Mastopathy (Fibrocystic breast disease)

Mastopathy (ICD-10 classification N60-N64) is a benign disease of the mammary gland, manifested in the pathological proliferation of its connective tissue. The disease occurs against the background of hormonal imbalance in a woman’s body. Mastopathy has a significant impact on the well-being of many women, and in some cases can lead to the development of a serious disease - breast cancer.

Mastopathy is a concept that combines a group of diseases of the mammary glands, characterized by the development of pathological changes in the gland tissue with a violation of the ratio of epithelial and connective tissue components. According to the WHO nosological classification of 1984, mastopathy is understood as fibrocystic disease of the mammary glands. The incidence of mastopathy of various etiologies in young women ranges from 30–45% and increases noticeably after 40–45 years.

Mastopathy is a benign change in gland tissue that is directly dependent on neurohumoral regulation. This means that the factors for the development of mastopathy are both pathologies associated with disturbances in the state of nervous regulation (stress, neuroses, depression), and a disorder of hormonal balance and internal homeostasis of the body.

Reasons for the development of mastopathy

There is currently no complete understanding of the causes and mechanisms of development of mastopathy, but there is every reason to assert that hormonal status plays a significant role in the occurrence of this disease. Factors contributing to the development of mastopathy: early menopause, menstrual irregularities (hormonal dysfunctions, polycystic ovary syndrome, improper use of hormonal contraceptives), prolonged absence of childbirth, numerous (more than three) abortions, irregular sex life (or lack thereof), diseases of the genital organs , lactation for less than three months, endocrine pathologies (hypo- and hyperthyroidism, dysfunction of hypothalamic and pituitary regulation, functioning of the adrenal glands, liver, pancreas), hereditary predisposition.

There is an assumption that the most significant pathogenetic factor in the development of mastopathy is progesterone deficiency with an excess of estrogen. In this case, there is an increase in proliferation (reproduction) of epithelial cells and connective tissue cellular elements. In addition, the production of prolactin plays a significant role in the pathogenesis of mastopathy. Prolactinemia increases the sensitivity of breast tissue to estrogen.

Why does the disease occur?

There are a large number of provoking factors that contribute to the development of mastopathy:

1. Stress experienced. There are emotional outbursts in the life of every woman. This is dissatisfaction in family life, dissatisfaction with one’s position in society, various domestic conflicts, and troubles in the professional sphere. With any stress, functional disorders occur in the neuroendocrine system.
2. Fertility. Number of pregnancies, births, abortions, age at birth, duration of breastfeeding, menarche and menopause.
3. Diseases of a gynecological nature, in particular diseases of the pelvic organs, which are chronic inflammatory in nature.
4. Disturbances in the endocrine system. Thyroid dysfunction, metabolic disturbances, polycystic ovary syndrome, diabetes mellitus.
5. Diseases of the liver and bile ducts.
6. A predisposition that is inherited.
7. Lactation period is too short or long. Refusal of breastfeeding.
8. Lack of iodine in the body.
9. Breast injuries.
10. Obesity.
11. Bad habits – smoking, alcohol abuse.
12. Tumor in the pituitary gland or hypothalamus.

Classification of mastopathy

The most common classification of mastopathy in clinical practice distinguishes three forms: mastalgia (mastoplasia or mastodynia), diffuse fibroadenomatosis and localized fibroadenomatosis. Mastalgia is characterized by a predominance of severe pain and is an indication for the prescription of analgesics.

Diffuse adenomatosis is the development of diffuse compactions and cysts in the gland tissue. Divided into two types:

• fibrous mastopathy, when connective tissue compactions are predominantly formed in the gland tissue
• fibrocystic mastopathy, if in the gland, in addition to foci of fibrosis, cysts (cavities filled with fluid) are formed.

With localized fibroadenomatosis, pathological changes are detected in a limited area of ​​the gland (segment, quadrant) and do not spread throughout the parenchyma of the organ. Detection of a localized formation in the mammary gland is an indication for a biopsy to exclude a malignant tumor.

general information

The formation of the mammary glands begins in the perinatal period, at 6 weeks from conception. From birth to puberty, the ducts lengthen and the nipples increase in size. When puberty begins, the ducts branch, glandular lobules are formed, and the morphological structure of the organ changes. The intercellular and interlobar segments consist of connective tissue. These areas are subject to hormonal changes.

Full development of the mammary glands ends after puberty and the second trimester of pregnancy. During the period from the end of puberty to the third trimester of pregnancy, epithelial tissues are considered immature. They cannot produce progesterone, which increases the risk of developing breast cancer.

Cyclic physiological processes in the body have a huge impact on changes in connective tissues. The structure of the mammary glands is constantly changing. This does not depend on the period of life and age. Often, dysplastic processes develop under the influence of such factors:

• sensitivity to hormonal levels;
• hormones produced by the thyroid gland;
• presence of sexual life and satisfaction with it;
• emotional background.

Benign changes in the mammary glands are called mastopathy or fibrocystic disease. The anatomical features and clinical manifestations of these changes differ significantly. Malignancy occurs, which is manifested by the appearance of pathologically altered tissues and cells. There is a risk of cells degenerating into malignant ones, so experts consider mastopathy as a precancerous disease.

Symptoms of mastopathy

Breast self-examination The most characteristic symptom of mastopathy is the detection of a lump in the mammary gland upon palpation. Often this lump can be painful, and the pain usually intensifies in the second phase of the menstrual cycle and just before menstruation. The compaction may be single, several nodules may be detected, and the entire gland may feel compacted. Mastopathy is characterized by damage to both glands, mainly their upper parts.

The predominance of the fibrous component is detected by touch as a compaction; cystic changes in the first stages may not be detected at all by palpation (duct microcysts). Pain in the mammary glands, as a rule, is dull, aching or pulling.

Its occurrence is associated with compression of nerve endings in glandular tissue by fibrous growths, as well as their partial sclerosis. The intensity of the pain syndrome depends on the severity of the pathology; most often, the occurrence and intensification of pain is associated with the menstrual cycle (before menstruation, at the peak of estrogen production, the pain intensifies). Sometimes there is irradiation of pain into the shoulder blade or arm.

In 10–15% of women, there are no complaints of pain, although upon examination significant pathological changes are detected. This is associated with different levels of pain sensitivity in women and the individual branching of the nervous system of the mammary glands. About 10% of mastopathy is accompanied by enlarged lymph nodes in the armpits. Sometimes palpation of the lymph nodes is moderately painful.

An increase in the volume of the mammary gland, their periodic engorgement (in the second period of the menstrual cycle) is associated with the formation of venous stagnation in the vascular network of the glands and swelling of the connective tissue. The glands can increase by 15%. This is characterized by a feeling of discomfort and pain during palpation (increased breast sensitivity). The combination of these symptoms is called premenstrual syndrome.

Sometimes there is discharge from the nipples of varying degrees of abundance and of varying nature. They can only be detected when pressing on the nipple, and can be quite pronounced. The consistency of the discharge is usually transparent or whitish; it can be greenish, bloody or brown. The greatest danger is bloody discharge, as it can be a sign of the development of a malignant process. The appearance of any discharge from the nipples, regardless of its nature, is a reason to contact a mammologist.

You also need to be careful about detecting a node (or several). Palpation of a dense, limited nodular formation may be a sign of localized nodular mastopathy, or it may be developing breast cancer. When nodes in the mammary gland that are suspicious from the point of view of malignancy are identified, a biopsy is always prescribed.

Types of fibrocystic disease

In most cases, the nature of mastopathy is diffuse, this is manifested by the following changes:

1. The predominance of glandular structures – swelling, proliferation of glandular tissues. This form is the most favorable.
2. The predominance of fibrous structures: swelling occurs, interlobular connective tissue septa increase in size and begin to put pressure on the surrounding tissues, the lumen of the ducts narrows, sometimes it becomes completely overgrown.
3. The predominance of cystic changes: one or more elastic cavities appear, which are filled with liquid contents and clearly demarcated from the surrounding tissues.
4. Mixed form - the number of glandular lobules increases, the connective tissue interlobular septa grow and increase in size.

The nodular form of mastopathy is the most unfavorable among all. In addition to the changes noted above, one or more nodes appear. In this case, an adenoma or fibroadenoma is diagnosed. This is a benign breast tumor. It can appear at any age, with women at risk from 20 to 40 years old. Sometimes fibroadenoma can quickly increase in size and reach a diameter of more than 10 cm. This happens during puberty. Transformation of fibroadenoma cells into malignant ones occurs in 2% of women.

It is worth paying attention to such a symptom as bloody discharge from the nipples. Such clinical manifestations arise as a result of papilloma, which forms inside the ducts. It ulcerates and bleeds. This is a serious reason for concern and a visit to the doctor.

Diagnosis of mastopathy

One of the most significant elements of timely detection of pathologies and neoplasms in the mammary glands is self-examination (self-palpation of the mammary glands). To identify formations, determine their shape, size, quantity, as well as to identify diffuse pathological changes in the gland tissue, instrumental diagnostic methods are used.

Mastopathy (mammogram) Biocontrast mammography is an X-ray examination of the mammary glands. Mammography is optimally performed in the first phase of the menstrual cycle. A chest photograph is taken in two projections: frontal and lateral. This study is one of the most informative and specific.

In addition, ultrasound of the mammary glands is currently used. As a rule, fibrocystic changes in glandular tissue affect the echogenicity of its structures and can be identified and studied quite qualitatively using this technique.

MRI of the breast marks areas of increased and decreased temperature of the gland tissue. The diaphanoscopy technique involves transilluminating the mammary gland using a light source. In this case, the neoplasm in its thickness will be noted as a darker spot. Using ductography, the system of the milk ducts is examined. A contrast agent is injected into the mammary gland through the nipple, after which an x-ray is taken.

Pneumocystography is performed under ultrasound control. Air is injected into the cyst cavity using a thin needle, which allows the walls to be straightened and carefully examined for wall formations.

When a nodular formation is detected, a breast biopsy is performed - a tissue sample is extracted using puncture with a thin needle for histological examination. To identify the etiological factors of mastopathy, methods of studying hormonal status are used. Colposcopy and cytological examination of vaginal epithelial cells allows us to draw a conclusion about the total hormonal background, since the shape and structure of the cells directly depend on the action of sex hormones.

They directly determine the content of hormones in the blood: progesterone and estrogens, follicle-stimulating, luteinizing hormones, as well as thyroid hormones and thyroid-stimulating hormone, adrenal hormones. Sometimes a test is performed for the presence of autoantibodies to thyroid cells to detect autoimmune thyroiditis.

To determine the general hormonal state of the body, studies of the organs of the endocrine system are carried out to identify possible pathologies (ultrasound of the thyroid gland, adrenal glands, liver, pancreas; radiography of the sella turcica, CT scan of the pituitary gland). To exclude immune and metabolic pathologies, an immunogram is done and a biochemical blood test is performed.

How to diagnose

When a woman turns to a mammologist with complaints or for a preventive examination, the doctor performs the following diagnostic procedures:

• examination, manual examination of the mammary glands, axillary, subclavian, regional lymph nodes;
• ultrasound examination of the mammary glands and lymph nodes;
• X-ray mammography is a mandatory test for all women after 40 years of age;
• laboratory blood tests - general analysis, biochemical parameters, hormone levels, tumor markers;
• if cysts are detected, their tissue is punctured and further cytological examination of the material is carried out;
• if nodular formations are detected, their contents and cells are collected, after which a cytological examination is performed.

Treatment of mastopathy

In the treatment of mastopathy, correction of the hormonal balance of the body plays a significant role. When choosing treatment tactics, consultation with a gynecologist and endocrinologist is necessary. These specialists jointly perform a thorough analysis of the endocrine system and prescribe medications that correspond to the identified pathologies.

In cases of severe estrogenism (and significant pain), medications that reduce the effect of these hormones on the mammary gland (tamoxifen, toremifene citrate) may be prescribed. To normalize the menstrual cycle, oral contraceptives are used (chosen according to hormonal status). To treat functional disorders of the thyroid gland, agents that regulate the production of thyroid hormones are used. Vitamin complexes help improve liver function and normalize metabolic processes.

Among other things, topical progesterone preparations are used (act directly on the gland tissue, helping to reduce the proliferation of connective tissue and epithelial cells, relieving swelling), and homeopathic remedies. Patients suffering from mastopathy are advised to limit the consumption of coffee and strong tea, stop smoking, and enrich their diet with fruits, vegetables, and foods high in fiber and vitamins. If a malignant tumor is suspected, the node is surgically removed; in other cases, conservative treatment is limited.

As a rule, mastopathy is not prone to complications and malignancy. With proper correction of the hormonal state, the prognosis is positive, but hormonal imbalances can provoke relapses.

Treatment

The main goal of mastopathy treatment is to eliminate pain, reduce the size of cysts and the volume of fibrous tissue in the gland, correct the hormonal status of a woman and prevent the development of tumors and cancer.

If there are concomitant gynecological (endometriosis, polycystic ovary syndrome) or endocrine diseases (diabetes mellitus, hypothyroidism), a gynecologist or endocrinologist is involved in treatment, respectively.

Drug therapy

• Hormonal therapy: preparations of female hormones (progesterone, small doses of estrogens);
• drugs that suppress the synthesis and secretion of prolactin (danazol, bromocriptine);
• oral contraceptives, used to regulate the menstrual cycle;
• antiestrogens, drugs that suppress the synthesis and action of estrogens.

Surgical therapy

• Sectoral resection of the mammary gland is an operation to remove a lobe of the mammary gland for a benign tumor, nodular mastopathy or suspected cancer.
• Mastectomy is the removal of the breast when a malignant tumor (cancer) is detected in it.

Prevention of mastopathy

Many factors contributing to the development of mastopathy make it difficult to develop a unified and consistent prevention scheme. However, the most significant factors should be avoided: stressful situations (as a preventive measure, it is recommended to take medicinal sedatives of natural origin - valerian, motherwort), creating a psychologically comfortable environment, and a positive way of thinking.

Proper balanced nutrition without excess calories, prevention of excess weight and obesity, but without indulgence in mono-diets and dubious weight loss methods, help maintain internal homeostasis and the proper functioning of the neurohumoral regulatory system. One of the dietary components that negatively affects the hormonal status of women is caffeine. Women should limit and, if possible, completely eliminate caffeine from their diet and in no case abuse strong coffee on an empty stomach.

Older women using oral contraceptives should stop smoking. Limiting the consumption of alcoholic beverages will also be useful in terms of preventing breast pathologies. A significant factor in maintaining a woman’s health is regular sex life and physical activity.

Fibroadenoma of the breast

Fibroadenoma of the breast

refers to benign neoplasms and occurs as a result of the replacement of glandular epithelial tissue with connective tissue.

The cause of fibroadenoma is hormonal imbalance

– an increase in estrogen levels with a simultaneous decrease in progesterone levels. The greatest risk of fibroadenoma formation occurs during hormonal changes in the female body - puberty, pregnancy, lactation, frequent abortions, menopause. Other causes that can cause fibroadenoma:

• inflammatory diseases of the female reproductive system;
• uncontrolled use of hormonal contraceptives;
• breast injuries;
• diseases of the thyroid gland and liver.

Based on morphological characteristics, fibroadenomas are divided into four main types:

Pericanalicular

– proliferation of fibrous and connective tissues around the milk ducts;

Intracanalicular

– connective tissue grows in the ducts of the mammary gland with a tight fit to the walls;

Mixed

– combines the characteristics of the two previous types, grows around the ducts and inside them;

Leaf-shaped (phyloid)

– fibroepithelial neoplasms in the form of several intertwined nodes. This type of fibroadenoma is characterized by rapid growth of the tumor and a high degree of malignancy (transition into a malignant process).

Diagnosis of fibroadenoma

Most often, fibroadenoma can be detected during a self-examination or during a routine visit to a mammologist. Small fibroadenomas are painless and do not cause discomfort. The presence of pain, changes in the color of the epithelium, deformation of the mammary gland, and discharge from the nipples indicate the development of leaf-shaped fibroadenoma or some other neoplasm.

To confirm the diagnosis of breast fibroadenoma, it is necessary to undergo an examination by a mammologist with mandatory mammography or ultrasound. An additional diagnostic examination of the fibroadenoma itself is an ultrasound-guided biopsy.

Reviews

Orange 02/05/2017

And I have a reason - the doctors did not notice the inflammation of the appendages after severe hypothermia, I walked around with inflamed ovaries for a year. Then I treated for a month. The inflammation was relieved, but during this time there was a slight disruption with hormones - right away the cyst was still there, it resolved within 2 months, but the mastopathy remained. I didn't take birth control.

Chance 03/21/2017

I also have fibrocystic mastopathy. There are two tassels in the left breast: 6 and 8 mm, without dynamics. They discovered them quite a long time ago and told me how the mug would go away. Now I have started treatment. I took Mastodinon for two cycles. It made my breasts hurt terribly before my period, I was ready to climb the wall, I stopped drinking. Now I use a cream from Dr.Nona (at least before my period I don’t feel any discomfort at all), and for the first month I take medications. Let's see what the result will be... But now one brush has become softer to the touch.

Olga, 25 06/30/2017

Nothing hurt at all, nothing came out of my chest... The doctor just felt it and sent me for an ultrasound. I've read everything. Of course, tumors do not resolve on their own. It's just scary to wake up one terrible day without one breast.