Pain, discomfort, seizures in the mammary gland - Causes, symptoms and treatment. MF.
In benign breast conditions, there are often complaints of pain, discomfort, it is possible that there is any formation in the gland tissues or discharge from the nipple. The mammary gland is a physiologically dynamic structure with constant cyclic changes in the processes of proliferation and involution. The changes that occur while this can be so pronounced that they will go beyond the concept of "norm".Therefore, dyshormonal diseases are often referred to the group of abnormalities in normal development and involution - ANDI( aberration of normal development and involution ).To the actual diseases, they include the most pronounced forms of such deviations. Interpretation of the degree of these disorders depends on the doctor and the patient.
Mastodynia ( mastalgia, Cooper's disease) is a pain in the breast. In premenopausal women, mastodynia can manifest itself in the form of a feeling of discomfort that occurs before menstruation. Presumptive cause - cyclic engorgement of the glands, caused by venous stasis and swelling of the stroma before menstruation;at this time the mammary gland increases in volume by more than 15%.Therapy is carried out simultaneously with the treatment of premenstrual syndrome. Assign NSAIDs, diuretics, norethisterone, episterone or bromocriptine.
Fibroidadenoma is the most commonly detected tumor( rather, a developmental disorder of the lobules of the mammary gland than the true tumor) of the mammary gland, especially at a young age. Fibroadenoma consists of connective and proliferative epithelial tissue.
• Diagnosis •• Fibroadenoma - a dense, well-delimited, mobile tumor with slow growth. During pregnancy, the size of the ultrasound often increases. Clear, smooth edges, the ratio of height and width is less than 1, homogeneous structure. Education is hypoechoic, with acoustic amplification behind it. There may be a one- or two-sided lateral acoustic shadow. The compression does not affect the internal echostructure and can lead to a change in shape( flattening of the tumor image) •• Mammography. Since most fibroadenomas occur in young women, routine mammograms are not indicated. In older women, it is seen in photographs as a single, uniform density formation that does not disrupt the structure of the breast. With age, fibroadenoma can become calcified. Calcification usually starts from the center and can capture the entire fibroadenoma. Characteristic of the presence of large calcinates, which look like "air corn" •• In the cytological material of cells is usually small, determine the bare nuclei. Cell proliferation can be pronounced, but it has no prognostic significance.
• Treatment is usually surgical. For small tumors in the depth of tissues( ultrasound or mammograms) or for multiple fibroadenomas - observation, with a doubtful diagnosis - excision biopsy. The probability of malignancy of fibroadenoma does not exceed 1%.
The leafy( fibroid) fibroadenoma is distinguished by its large dimensions, polycyclic contours, rapid growth. May degenerate into sarcoma( approximately 10% of cases).Ultrasound: a picture of fibroadenoma. Mammography: usually lobular, dense with clear, even edges. Cytology: a large number of cellular contents, atypia of cells. Mandatory surgical treatment. With incomplete excision recurs.
Hamartoma( fibroadenolipoma) is a malformation of the breast tissue in the form of an isolated( outside the anatomical structure) islet of normal tissue. Most often they are asymptomatic. When palpation - a separate, often dense, mobile education. Mammography: well-defined formation, containing both fatty and glandular tissue. A thin, X-ray negative line( pseudocapsule) is visible, surrounding at least part of the formation. The diagnosis is usually based on a characteristic radiographic picture. Operative treatment is indicated for differential diagnosis or at the request of the patient( cosmetic defect).
Mastopathy ( dyshormonal diseases of the breast).For mastopathy is characterized by a wide range of proliferative and regressive changes in the gland tissues with a violation of the ratio of epithelial and connective tissue components. The main link of pathogenesis is the violation of hormonal regulation. Proliferative changes include hyperplasia, proliferation of lobules, ducts, connective tissue, and regressive changes - atrophy, fibrosis, cyst formation.
• Frequency. Mastopathy occurs in 30-40% of women of childbearing age( most often at the age of 40, with age, the frequency gradually decreases).
• Pathogenesis. The main cause is a violation of the hormonal balance in the woman's body caused by various pathological conditions that need to be identified for adequate treatment. • Increasing the level of estrogen( absolute or relative) causes hyperplasia of the ductal part of the gland with the development of cystic changes. • Increased progestin content causes the development of adenosic structuresglandular hyperplasia, entraining acinus of the lobules) with the onset of pain syndrome •• Increased prolactin levels lead to the development of galKtorov and galaktooforitov, impaired secretion of LH( failure), whereby amenorrhea occurs due to a violation of progesterone production. An increase in the level of prolactin in the blood, as a rule, is accompanied by an increase in the level of estriol, estradiol • • Equally important is the violation of the biological rhythm of hormone release, which is inherent in a normally functioning neuroendocrine system. If the rhythm of hormone release and their relationship is disturbed, a longer action of one hormone occurs and an inadequate action of the others, which leads to a change in the normal cyclic processes in the mammary gland.
• Classification • • Diffuse ••• With predominance of glandular component( adenosis) ••• With predominance of fibrous component ••• With predominance of cystic component ••• Mixed form •• Nodal fibroadenomatosis.
• Clinical picture. The main complaint - aching blunt pain, giving a feeling of bursting and heaviness, increasing in the premenstrual period( in 85-90% of women).Define the painful areas of compaction in the breast tissue( in all). • Mastopathy with a predominance of the glandular component( hyperplasia of the lobules of the gland) is manifested by pain, engorgement and diffuse densification of the entire gland or its site, often with a pronounced "granularity" of the tissue. The boundaries of the seal smoothly pass into the surrounding tissues. Manifestations intensify in the premenstrual period. More often observed at the end of the period of puberty, as well as in women at the initial stages of pregnancy( as a transient condition).On the roentgenogram - multiple shadows of irregular shape with fuzzy boundaries •• Mastopathy with a predominance of fibrosis - fibrosis of interlobular connective tissue, proliferation of intraluminal tissue and narrowing of the lumen of the duct of the gland until complete obliteration. It manifests as painful, palpation is determined by densified thickening sites. • Mastopathy with predominance of the cystic component manifests itself as painfulness, intensifying before menstruation, the presence of multiple elastic tumor-like formations( cysts are formed from atrophied lobules and enlarged mammary ducts) with clear contours. Mammogram and ultrasound: multiple rounded formations with distinct outlines •• Mixed form - lobular hyperplasia, sclerosis of intra-lobular and interlobular connective tissue and atrophy of alveoli with expansion of ducts and their transformation into cystic formations •• Nodal form. The changes are of a local nature( single or multiple nodes).When palpation is determined individual seals without clear boundaries, not soldered to the skin, can vary depending on the menstrual cycle.
• Diagnosis is based on anamnesis, clinical picture, palpation of the mammary glands and is confirmed by ultrasound, puncture biopsy or aspiration of the contents of the cysts. Mammography is used only as a method of differential diagnosis with tumors or as a screening test. Isolated determination of the content of hormones in the blood is ineffective, to clarify the nature of the disease, it is more justified to conduct colpositology research.
• Diet: food regime, excluding methylxanthines, - tea, coffee, chocolate.
• Treatment •• Conservative, taking into account the type of hormonal disorders and the causes that caused them, which makes certain difficulties in connection with the multifactorial regulation of the functional state of the breast. Usually use micro doses of iodine, vitamins;gestagens( derivatives of norethisterone and progesterone), antiprolactin drugs( bromocriptine), androgens( testosterone derivatives) •• Surgical treatment of focal forms is ineffective, as endogenous factors that contribute to the occurrence of relapse persist.
• Follow up until the formations completely disappear. Excisional biopsy is indicated for nodular fibroadenomatosis and suspected malignant neoplasm( after a complete examination: ultrasound, mammography, fine needle aspiration biopsy).
• Risk of malignancy.70-90% of mastopathies( diffuse forms) are not accompanied by an increased risk of developing breast cancer. In cases of atypical hyperplasia of the epithelium( according to fine needle aspiration biopsy), the risk of developing carcinoma is 3-6 times higher than in the general population. At detection of atypical cells and breast cancer in a family history, the risk is 10-15 times higher.
Intra-flow papillomas are papillary epithelial outgrowths that grow in the expanded spaces of the ducts of the mammary glands. This is one of the most common causes of discharge from the nipples. Often there are abundant spontaneous serous discharge, less often - bloody. Multiple papillomas are regarded as an obligate pre-cancer.
• Diagnosis is based on the clinical picture, doktografiya( mammography with the introduction of contrast agent in the affected duct of the gland), cytological study( the presence of papillary structures).Cytological research and mammography are mandatory, since malignant neoplasms are also characterized by discharge from the nipple bloody character( especially with intra-growth).The presence of disseminated microcalcinates in the papilloma zone indicates a more likely presence of cancer. At US of a papilloma it is possible to reveal at the expense of expansion and overflow of the amazed duct.
• Surgical treatment - excision of the affected duct. Chromoductography is necessary before the operation.
Fatty necrosis of the breast ( lipogranulomy ) - aseptic necrosis of adipose tissue. Possible causes: trauma, excessive physical exercises, surgeries, injections.
• Clinical picture. When palpation is detected, the formation, sometimes soldered to the skin( possibly the nipple's entanglement).Skin coloring, as a rule, is normal. The radiological picture at first resembles that of malignant tumors. Later, the focus of necrosis calcifies( usually a spherical calcification of the "egg shell" type is formed), which confirms the non-malignant nature of the process. Fine needle aspiration biopsy is of little informative( no cellular material).Diagnosis is facilitated by the presence of a history of injury, which, however, does not exclude the possibility of having cancer.
• Treatment( given and difficulties in differential diagnosis) is operational.
Mondor's disease ( Thoraco-epigastric thrombophlebitis) is a thrombosed vein, defined as a stern under the skin from the mammary gland to the axillary region or to the navel. The main cause is trauma, incl.and operating room. The diagnosis is easy to establish with a routine examination. Treatment. Heat locally, analgesics,( possible use of NSAIDs).Anticoagulants are not shown.
Galactocele is a simple cyst filled with milk. Aspiration is a diagnostic and therapeutic measure. When recurring, repeated punctures with aspiration are shown, resection is rarely performed.
Subareolar abscess( plasma mastitis) occurs more often in adolescents in the post-puertant period and in women 35-40 years( more often in smokers).The main cause is the inflammation of additional glands located under the areola( Morgagni's tubercles).As a result of inflammation, an abscess is formed, which is opened along the margin of the areola with the formation of a fistula. Subsequently, fibrosis develops between the nipple and the margin of the areola, the nipple retracts.
• Clinical picture. In adolescents, sudden pain( usually after hypothermia) appears painful densification along the margin of the areola or under the nipple, the skin over it is hyperemic( in adults, in the initial stages, often the only manifestation of the disease is discharge from the nipple), later, multiple foci of abscess formation with fibrillation on the edgeareola, nipple retraction( it must be remembered that sometimes this can happen cancer).
• Treatment. Acute stage - antibiotic therapy, dimethyl sulfoxide solution( 1: 5) topically, puncture of abscess with aspiration of contents( with ineffective puncture - surgical drainage of abscess cavity).The remission stage is an operative treatment with excision of fistula and all dilated ducts.
ICD-10 • N60 Benign Breast Dysplasia