Mammary glands in children

From the sixth week of embryonic development, almost simultaneously with such organs as the heart and lungs, mammary glands begin to form in children. First, dense germination of the epidermis appears in the embryonic tissue (mesenchyme), which extend from the axilla to the inguinal region. Later these structures turn into acini and remain only in the chest area. And the nipples are formed in the perinatal period (after the 22nd week of gestation) - the spread of the mesenchyme underlying the areola. In newborns of both sexes, the nipples are in small indentations and soon after birth, due to the proliferation of their surrounding connective tissue, take on a normal appearance. All this is physiology.

However, there are many pathological processes, in which an increase in mammary glands in a child that does not correspond to age can occur, as well as redness or denseness of the mammary glands in children.

[1], [2], [3], [4]

Mammary glands in children of the first year of life

At the majority of full-term infants in the first days of life - due to the termination of the inflow of maternal sex hormones into the bloodstream - the so-called sexual crisis develops. On the 3-4th day after birth, there is engorgement or swelling of the mammary glands in children, which may increase during the next 5-7 days. There may be redness of the mammary gland in the child, and from the nipples may appear insignificant by the volume of discharge similar to milk liquid. This phenomenon physicians are also called physiological mastopathy of newborns.

As noted by pediatricians, neonatologists, there may be a consolidation of the mammary glands in children - right under the nipple. Education is always single, up to 2-3 cm in size. It can disappear in a couple of weeks, or it may not go away for several months while the baby is breastfed: some children have increased sensitivity to the hormone prolactin, which contains breast milk.

Parents need to know that this is not a disease, but a specific reaction of the child's body. It is necessary to consult a doctor, but nothing to treat is not necessary, you should only carefully observe hygiene. Because its non-compliance is fraught with mastitis (inflammation of the breast) of newborns, which is able to go into an abscess.

And in this case, the causes of diseases of the mammary glands in a child during infancy are infection, most often staphylococcus or streptococci, and the development of an inflammatory process that needs to be treated (see below).

Mammary glands in prepubescent children

The increase in mammary glands in a child before puberty, in particular, in girls under 8 years old, is a deviation. According to the doctors' definition, this is a premature telarche, that is, the beginning of the development of the mammary glands before the girls enter the puberty period (which begins after 10 years). Premature bodily is considered a benign isolated state, so to speak, a local process, which consists in the development of the mammary glands without the appearance of other secondary sexual characteristics.

Its causes may be problems with the ovaries (cysts), adrenal glands or thyroid (hypothyroidism), as well as the use of exogenous hormones or drugs. For example, several years ago, Turkish researchers (Gazi University, Ankara) found that prolonged use of fennel used to regulate intestinal function in infants and to relieve the condition with bloating causes breast enlargement in the child and can lead to too early development of the breast girls to two years. The fact is that the biologically active substances of this plant stimulate the synthesis of estrogens.

It should also be taken into account that the asymmetric development of mammary glands in girls under the age of 12 corresponds to the features of this process: one gland (usually the left one) develops earlier than the second, but ultimately, the breasts become symmetrical.

According to some reports, about 4% of girls with premature telapha have central premature puberty. What does this mean? This is when the enlargement of the mammary glands in girls begins earlier than 8 years of age and is accompanied by hair embolism of the pubic and axillary regions. To date, there are good reasons to consider as one of the key causes of this pathology mutations in the leptin (Lep) and leptin (Lepr) receptors, the fatty tissue peptide hormone responsible for regulating energy exchange in the body. According to studies of endocrinologists, an increase in mammary glands in a child in almost 80% of cases is observed when the body weight exceeds the average age by 9-10 kg.

Causes of breast diseases in a child

Experts call the following causes of breast diseases in the child, as well as their pathological development:

• damage to the brain system (due to infection, trauma, intracranial neoplasm or radiation), which inhibits the hypothalamic-pituitary-gonadal axis, leading to premature release of gonadotropic hormones, luteinizing (LH) and follicle-stimulating (FSH);
• hypothyroidism;
• prepubertal hypogonadism (decrease in testosterone levels in boys due to functional testicular failure);
• the follicular ovarian cyst;
• germinogenous ovarian tumors;
• congenital hyperplasia of the adrenal cortex;
• prolactin (a pituitary tumor that produces prolactin);
• embryonic tumor of the hypothalamus (hamartoma);
• swelling of the pineal body (pinealoma);
• McCune-Albright Syndrome (congenital increased growth hormone growth hormone, STH).

Mammary glands in obese children of both sexes are often increased; a tumor consisting of fat cells surrounded by a connective tissue - a breast lipoma can be formed .

In boys of pubertal age (over 12 years) there is an increase in the mammary glands, which is called juvenile gynecomastia. Its cause lies in the age-related increase in pituitary gland production of follicle-stimulating hormone (FSH). As a result, there is a temporary imbalance of sex hormones, which eventually passes.

The pain in the mammary glands of a child, as well as the hardening of the tissues in the nipple region, can be the result of even the slightest injury.

In adolescent girls, against the background of the hormonal instability characteristic of this age, fibrocystic and hyperlastic changes in the breast can be detected:

• a mammary gland cyst in a child (benign circular formation in the form of a cavity with internal contents);
• Hyperplasia of the breast in a child - see Breast hyperplasia
• fibroadenoma (a mobile benign tumor) - see Fibroadenoma of the mammary gland

The prognosis for the majority of benign varieties of fibrocystic mastopathy is favorable. However, with significant proliferation of the epithelial tissues of the breast, there is a threat of malignant degeneration of the neoplasia.

[5], [6], [7], [8]

Breast cancer in a child

In pediatric practice, breast cancer in a child is diagnosed extremely rarely. Most of the problems with the mammary glands in childhood are benign mastopathy and many are resolved without specific treatment.

Nevertheless, there is a juvenile secretory carcinoma - a rare form of the disease, most often diagnosed precisely in adolescent girls. Secretory breast carcinoma is a special variant of invasive protocol cancer, typical for underage patients. It develops slowly in the form of small, poorly defined on ultrasound of single or multiple nodular neoplasias (0.5-3.5 cm in size) in the ducts of the mammary glands. The peculiarity of this type of tumors consists in periodic secretory secretions from tumor cells; Also in malignancies there may be microcalcifications.

Breast cancer in a child of puberty in the form of phyloid cystosarcoma also refers to rare diagnoses. But this is a very aggressive tumor, exciting and parenchyma of the breast, and its skin.

There are other types of cancer that can spread as metastases to the breast tissue - for example, lymphomas that affect the lymph nodes in the chest and axillary region; leukemia, soft tissue sarcomas, neuroblastoma, and others.

The causes of mammary gland diseases in a child in the case of detection of oncology are often associated with both hormonal jumps of transitional age and a predisposition inherited from the maternal line, in particular, mutations of the BRCA1 and BRCA2 genes. According to the American National Cancer Institute (NCI), mutations of BRCA1 increase the risk of developing breast and ovarian cancer by 55-65%, and BRCA2 mutations by 45%.

[9], [10]

Symptoms of breast diseases in a child

Briefly, we list the typical symptoms of mammary gland diseases in a child.

When mastitis in newborns are noted: an increase in the mammary gland with a zone of compaction of subcutaneous tissues; hyperemia; soreness; high body temperature (up to + 38 ° С); can be a worsening of appetite, a disorder of the digestive tract (vomiting, diarrhea). When the abscess develops, the temperature reaches + 39 ° C, a purulent infiltrate is formed in the redness zone, the child is inhibited and refuses to breast.

For juvenile gynecomastia, boys are characterized by: a swelling similar to swelling in the mammary glands in children, which occurs below the nipples - with increased sensitivity of the nipples. And with gynecomastia associated with hypogonadism, the boy's breasts are painful to the touch, and there are symptoms such as underdevelopment of secondary genital organs, excess fat in the upper body, pallor of the skin, lethargy, sleep disturbances, etc.

Symptoms of fibrocystic pathologies and hyperplasia of the mammary gland in adolescent girls can be manifested in the form of swelling of the mammary glands after the completion of menstruation, a feeling of bursting in the chest, swelling and mastalgia (soreness of different intensity), the presence of elastic or harder rounded nodules in the breast tissue, or elongated (cicatricial) neoplasia. In fibrotic pathologies, education is formed in the upper quadrant of the gland (closer to the armpit). Larger formations can lead to a change in the shape of the glands or their asymmetry. In the affected area, the color of the skin may change, and liquid secretions are possible from the nipple. In the presence of cysts, which in teenage girls are localized under the nipple, often the skin in the areola zone has a bluish tinge.

It should be borne in mind that in many cases, these pathologies proceed without significant symptoms, and neoplasia is detected quite by accident.

Breast cancer in a child can manifest itself in almost the same symptomatology. In addition, often discomfort and soreness can be felt in the armpit area, the nipple is slightly drawn into the areola, and the skin on the chest can look like the peel of an orange.

Diagnosis of breast pathologies in children

Clinical diagnosis of breast pathologies in children is carried out on the basis of a survey that begins with a physical examination of the child and an anamnesis (including family history).

To determine the level of hormones in the blood serum (such as estradiol, prolactin, testosterone, LH, FSH, 17-OPG and DHEA-C, gonadoliberin, somatropin), it is necessary to submit a biochemical blood test. Also, the blood is examined for AFP - a marker of germ cell tumors alpha-fetoprotein and markers of tumor growth.

By appointment, not only ultrasound of the mammary glands to the child, but ultrasound sonography of the thyroid gland, adrenal glands and pelvic organs. Mammography is not performed for children.

Differential diagnosis of breast pathologies in children is carried out using computer or magnetic resonance imaging of the adrenal glands and brain structures: pituitary, hypothalamus, pineal body.

In fibro-cystic and hyperlastic changes in the mammary glands - to exclude oncology - a fine needle aspiration biopsy of the formation (or axillary lymph node) is performed with a histological examination of the biopsy specimen obtained.

[11]

Treatment of diseases of mammary glands in a child

Equal treatment for all diseases of the mammary glands in a child is impossible, and therapeutic methods are determined by a specific diagnosis.

So, the swelling of the mammary glands in children of the first months of life does not need treatment, but with purulent mastitis antibiotics, and sometimes abscess drainage (which the surgeon conducts in a hospital) can not be avoided. And the best prevention of mastitis in infants is the perfect cleanliness and proper care of the baby.

Treatment of early development of the breast (telapha) treatment does not require. Nevertheless, you need to track any changes in the size of the breasts of girls.

More on how to treat premature puberty, read - Premature puberty - Treatment

The enlargement of the mammary glands in the boy also requires observation, and if the juvenile gynecomastia does not pass spontaneously within a couple of years after the diagnosis is determined, the endocrinologist, on the basis of the results of the analysis for the level of hormones in the blood, will prescribe treatment with hormonal drugs and recommend wearing a bandage on the chest.

When surplus fatty tissue can also apply its pumping (liposuction).

Mastopathy in girls during the pubertal period should be treated with a pediatric gynecologist or mammologist. But other specialists can come to the aid, since the etiology of cystic education is associated with the thyroid gland, and the hyperplasia of the mammary gland in a child can arise due to neuroendocrine pathologies and disorders of the hypothalamic-pituitary-gonadal system.

With oncology, the treatment of breast diseases in a child is carried out in the same ways as in adults (surgically, chemotherapy).

Doctors say that with a timely request for medical help, the prognosis of most pathologies of the mammary glands in children is positive. But their prevention has not been developed to date.