Duphaston should be 10 mg 2-3 r per day for 20 days (from 5 to 25 day cycle) or permanently.

Norkolut blocks the production of gonadotropin and prevents the maturation of follicles.

Assign 1-2 tablets on certain days of the cycle.

In some cases, the doctor makes a decision about the operative treatment of adenosis (usually when a malignant process is suspected).

Medicinal treatment

When choosing hormone therapy, specialists prefer LINDINET 30, which helps to reduce the clinical manifestations of sclerosing adenosis.

After 2 months from the beginning of taking the drug, symptoms of the disease and the normalization of menstruation pass.

During the reception, there may be some adverse reactions of the body: increased pressure, thromboembolism (including myocardial infarction, stroke), and hearing loss is also possible.

Accept Lyndynet 30 according to the scheme - every day for 1t. For 21 days, then a 7-day break is made and the course is repeated. The duration of treatment on average is 6 months, the decision on continuing treatment is made by the attending physician.

In addition to Lindineth 30, other oral contraceptives may also be prescribed, including dienogest (2 mg): Genegest, Janine Silhouette.

The gestagens are used with more pronounced symptoms of adenosis, which are especially amplified before menstruation.

Among such drugs are Norkolut, Pregnin, Dufaston, Progesterone (oily solution), which are prescribed from the 16th to the 25th day of the cycle. The effect of treatment is manifested after 2 months - discharge from the nipples, engorgement and pain of the mammary glands decreases (sometimes completely stop). The course of treatment is from 3 to 6 months.

Pregnin belongs to the group of progestogens and is an analog of the hormones of the yellow body. Assign 1-2 tablets 2-3 times a day, with an increase in dosage may increase pressure, puffiness, a short increase in uterine bleeding.

Progesterone (oily solution) - the hormone of the yellow body has a gestagenic effect. It is usually prescribed on 5 mg daily, can cause drowsiness, apathy, headaches, impaired vision, a decrease in the menstrual cycle, swelling, increased pressure, weight gain, allergies.

Sclerosing adenosis of the mammary gland with gestagenic drugs is treated within 3 to 6 months, at the discretion of the doctor, the medication can be extended.

Alternative treatment

Sclerosing adenosis of the mammary gland can be tried by alternative means, but it is worth remembering that any prescriptions, even innocuous ones at first glance, should be done after a doctor's consultation.

With adenosis, compressions can be used:

• pumpkin pulp for 3-5 days apply to the affected breast
• a leaf of cabbage, greased with butter and sprinkled with salt to apply at night to the chest for a week (usually in the morning the pain decreases).
• grated fresh beet with 2 tbsp. Vinegar in a warm form is applied to the chest for 8 to 10 days.

These methods help to reduce unpleasant symptoms of the disease.

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

Herbal Treatment

Today, the treatment of various forms of mastopathy, including sclerosing adenosis of the breast, can be performed with the help of medicinal herbs, but in this case an integrated approach is mandatory.

Phytotherapy can use plants of several groups - gonadotropic (selectively affect female sex hormones), antitumor herbs, immunomodulators.

Gonadotropic plants are poisonous (they have a quick healing effect and a lot of adverse reactions) and ordinary (they act more slowly, have mild properties and a minimum of side effects).

Poisonous plants of this group: Dahurian klopogon, prince of Okhotsk, meadow chamber, kirkazon twisted, to ordinary they include oregano, balm, boron, cherry chestnut, lavender, radiola, zyuznik, shandra, angelica.

Herbs with antitumor effect: psyllium, St. John's wort, elecampane, calendula, lemon balm, hawthorn, nettle, wormwood, horsetail, mint, aloe, immortelle, rhizome of ayr, etc.

To enhance immunity, use ayr, aralia manchurian, aloe, echinacea, chamomile, hawthorn, ginseng.

It helps to remove symptoms of adenosis following recipe: valerian root, string, celandine, St. John's wort, nettle, hips, mint, hawthorn flowers 1 tbsp each. Mix all ingredients, take 1 tablespoon. And pour 1 liter of boiling water, insist 15-20 minutes, take 2 times a day (between meals).

Homeopathy

Sclerosing adenosis of the mammary gland can be treated with the help of homeopathy, this method is recommended by a number of specialists, recognizing it is effective, in the case of this pathology.

With this type of adenosis, the homeopathic drug Mastodinone is usually prescribed.

The product is available in the form of tablets or drops. The therapeutic effect is achieved due to natural components - a colorful multi-colored handkerchief, an alpine violet, a horseshoe bitter, a prutnyak, a stylist vysilistnikovidny, a lily tiger (it should be noted that the composition also has alcohol). The drug reduces the production of prolactin and has a positive effect on breast tissue, preventing pathological processes.

Approximately in half a year it is possible to observe medical effect, thus Mastodinon can be used both in structure of complex therapy, and independently.

Side effects during the reception are extremely rare, most often expressed in allergic reactions. Sometimes, nausea, stomach pain, weight gain, headaches, acne may be disturbing.

Do not take the drug to girls under the age of 12, during feeding, pregnant women, as well as with individual intolerance to certain components.

It should be noted that drinking and smoking negatively affect any treatment, homeopathy is not an exception, despite the fact that all homeopathic preparations have natural components.

Take Mastodinone usually need 2 times a day for 1 tab. Or 30 drops.

The drops should first be shaken well before use and diluted with water.

Homeopaths recommend taking this medication 20 minutes before meals or 40 minutes after.

Mastodinone should be taken at least 3 months, but noticeable improvement in the condition is observed after six months of continuous treatment.

Operative treatment

Sclerosing adenosis of the breast is treated surgically extremely rarely. When choosing this method of treatment is usually appointed sectoral resection.

The operation can be performed under local or general anesthesia (depending on the number and size of the nodes, age, concomitant diseases).

During the operation, the surgeon always cuts the edge of the areola, the remote node is subsequently sent for histology to clarify the nature of the lesion or determine the further tactics of treatment.

Usually the next day after surgery, the patient is discharged from the clinic, the doctor can prescribe an anesthetic.

If a woman has one knot or multiple knots not prone to growth, the disease is not treated, and a woman is scheduled for regular examination (once every 6 months, ultrasound and mammologist examination).

Prevention

Hormonal changes in the female body occur regularly, but such dyshormonal diseases as sclerosing adenosis of the breast can be prevented, both in teenage girls and after 40 years.

Preventive measures are simple enough, it is necessary to identify and treat gynecological and other diseases in a timely manner. It is also necessary to remember the following measures that help reduce the risk of dyshormonal diseases: first pregnancy (necessarily full), absence of abortions, regular examination of the gynecologist, reduction of stressful situations.

Importance of exercise is important, well affect the overall health of women swimming. Do not forget about proper nutrition.

Forecast

Sclerosing adenosis of the breast does not pose a threat to the life of a woman, but nevertheless, the pathological process can degenerate into a malignant formation, so in this case, timely diagnosis and regular monitoring in the mammal is crucial.

Sclerosing adenosis of the mammary gland is a benign process in which the glandular structure grows. The disease is associated with hormonal changes in the woman's body, especially leads to the development of adenosis, a prolonged hormonal imbalance. Pathology in most cases does not require treatment, sometimes sedatives can be prescribed (if hormonal disorders are associated with stress), hormones, treatment of existing comorbidities is also indicated, and surgical treatment is rarely prescribed.

[27], [28], [29], [30], [31]