Tumors of the breast

Tumors of the breast are characterized by the presence of a delimited formation or zone with a violation of the normal echostructure of the mammary gland. The nature and type of growth of volumetric education are determined on the basis of the following features: the structure and nature of the contours; relationship with surrounding structures; echogenicity and type of internal structure; acoustic effects observed in the tumor; Vascularization.

Expansive growth assumes equal contours. The tumor does not destroy surrounding tissues, but only spreads and compresses them. With infiltrative growth, the contours of education are often fuzzy and uneven. It can be difficult to distinguish between a tumor and surrounding tissue.

The tumor can have its own anatomical capsule or pseudocapsule, formed by compressed or reclassified surrounding tissues.

Echogenicity of the tumor may be different, but for malignant tumors, the overall echogenicity and heterogeneity of the internal structure are more typical.

Acoustic effects in breast tumors are different - from slight amplification to the appearance of an acoustic shadow behind the formation. Acoustic shadow is defined behind 30-65% of malignant tumors.

To determine the nature of formation, the ratio of the transverse diameter of the tumor (P) and anteroposterior diameter (PZ) can be useful. When the transverse diameter (parallel to the skin) is greater than the anteroposterior (P / PZ> 1), i.e. There is a horizontal orientation, the pathological process is most often benign. The prevalence of anteroposterior size (P / PZ <1), i.e. Vertical orientation, is more common in malignant tumors. Some authors believe that a more successful criterion for assessing the quality or malignancy of a tumor is a comparison of the ratio of A / CI with 1.4. In particular, up to 100% of cancers have a ratio of A / C3 <1.4, while benign pathological processes are characterized by A /> 1.4. Thus, the I / O index should be considered as one of the criteria characterizing the tumor.

Benign breast tumors

Fibroadenoma

Fibroadenoma is 95% of all benign breast tumors. The most common fibroadenoma of the breast is symptoms in women aged 15 to 40 years. During this period, the onset of fibroadenoma of the breast is the result of improper development of the glandular tissue. Fibroadenoma, which occurs and develops in a pregnant and lactating woman, is called lactational fibroadenoma. Long-existing fibroadenomas undergo involution, hyalinization and calcination, which is manifested by the heterogeneity of the echostructure with the presence of hyperechoic inclusions. The dimensions of these inclusions can be very small or occupy almost the entire formation. Since the formation of fibroadenoma is associated with estrogen stimulation, a new development and an increase in its size may occur in the pre-menopausal and menopausal periods on the background of hormone replacement therapy.

As a rule, fibroadenoma, its symptoms are a single entity. In 10-20% of fibroadenomas are multiple, often bilateral. In about half the cases, the tumor is located in the upper outer quadrant. The size of the fibroadenoma usually does not exceed 2-3 cm. Its shape is often oval, with the predominance of the long axis P over the short axis of the PP. The ratio P / PZ> 1.4 is found in 86% fibroaden.

Echographically, fibroadenoma is a solid formation with clear, even contours. When squeezing the sensor, the symptom of "slippage" is noted - tumor displacement in the surrounding tissues, which confirms the spreading nature of fibroadenoma growth. Depending on the size of the fibroadenoma, the ultrasound pattern has its own characteristics. Thus, with a size of up to 1 cm, a regular rounded shape is noted, a homogeneous internal structure of reduced echogenicity. Contours equal, clear or indistinct. A hyperechogenic rim around the periphery is noted in about 50% of cases. Fibroadenoma breast symptoms - more than 2 cm often have an irregular rounded shape, a clear even or uneven contour. The larger the size and duration of fibroadenoma existence, the more often the hyperechoic rim is determined due to the degeneration of surrounding tissues. More than half of the cases show a heterogeneity of the internal structure against the background of a general decrease in echogenicity. In 25% of cases micro- and even macrocalcinates are noted. Liquid-containing inclusions are often determined. Gigantic is called fibroadenoma more than 6 cm. This tumor is characterized by a slow development and the appearance of large coral petrified with a pronounced acoustic shadow. According to the echogenicity fibroadenoma can be hypoechoic, isoechoic and hyperechoic. The detection of fibroadenomas with the help of echography depends on the echogenicity of the surrounding tissues.

Hypoechoic fibroadenoma is poorly differentiated in the mammary gland with an increased content of adipose tissue. At the same time, a hypo- or iso-echogenic fat segment that is well-delimited and secreted against the background of surrounding tissues can mimic fibroadenoma.

A delimited zone of fibrosis or sclerosing nodular adenosis can also mimic fibroadenoma.

The ultrasound image of the mammary fibroadenoma  can mask, especially in young, a well-delimited malignant tumor (usually medullary cancer).

Degenerative changes in the structure of fibroadenoma in the form of acoustic shadows behind calcifications, heterogeneity of the internal structure, uneven contours can mimic the symptoms of breast cancer in older women.

Fibroadenomas in the presence of large calcifications are well differentiated by X-ray mammography. In the absence of calcifications, an x-ray mammogram can not distinguish the symptoms of a breast fibroadenoma from a cyst.

An important diagnostic criterion for echography can be an assessment of tumor vascularization. According to Chorsevani, Morishima, vascularization is defined in approximately 36.0% of fibroadenomas (the average age of women was 38.5 years). The revealed vessels were located at the periphery of the nodes at 67.0-81.1%, along the entire site - in 13.6%, the uneven distribution of the vessels was detected only in one case (4.6%).

Cosgrov affirms that the detection of vessels with vascular dysplasia previously unvascularized with color Doppler mapping makes it possible to suspect malignancy.

Phyloid tumor

This is a rare fibroepithelial tumor of the breast. On the cut resembles the folded leaves of cabbage. A tumor often occurs at the age of 50-60 years. Being benign, a tumor in 10% of cases can degenerate into sarcoma. Differentiate the benign or malignant nature of the lesion is possible only histologically. The echographic picture is characterized by visualization of a solid hypoechoic well-delimited formation without additional acoustic effects. The structure of the tumor may be non-uniform due to cystic slit-like cavities.

Lipoma

True lipomas are a knot of mature adipose tissue surrounded by a connective tissue capsule. When palpation in the mammary gland is determined by a soft mobile formation. Ultrasonic picture of lipoma resembles fatty tissue of the breast - hypoechoic, homogeneous, compressible. In the presence of fibrous inclusions, the structure of the lipoma is less

Homogeneous, with hyperechoic inclusions, a hyperechoic rim can be detected. Lipoma can be difficult to isolate in the mammary gland with an increased fat content. With echography, lipoma should be differentiated with fibroadenoma, with a very contrasting fatty lobe or other fatty inclusions.

Adenolipoma, fibroadenolipoma are a variant of fibroadenoma and represent an encapsulated tumor consisting of fatty, fibrous tissue and epithelial structures. Adenolipomes can reach large sizes. When echography, adenolipomes have a heterogeneous structure with hypo-and hyperechoic inclusions.

Fibroangioloma can be very echogenic. In older women, a clear formation is revealed in a dense fibrous capsule. The absence of a capsule does not allow to differentiate the lipoma from the surrounding fatty tissue. The tumor can reach large sizes.

Hamartoma

Gamartoma is a rare benign breast tumor. It can be located both in the gland itself, and at a distance from it. The ultrasound image of the hamartoma is very variable and depends on the amount of fat and fibroglandular tissue in the form of hypoechoic and echogenic sites. The effect of distal pseudo-enhancement or weakening is determined depending on the structure of the tumor. With X-ray mammography, a well-defined encapsulated formation with a heterogeneous structure is determined.

Papilloma

Papillomatosis is a neoplastic papillary proliferation within the milky duct. These papillary growths are benign proliferation of some cells of the epithelium. Most often they arise at the age of 40-45 years in the form of a single inclusion inside the end duct or in the lacteal sinus. Most solitary intraprostatic papillomas are benign. Single intraprostatic papillomas are manifested in the form of formations, which are difficult to differentiate with fibroadenoma. They are rarely more than 1 cm.

The echographic image of the intraprostatic papilloma can be of four types:

1. intraprotective;
2. intracystic;
3. solid;
4. specific (multicavity and mottled image).

The ultrasound image of the intraluminal type of papilloma can be in the form of an isolated expansion of the duct or a solid formation of a rounded shape, of different echogenicity, without the effect of distal weakening against the background of an isolated expansion of the duct.

The intracystic type can be represented by an ultrasound image of a cyst with solid inclusions along the inner contour. A solid component can be of various sizes and echogenicity.

A solid type is characterized by the formation of a solid structure of small dimensions (maximum size is 9 mm) with a connecting or closely located dilated milk duct. Most solid formations have a posterior reinforcement; there is never an acoustic shadow. Characteristic are high indices of the ratio of П and ПЗ.

Diffuse intraprostatic papillomatosis is characteristic for the destruction of terminal, peripheral, milky ducts. Being a disease of young women, has a second name - juvenile papillomatosis. In 40% of cases it is accompanied by atypical hyperplasia of epithelial cells of suspicious histological character. That is why with diffuse papillomatosis the risk of breast cancer is high. Echographic picture of juvenile papillomatosis

Characterized by the presence of poorly delimited heterogeneous mass without the effect of distal weakening, with small anechogenous areas along the edges or around the formation. In ultrasound examination, it is necessary to evaluate the flatness and clarity of both the external and internal contours, and when the cystic enlargement is detected, the content is stirred. Mammography is not informative. Galactography is the main method of visualization of intra-flow formations. By introducing contrast, it is possible to detect not only an obturation, but also a very small defect in the duct wall. There were data on the conduct of echogalactography with ultrasound evaluation of contrasted ducts.

Sclerosis of the glandular tissue (sclerosing adenosis)

Sclerosis of tissues usually accompanies involutive processes and is a variant of glandular degeneration. The ultrasonic picture is quite nonspecific. Most often, hyperechoic structures or their clusters are identified, behind which an acoustic shadow of varying intensity is detected. The rear wall and the underlying structures are not differentiated. The ultrasound image of sclerotized tissues can be characterized only by an acoustic shade of irregular shape. The risk of missing a malignant process located in the zone of an acoustic shadow makes biopsy and morphological verification of the process necessary.

Steatonecrosis

This is a rare lesion of the mammary glands, which occurs, as a rule, in obese elderly women. As a result of a mammary gland trauma, steatonecrosis does not have a specific histological picture. With steato-necrosis, mammary gland thickening can occur due to sclerosing adenosis, fibrous scars, chocolate cysts with pronounced calcification. These changes can exist for years or spontaneously regress. Usually steatonecrosis is located in the subcutaneous or in the back of the nipple. With a superficial location, steatonecrosis can cause skin fixation, retraction and retraction of the nipple. When palpating the zone of steatone croz, a small hard knot with fuzzy contours is determined. The ultrasound picture is diverse. Necrotized fat can be defined as a complex of liquid-containing masses, as an irregular form of hypoechoic or hyperechoic formation with a distal acoustical shadow. The change in surrounding tissues can be expressed as a violation of the normal orientation of the skin, the constriction of Cooper ligaments. Differential diagnosis is performed with a hyperplastic form of breast cancer, with radial scars, hyperplastic fibrosis or with residual abscess and hematoma. Similar changes in the structure of the breast are noted after biopsy and other types of invasive interventions.

Rare benign breast changes

A number of rare breast diseases have a very nonspecific ultrasound and mammogram picture and require an obligatory biopsy to establish a diagnosis.

Leiomyoma

The emergence of this benign tumor is a consequence of underdevelopment of the smooth muscles of the breast. Mammographic and ultrasound images are not specific. On echograms, the leiomyoma is visualized by a solid, well-delineated formation with a homogeneous internal structure.

Post-musculoskeletal adenoma

The posterior adenoma refers to benign proliferative nipple disease. At the same time there is a smoothing, pulling and inversion of the nipple due to the formation located in the hindlegs. A nipple abrasion presupposes a clinical diagnosis of a malignant lesion (Paget's cancer) even before the biopsy. Ultrasonic and mammographic data do not allow to differentiate this benign tumor with its malignant analogue.

Diabetic fibrosis

This lesion of the breast can occur in patients with diabetes. When palpation, solid, with hummocky contours, knots not welded to surrounding tissues come to light. When the echography reveals pronounced acoustic shadows behind the superficial sections of the breast, masking the underlying tissues. Breast cancer demonstrates nonspecific diffuse darkening. Carrying out a puncture biopsy is inexpedient because of the high density of palpable masses. This does not allow the amount of material in the needle sufficient to make a diagnosis.