Mastopathy of mammary glands

According to the definition of WHO (1984), mastopathy is a fibro-cystic disease characterized by a proliferative and regressive changes in the gland tissue with an abnormal ratio of epithelial and connective tissue components.

[1], [2], [3], [4], [5]

Epidemiology

Mastopathy is one of the most common diseases in women: in the population, the incidence is 30-43%, and among women with various gynecological diseases, reaches 58%. The frequency of mastopathy reaches a maximum of 45 years.

[6], [7], [8], [9], [10], [11], [12]

Causes of the mastopathy

Mastopathy is a benign disease. However, in a number of cases, this pathology can be an intermediate stage in the development of malignant process. Since benign diseases and breast cancer have much in common in the etiological factors and pathogenetic mechanisms, the risk factors for the development of mastopathy and cancers cancer are largely identical.

In the emergence and development of dyshormonal diseases of the mammary glands an important role is played by the state of the hypothalamic-pituitary system. Violation of the neurohumoral component of the reproductive cycle leads to the activation of proliferative processes in hormonally dependent organs, including those in the tissues of the mammary glands, which are targeted for steroid hormones of the ovaries, prolactin, placental hormones and mediated hormones of other endocrine glands in the body. Numerous clinical observations confirm that benign breast diseases in 70% of cases are combined with various disorders in the neuroendocrine and reproductive systems. A decisive role in the development of diseases of the mammary glands is given to progesterone-deficient conditions, in which excess estrogen causes the proliferation of all gland tissues.

However, mastopathy is often observed in women with ovulatory cycles and undisturbed reproductive function. In this case, the decisive role in the development of breast pathology is not due to the absolute value of hormones in the blood plasma, but to the state of the receptors of sex steroids in the gland tissue, since the state of the receptor apparatus determines the appearance of the pathological process. In unmodified breast tissue, the number of receptors is minimal. Against the background of hormonal imbalance in some women, changes in the mammary glands can not go beyond the limits of the physiological norm, while others, under the condition of activation of the receptor apparatus, are able to pass into the pathological process with the subsequent development of proliferative processes.

In the emergence of dyshormonal pathology of the mammary gland, a liver disease plays an indirect role. As is known, in the liver there is enzymatic inactivation and conjugation of steroid hormones. Maintaining a constant level of hormones in the circulating blood is due to their enterohepatic metabolism. Diseases of the hepatobiliary complex most often initiate the development of chronic hyperestrogenia due to delayed utilization of estrogens in the liver. These data are confirmed by the high frequency of hyperplastic processes in the mammary glands with liver diseases.

Thyroid hormones (thyroxine, triiodothyronine) play an important role in the morphogenesis and functional differentiation of mammary epithelial cells. The action of thyroid hormones on the mammary gland can be realized directly or through action on receptors to other hormones, in particular to prolactin. In 64% of patients with various forms of mastopathy, the thyroid gland was diagnosed.

[13], [14], [15], [16]

Risk factors

At present, there is no specific risk factor for developing mastopathy, since it is a multifactorial disease associated with both genetic factors and environmental factors.

[17], [18], [19]

Symptoms of the mastopathy

The main complaint of patients with mastopathy is pain, usually in the premenstrual period, sometimes from the second half of the menstrual cycle. Pain may be localized and radiate into the arm or scapula. Women also note painful areas of densification in the mammary gland tissue.

Although the pain is the main symptom of mastopathy, 10-15% of women do not experience pain, despite the fact that during examination and palpation they reveal the same changes that women experiencing severe pain. Perhaps this is due to a different threshold of pain sensitivity, due to the level of endorphins in the central nervous system. The onset of pain is due to compression of the nerve endings with edematous connective tissue, cystic lesions and their involvement in sclerized tissues. Approximately 10% of women report an increase in axillary lymph nodes and their sensitivity to palpation.

Stages

There are three clinical phases of mastopathy:

1. the first phase - the age of 20-30 years, the menstrual cycle is regular, but often shortened to 21-24 days; a week before menstruation there is agitation, breast tenderness, iron tightens and becomes sensitive at palpation;
2. the second phase - 30-40 years, the pain in the mammary glands is permanent and lasts 2-3 weeks before menstruation; In the gland palpable separate painful lobules with cystic inclusions;
3. the third phase is older than 40-45 years, the pain in the mammary glands is less intense and unstable; palpated multiple cystic formations, some reach 1-3 cm in diameter, contain a brownish-green secret, appearing from the nipple when pressed on the sucking field.

[20], [21], [22], [23],

Forms

For clinical practice, it is convenient to classify fibrocystic mastopathy (PKM), which distinguishes diffuse and nodal forms of changes in the glands, which are found on X-ray photographs with ultrasound scanning and morphological examination.

Classification of mastopathy

• Nodal fibrocystic mastopathy
• Diffuse fibrocystic mastopathy:
  • with a predominance of the glandular component (adenosis),
  • with predominance of the fibrous component;
  • with predominance of the cystic component;
  • mixed form

Diffuse and nodal fibrocystic mastopathy can have both a proliferating and nonproliferative form. When proliferating in the epithelium lining the milk passages, intraductive papillomas develop; in the epithelium lining the walls of cysts - cystadenopapilloma. It is possible to develop atypical and malignant changes in proliferating epithelium.

The criterion for determining the subspecies is the ratio of connective tissue, glandular components and adipose tissue.

Isolate a special form of breast pathology in the premenstrual period - mastodynia, or mastalgia - cyclic engorgement of the gland caused by venous congestion and swelling of the stroma; The mammary gland increases in volume by more than 15%.

[24], [25], [26], [27]

Fibrous-cystic mastopathy with predominance of glandular component (adenosis)

Morphologically this form of fibrocystic mastopathy is characterized by highly differentiated, non-clotted hyperplasia of the lobules of the gland.

Clinically, it manifests itself as painfulness, engorgement and diffuse densification of the entire gland or its site. The boundaries of the seals smoothly pass into the surrounding tissues. Soreness and roughness increase in the premenstrual period. Adenosis is observed in young girls at the end of puberty, as well as in women in the early stages of pregnancy as a transient condition. When X-ray examination, multiple shadows of irregular shape with indistinct boundaries, which correspond to areas of hyperplastic lobules and lobes, are noted. Sometimes, in an extensive process, shadows capture all of the gland.

[28], [29], [30], [31], [32]

Fibrous-cystic mastopathy with predominance of fibrosis

Morphologically, this form is characterized by fibrotic changes of the interlobular connective tissue, proliferation of the intraluminal tissue with a narrowing of the lumen of the duct of the gland until its complete obliteration.

The clinical picture is characterized by soreness, with palpation of the gland tightened, tightening areas are defined. Fibrous processes prevail in women of premenopausal age. X-ray picture of this form of fibrocystic mastopathy is a layer of dense homogeneous areas with pronounced tightness. Radiographs have the form of "frosted glass."

[33], [34]

Fibrous-cystic mastopathy with predominance of the cystic component

The morphological picture of the cystic form of fibrocystic mastopathy is characterized by the presence of multiple cysts, formed from atrophied lobules and enlarged gland ducts. Fibrous changes in interstitial tissue are also characteristic. However, in cysts, proliferative processes may appear in the epithelium lining the cyst wall, with the formation of papillary formations.

As with other forms of fibrocystic mastopathy, a characteristic clinical sign is soreness, which increases before menstruation. X-ray fibrocystic mastopathy with a predominance of the cystic component is characterized by a large-piebald pattern, on which multiple clearings with a diameter of 0.3 to 6 cm with clear contours are determined. The color and consistency of cystic contents are different. The liquid is partially resorbed by histiocytes. In 25% of patients, cysts are calcified. Calcination, like bloody contents, is considered a sign of malignant process.

All three diffuse forms of fibrocystic mastopathy in pure form are rare. It is much more common in clinical practice to deal with a mixed form of mastopathy, in which all the above morphological changes are expressed: hyperplasia of the lobules, sclerosis of the interlobular and interlobular connective tissue and atrophy of the alveoli with the widening of the ducts and their transformation into cystic formations.

[35], [36],

Nodular form of fibrocystic mastopathy

This form of fibrocystic mastopathy is characterized by the changes described above, but having a local character in the form of single or multiple nodes. When palpation, individual seals are determined without clear boundaries, not welded to the skin, increasing the day before and decreasing after the end of menstruation. With this form of fibrocystic mastopathy, soreness is most pronounced, the pain radiates to the shoulder, scapula. Sometimes axillary lymph nodes increase.

Treatment of the mastopathy

Women who have fibrocystic mastopathy is found accidentally as a concomitant pathology without expressed complaints, special treatment is not required. Such patients should be examined (ultrasound and / or mammography and diagnostic puncture) and further follow-up can be continued with a gynecologist or surgeon at least once a year.

Women with moderate cyclic or permanent form of mastodynia and diffuse fibrocystic breast structure changes (without obvious macro-cysts) are conservatively treated with hormonal therapy and non-hormonal therapies. Most often this applies to young, practically healthy women.

Non-hormonal treatment of mastopathy

Correction of diet

There is a close relationship between the use of methylxanthines (caffeine, theophylline, theobromine) and the development of fibrocystic mastopathy. These compounds promote the development of fibrous tissue and the formation of fluid in the cysts. Therefore, limiting the products containing methylxanthine (coffee, tea, chocolate, cocoa, cola) or completely refusing them can significantly reduce the pain and swelling of the mammary glands.

Both fibrocystic mastopathy and breast cancer have a connection with sluggish bowel activity, chronic constipation, altered intestinal microflora and insufficient fiber in the daily diet. At the same time, there is a reabsorption from the intestine of estrogens already extracted from the bile. Therefore, patients with fibrocystic mastopathy should eat foods that are rich in fiber and adequate fluid intake (at least 1.5-2 liters per day). Since estrogen utilization occurs in the liver, any diet disorders that hamper or limit normal liver function (cholestasis, fat-rich foods, alcohol, other hepatotoxic substances) may in time affect the clearance of estrogens in the body. In its turn. To facilitate and normalize liver function, additional intake of vitamins B (especially B6), A, C and E is desirable as nutritional supplements or even in therapeutic doses.

[37], [38], [39], [40], [41], [42]

Diuretics

Cyclic mastopathy, as one of the manifestations of premenstrual syndrome, especially if it is accompanied by swelling of the hands and feet just before menstruation, can be treated with mild diuretics (eg, herbal teas). It is also advisable to limit the use of table salt during this period.

Nonsteroidal anti-inflammatory drugs are recommended to reduce cyclic mastalgia for a week or several days before the next menstruation, when the most severe pains in the mammary glands appear, but this can not be recommended as a permanent and long-term treatment.

[43], [44], [45], [46], [47], [48]

Remedies for blood circulation

It is recommended to use preparations of vitamin P (ascorutin) or products containing this vitamin (citrus fruits, hips, black currant, black chokeberry, cherry, raspberry) to improve microcirculation and reduce local swelling of the breast.

Integrated, natural products

At the present time, many different complex herbal products with vitamins, antioxidants and trace elements are offered for the treatment of both mastopathy and premenstrual syndrome, including cyclic mastalgia (vetoron, clamina).

Soothing means

Mammary glands - very sensitive to psychoemotional stress body. Troubles at work or at home, chronic dissatisfaction, fatigue, anxiety, depression - all this can cause, maintain or intensify pain. Depending on the psychoemotional state of a woman, it is advisable to include sedatives in the scheme of complex treatment of mastopathy, first preferring light preparations of plant origin (tincture of motherwort, valerian, etc.), if necessary, to more potent sedatives.

Choosing a bra

Women with a cyclic or permanent form of mastalgia should always pay attention to this subject of the female toilet, since both completely ignoring it and wearing a bra of inappropriate shape or size can cause chronic deformity of the breast, its compression or overload of the ligament apparatus, especially in women with large and lowered breast. Often, if these causes are eliminated, the pain in the mammary gland decreases or even completely disappears.

[49], [50]

Mammary gland massage with mastopathy

Female bust basically consists of glandular tissues, which are densely packed with numerous blood vessels, lymphatic system, sebaceous and sweat-producing glands. It is not strange, it is this part of our body that is maximally protected.

Applying newfangled cosmetology means, antipersperanty daily action, people do not even think that thereby for a long time to block the weekend pores. Therefore, the lymph system is not able to remove from the human body toxins, products of decay and processing. But where to go, naturally they begin to be cumulated in neighboring tissues, that is, in the tissue structures of the breast. Often this development of events can lead to the formation of pathology, one of which is quite capable of becoming mastopathy, the percentage of manifestations of which, today, is quite large.

Therefore, in order to reduce the risk of its development or, in case of its diagnosis, gynecologist or mammologist doctors prescribe breast massage in case of mastopathy, which is one of the methods of complex treatment that allows to rid the woman of this problem.

This massage has a lymphatic drainage effect. This allows you to activate blood flow, lymph flow, preventing the appearance of stagnant phenomena.

It is the stagnation of the processes, in most cases, that is the catalyst for the formation of various kinds of neoplasms.

In the light of the development of the disease, normal lymph flow is especially important. After all, lymph is a "sanitizer" of the body, which cleans it, removing all debris, in parallel, conducting disinfection. It is thanks to lymph that our breasts are protected from invasive flora and other negative influences.

As for mastopathy, then with this disease there can be no question of independent treatment. Therapy should be comprehensive and prescribed by a qualified specialist, after a woman is examined and at the hands of a complete picture of the disease.

It is worth immediately to reassure women that this disease has long been treated favorably. Therefore, the main thing is not to start the process and promptly conduct treatment, seeking help from a mammologist.

To date, there is no single system of therapy that would completely suit and satisfy the point of view of all doctors. Different and complex protocols for the treatment of this disease, including medicamental and physiotherapy measures. In this dispute, the technique of massaging is also involved in the treatment of this pathology.

Therefore, to date, the use of massage in the treatment of mastopathy is controversial. Some experts believe that such an effect on the breast with the available mastopathy, can become a catalyst for the degeneration of existing benign tumors into cancerous structures. And such a risk is high enough. Therefore, they believe that they do not have the right to risk the health and life of women.

Others refute this judgment, proving the beneficial effect of physiotherapy on the relief of the problem associated with mastopathy.

It is worth recalling once again that treatment of this disease should be comprehensive. At the same time, if the doctor decided to prescribe a massage in the protocol of treatment, then to engage in amateur and self-medication should not be. This treatment procedure should only be done by a professional!

This therapy is long enough, therefore, to cope with the disease, you need to have patience. But it's worth it.

It is worthwhile to suggest one of the massage methods acceptable in this situation. Sequencing:

• It is necessary to sit down, relax, calm down, adjust your breathing and drive away any thoughts. Relax is an additional plus of this procedure.
• The cushions of the large, middle and index phalanx begin to make circular spiral movements that first move clockwise, and then in the opposite direction.
• In doing so, try to evoke a love of yourself and direct it to a massaged site. Try not to lose this condition for three to five minutes, during which the massage is performed.
• In parallel, it is necessary to represent the fact that the disease is leaving the body and recovery comes. Believe me, the result of such work will pleasantly surprise.
• It is necessary to direct its circulation to the central part of the brain, where the pituitary gland is located, which controls the production of hormones, supporting the hormonal background.
• Imagine a light energy that penetrates and heals. Continuing to massage, it is necessary to direct this "solar stream" and on the ovaries. Such events will not pass in vain. And soon it will be possible to notice a positive shift in the course of the disease.

It should only be noted again that self-medication should not be taken, this approach to therapy can bring a deterioration in the state of women's health. The procedure should be done by a specialist, and the procedure described above is allowed for use at home only with the permission of the attending physician.

Hormonal therapy of mastopathy

Hormone therapy is aimed at reducing the excessive stimulating effect of estrogens on the breast tissue, less often - on the correction of dispropylactinemia or hypothyroidism.

Antiestrogens

To provide a stimulating effect, endogenous estrogens need to bind to specific cell receptors. In the case of relative hyperestrogenesis, antiestrogens (tamoxifen, toremifene), blocking estrogen receptors in target tissues (including in the mammary gland), do not allow estrogens to bind to receptors, reducing their biological activity.

Some patients may have pain and swelling in the first weeks of treatment, which can be explained by the partial estrogenic effect of antiestrogens; in rare cases, because of this, you have to interrupt treatment.

[51], [52], [53], [54], [55], [56], [57]

Oral contraceptive means

Properly selected and used oral contraception provides a constant suppression of steroidogenesis and ovulation, suppression of the synthesis of ovarian androgens, as well as estrogen receptors in the endometrium, equalization of excessive fluctuations of cyclic hormones, long-term protection against the development of ovarian cancer and endometrium. Symptoms of mastopathy often decrease or even completely pass within the first two months, however, objective results can be expected no earlier than 1 to 2 years after the beginning of oral contraceptive use. At the same time, in some women during oral contraceptive use, pain in the mammary glands and other symptoms of mastopathy may even increase. Then you have to switch to another type of contraception or change the means of oral contraception.

Gestagens

The therapeutic effect of gestagens in the treatment of premenstrual syndrome and fibrocystic mastopathy is associated with oppression of functional pituitary-ovarian links and a decrease in the stimulating effect of estrogen on mammary gland tissue. In recent years, the use of progesterone derivatives - medroxyprogesterone acetate (MPA) has increased, because they have more pronounced gestagenic properties, moderate anti-estrogenic activity and minimal or practically absent androgenic effect. Especially shown are gestagens to patients with established luteal phase failure and caused by this relative hyperestrogenism, anovulatory bleeding, uterine myoma.

Androgens (danazol) as antagonists of estrogens are used to treat mastopathy. The basis of the action of danazol lies its ability to inhibit the synthesis of gonadotropic hormone (proved in experiments with laboratory animals) and some essential enzymes in ovarian steroidogenesis. The drug has a progestogen and a weak androgenic effect.

Prolactin secretion inhibitors

These drugs (bromocriptine) are prescribed only to patients with hyperprolactinemia.

Analogues of gonadotropin-releasing hormone

As a result of the use of gonadotropin-releasing hormone analogues (Gn-RG), the level of circulating estrogens and testosterone is significantly reduced. In addition, the presence of receptors for estrogens and progesterone in breast cancer tissue suggests that Gn-RH specifically affects (autocrine or paracrine) the growth of breast tissue cells.

Conservative therapy PKM requires long courses (3-6 months). However, only 1 year after the end of treatment, relapse occurs in 60-70% of cases. Therefore, the search for new methods of prevention and therapy of this disease remains urgent.

[58], [59], [60], [61], [62]

Surgical treatment of mastopathy

In the case of cystic fibrosis and other forms of nodular mastopathy, a sectoral resection of the mammary gland with an urgent histological examination of the node is indicated so that, if a malignant disease is detected in the remote preparation, a radical operation is performed immediately.

In those cases when proliferating fibro-adenomatosis is detected in the cytological examination, a simple mastectomy is the method of choice. This form of mastopathy should be considered as an obligate pre-cancer.