Pain , discomfort, in the mammary gland seal - Causes, symptoms and treatment.MF .
In benign breast conditions are often complaints of pain, discomfort, there may be some education in the tissues of the prostate, or discharge from the nipple.Mammary gland - physiologically dynamic structure with constant changes of cyclic processes of proliferation and involution.Occurring at the same time changes can be so pronounced that they will go beyond the concept of "normal".Therefore dishormonal disease is often referred to a group of variations in the normal development and involution - ANDI ( aberration of normal development and involution ).By itself diseases include the most prominent forms of such deviations.Interpretation of the extent of these disorders depends on the doctor and the patient.
mammalgia (mastalgia, Cooper's disease) - pain in the breast.In premenopausal women mammalgia can manifest itself in the form of discomfort that occurs before menstruation.Estimated reason - cyclic engorgement glands due to venous congestion and puffiness stroma before menstruation;at this time
fibroadenoma - most often detectable tumor (rather infringement of breast lobules than the true tumor) breast cancer, especially at a young age.Fibroadenoma consists of connective and epithelial tissue proliferating.
• Diagnosis •• fibroadenoma - a dense, well-demarcated, mobile tumor with slow growth.During pregnancy often increases in size •• ultrasound.Precise, smooth edges, the height and width ratio of less than 1, homogeneous structure.Education hypoechoic, with acoustic enhancement behind him.There may be single or double-sided lateral acoustic shadow.Compression does not affect internal echostructure and may alter the shape (the image of the tumor flattening) •• Mammography.Since most fibroadenomas occur in young women, routine mammography is not shown.In elderly women visible in the images as a single, uniform density education without violating the breast structure.With age, the fibroadenoma may calcify.Calcification usually starts from the center and can capture all the fibroadenoma.Characterized by a large calcifications of the form "popcorn» •• The cytologic material of cells is usually small, determine the bare core.Cell proliferation can be pronounced, but it has no prognostic value.
• Treatment is usually surgical.When tumors of small size deep tissue (ultrasound or mammography data) or multiple fibroadenomas - observation, with the diagnosis of doubtful - excisional biopsy.The probability of malignancy fibroadenoma does not exceed 1%.
leaflike (filloidnaya) fibroadenoma is large, polycyclic contours, rapid growth.It can degenerate into sarcoma (about 10% of cases).Ultrasound: fibroadenoma picture.Mammography: usually lobed, dense formation with clear, smooth edges.Cytology: a large number of cell content, cell atypia.Required surgery.Incomplete excision recurs.
hamartoma (fibroadenolipoma) - malformation of the breast tissue in the form of an isolated (outside of the anatomical structure) islet normal tissue.Most are asymptomatic.On palpation - a separate, more dense, mobile education.Mammography: a well-marked degree, and contains fat and glandular tissue.Visible thin line rentgennegativnaya (pseudocapsule) surrounding at least a part of education.The diagnosis is usually put on the characteristic X-ray pattern.Surgical treatment is indicated for the differential diagnosis or at the request of the patient (cosmetic defect).
mastitis (dishormonal breast disease).For mastopathy is characterized by a wide spectrum of proliferative and regressive changes in breast tissue in violation of the ratio of epithelial and connective tissue components.The main link of pathogenesis - a violation of hormonal regulation.Proliferative changes include hyperplasia, proliferation of lobules, ducts, connective tissue, and regressive - atrophy, fibrosis, cyst formation.
• Frequency.Mastopatia occurs in 30-40% of women of childbearing age (most often at the age of 40 years, with the age of the frequency gradually decreases).
• Pathogenesis.The main reason - hormonal imbalance in women, caused by various pathological conditions which need to be identified to adequately treat •• Increased estrogen levels (absolute or relative) is ductal hyperplasia of the breast with the development of cystic changes •• Elevated levels of progestin causes the development adenoznyh structures (glandular hyperplasia, lobular acini addictive) with the occurrence of pain •• Increased prolactin levels leads to the development of galactorrhea and galaktooforitov, disruption of LH secretion (failure), causing amenorrhea due to a violation of progesterone production.Increasing the level of prolactin in the blood, usually accompanied by increased levels of estriol, estradiol •• It is equally important, and violation of the biological rhythm releasing hormone, which is inherent in a well-functioning neuroendocrine system.In violation of the rhythm of release of hormones and their ratio is more long-term effect of some hormones and poor - the other, leading to a change of normal cyclical processes in the mammary gland.
• Classification •• ••• With the prevalence of diffuse glandular component (adenosis) ••• With the predominance of the fibrous component ••• With the prevalence of cystic component ••• •• Mixed form Hub fibroadenomatosis.
• Clinical picture.The main complaint - aching dull pain, which give a feeling of fullness and weight, increasing in the premenstrual period (in 85-90% of women).Determine the painful areas of the seal in the breast tissue (all) •• Mastopatia with a predominance of glandular component (lobular hyperplasia prostate) manifests tenderness, bloating and diffuse throughout the gland seal or her area, often with the presence of a pronounced "grain" fabric.Borders seal smoothly into the surrounding tissue.Manifestations worse in the premenstrual period.More often observed at the end of puberty, and women in the early stages of pregnancy (as a transient condition).On the radiograph - multiple shadows of irregular shape with fuzzy boundaries •• Mastopatia with a predominance of fibrosis - fibrosis of the interlobular connective tissue proliferation of ductal tissue and narrowing of the lumen of the gland duct up to the complete obliteration.Appears soreness, palpation determine the compacted areas tyazhistye •• Mastopatia with a predominance of cystic component manifested soreness, increasing before menstruation, the presence of multiple elastic tumor formations (cysts formed from atrophied lobules and ducts advanced breast) with precise contours.A mammogram and ultrasound: multiple rounded education with precise contours •• Mixed form - hyperplasia lobules sclerosis intralobular and interlobular connective tissue and atrophy of the alveolar ducts and with the expansion of their transformation into cysts •• nodular.Changes are local (single or multiple nodes).Palpation define separate seal without clear borders, not welded to the skin may vary depending on the menstrual cycle.
• Diagnosis is based on history, clinical presentation, palpation of mammary glands and confirm the results of ultrasound, needle biopsy or aspiration of cyst contents.Mammography is used only as a method for the differential diagnosis of tumors or as a screening examination.Isolated determine the content of hormones in the blood is inefficient, to clarify the nature of the disease is more justified colpocytologic conducting research.
• Diet: food regime that excludes methylxanthines, - tea, coffee, chocolate.
• Treatment •• conservative, taking into account the type of hormonal disorders and their causes, which makes certain difficulties in connection with the regulation of multi-functional state of the breast.Usually use small doses of iodine, vitamins;progestogens (norethisterone and progesterone derivatives), antiprolaktinovye drugs (bromocriptine), androgens (testosterone derivative) •• Surgical treatment of focal forms ineffective because stored endogenous factors that contribute to relapse.
• Monitoring is carried out until the complete disappearance of formations.Excisional biopsy is indicated for nodular fibroadenomatosis and suspected malignancy (after the full range of tests: ultrasound, mammography, fine needle aspiration biopsy).
• The risk of malignancy.70-90% of mastopathy (diffuse form) are not accompanied by an increased risk of developing breast cancer.In cases of atypical epithelial hyperplasia (according to needle aspiration biopsy) risk of developing carcinoma in 3-6 times higher than in the general population.Upon detection of atypical cells and breast cancer family history risk 10-15 times higher.
intraductal papilloma - papillary epithelial outgrowths, sprawling in the extended space of the breast ducts.This is one of the most frequent causes of discharge from the nipple.Most occur spontaneous abundant serous discharge, at least - spotting.Multiple papillomas ratsenivayut both obligate precancer.
• Diagnosis is based on clinical presentation, ductography (mammography with the introduction of a contrast agent into the affected gland duct), cytology (the presence of papillary structures).Cytology and mammography are required, as well as for malignant neoplasms characterized by bloody discharge from the nipple nature (especially with intraductal growth).The presence in the area papilloma scattered microcalcifications indicative of a probability of the presence of cancer.Ultrasound papillomavirus can be detected due to the expansion and overflow the affected duct.
• surgical treatment - excision of the affected duct.Before the operation, you must perform hromoduktografiyu.
breast Fat necrosis ( lipogranulёma ) - aseptic necrosis of adipose tissue.Possible causes: trauma, excessive physical exercise, surgery, injections.
• Clinical picture.On palpation reveal the formation, sometimes fused with the skin (possible retraction of the nipple).Colouring of skin, usually normal.First X-ray picture resembles that in malignant tumors.Later necrosis calcify (usually formed spherical calcification of the "egg-shell") that allows you to confirm the non-cancerous nature of the process.Fine-needle aspiration biopsy uninformative (no cell material).Diagnostics facilitates the presence of trauma history, but that does not preclude the presence of cancer.
• Treatment (including and difficulties in the differential diagnosis) operative.
Mondor disease (thoraco-epigastric thrombophlebitis) - Vienna thrombosed, defined as the cord under the skin of the breast to the axilla or navel.The main reason - injury, includingand operating.The diagnosis is easy to install in normal inspection.Treatment.Heat topically, analgesics (NSAIDs may be used).Anticoagulants are not shown.
galactocele - simple cyst filled with milk.Aspiration - diagnostic and therapeutic measure.When recurrence shows repeated puncture with aspiration, resection is performed rarely.
Subareolyarny abscess (mastitis plasmatic) more common in adolescents postpubertantnom period and in women 35-40 years of age (more common in smokers).The main reason - an inflammation of additional glands located under the areola (tubercles of Morgagni).As a result of inflammation formed an abscess, which opened on the edge of the areola to the formation of a fistula.Subsequently, between the nipple and areola edge of developing fibrosis, nipple retracted.
• Clinical picture.In adolescents, all of a sudden (usually after hypothermia) appears sickly seal around the edge of the areola or under the nipple, the skin over it hyperemic (adults in the early stages is often the only manifestation of the disease - discharge from the nipple), multiple foci of abscess formation may occur in the future with fistula formation at the edgeareola, nipple indrawing (remember that sometimes because cancer can occur).
• Treatment.The acute stage - antibiotics, pp dimethyl sulfoxide (1: 5) locally abscess puncture with aspiration of contents (with the ineffectiveness of the puncture - surgical drainage of the abscess cavity).Remission - surgical treatment with excision of fistulas and all extended ducts.
ICD-10 • N60 dysplasia Benign breast