Adenosis of the breast

Adenosis of the breast is a form of fibrous mastopathy with a large amount of a glandular component, characterized as a highly differentiated hyperplasia of the lobules of the breast. Clinical signs of adenosis of the breast are: pain syndrome, propping or pulling character in the gland, its engorgement in the luteal phase of the cycle. The enlargement of the mammary gland with its engorgement is diffuse in the form of densification of the entire gland, or maybe parts thereof. The boundaries of the seals in case of diffuse adenosis of the mammary gland evenly pass to the tissues surrounding these seals.

Adenosis of the breast occurs in women at the end of the prepubertal period, in women in the third decade of life. Also, this problem is known to women in the first three months of pregnancy and goes by itself to the second trimester.

Causes of adenosis of the mammary gland

Before the onset of menstruation, the development of the mammary glands depends on the effect of estrogens, after the onset of menarche - estrogens and progesterone. The first are responsible for the development of ducts, connective tissue and its growth. Progesterone regulates the formation of glandular tissue, an increase in the number of alveoli. Prolactin secretes milk with lactocytes. Under its influence, the amount of estrogen receptors in the tissues of the mammary glands increases. Even in the development of the breast, a somatotropic hormone is involved. It is known that the action of hormones also undergo parenchyma glands, the tissues of which are influenced by thyroid hormones and insulin. For the rapid development of adverse events in the mammary glands, a receptor device with a high activity is responsible.

All epithelial lesions of mammary glands of benign nature are divided according to histological type into hotel categories: tissue damage without active proliferation, characteristic proliferative reactions without atypia of cells, atypical hyperplasia. With glandular adenosis of the breast, there is no active proliferation of cells in the tissues, because this form of the disease is considered the least dangerous variant of all forms of mastopathy.

Adenosis refers to benign lesions of the epithelium of the glandular tissue of the mammary glands, which do not lead to invasive breast cancer. But, adenosis can be both diffuse and focal. In adenosis of the breast, excessive formation of fibrous tissue occurs, which is intermixed with healthy glandular cells, thereby damaging the lobules of the mammary glands.

The main cause of the occurrence of adenosis of the breast is hormonal disorders. This applies especially to the excessive production of sex hormones during puberty and pregnancy. With such a hormonal disorder, an increase in the level of estrogen in the blood, an increase in the level of prolactin and a decrease in the production of progesterone. This is a known mechanism for the development of any form of mastopathy, but with adenosis of the breast, the duration of a similar hormonal imbalance is noted. In order to determine for what reason adenosis developed, it is necessary to conduct a laboratory diagnosis of blood tests for the hormonal ratio.

Often, the emergence of adenosis of the breast is preceded by hyperplastic processes in the organs of the small pelvis. These include: endometrial hyperplasia, in which there is also an increased level of estrogen with reduced progesterone production;Dysfunctional disorders of the ovaries with the formation of cysts, especially of a functional nature;Pathological processes in the thyroid gland( hypo- and hyperthyroidism);Fatty degeneration of the liver as a result of excess weight or consumption of fatty foods, as well as foods with easily digestible carbohydrates.

Symptoms of adenosis of the breast

Adenosis of the mammary gland is divided into a local and diffuse form.

With local adenosis formation of seals with lobular structure is observed. Moreover, each lobule can be quite large in size and can be surrounded by a fibrous capsule. Seals with local adenosis are grouped exclusively on one tissue site in the mammary gland.

In diffuse adenosis, the formations do not have clear boundaries and any particular shape. Uneven growth of the formation and gives the name of diffuse adenosis of the mammary gland.

In modern medicine, there are five important forms of adenosis of the breast. Sclerosing adenosis of the breast is characterized by the most localized proliferation of the acini with preservation of the epithelial and myoepithelial layers. Such layers are surrounded by a basal membrane. But, given that, the cramping of the acini surrounding the lobules with fibrosis tissues can sometimes be quite pronounced with sclerosing adenosis, the lobule configuration remains intact. At standard inspections this configuration is well visible.

In the apocrine form of adenosis, metaplasia of expanding epithelium is observed. Sometimes, this condition is called apocrine metaplasia, especially when it comes to the focus of adenosis with pronounced epithelial proliferation. Apocrine form shows a pronounced polymorphism of nuclei in cells, which makes this form somewhat similar to infiltrating cancer.

The protocular form of adenosis of the breast is characterized by an expansion of the ducts, limited to cells with cylindrical metaplasia of the epithelium.

The micro-glandular form of adenosis is a rare form characterized by diffuse proliferation of the smallest ducts, in which neither compression nor sclerosis of ducts is observed.

Adenomyoepithelial form of adenosis is characterized by the formation of adenomyoepithelioma in the mammary gland. Refers to focal adenosis.

Symptoms of adenosis of the breast are similar to manifestations of any other form of mastopathy. Many women can detect adenosis of the breast in themselves.

Glandular adenosis, also called diffuse, manifests itself in the form of increased sensitivity and engorgement of the mammary glands on the eve of menstruation, itching in the nipples, a feeling of heaviness in the glands, discharge from the nipples. Moreover, the secretions can be either transparent, or milky, brown or greenish shades. Bloody discharge from the nipples are the most dangerous symptoms in adenosis of the mammary glands, which can speak of the development of malignant process. Such discharges in adenosis are relatively rare and suggest a neglected course of the disease.

In focal adenosis of the breast, symptoms are: pain in a certain quadrant of the breast, an increase or asymmetry in the mammary gland, the detection of densification, sometimes of multiple nature. With local adenosis, regional lymph nodes can also be increased: in the armpits and above the clavicle.

Sclerosing adenosis of the breast

Sclerosing adenosis of the mammary gland is a lesion of the lobules of the mammary gland with the rapid formation of fibrosis tissues that alternate with the glandular cells. Sclerosing adenosis is manifested by nodules that are small in size, mobile and dense. At full-time examination and during the mammological examination they are very similar to breast cancer. To exclude cancer at times, a biopsy of the suspicious node is used.

The causes of sclerosing adenosis can be called a violation of the metabolism of estrogen-progesterone and dysfunction in the thyroid gland. Hypothyroidism( insufficient function of the thyroid gland) plays a significant role in the development of not only sclerosing adenosis, but also other pathological conditions in the female body, including in the mammary glands.

Sclerosing adenosis of the mammary gland is manifested as a painful syndrome, a traumatic character. Sometimes such pain may be more severe, depending on the phase of the menstrual cycle( pain increases in the luteal phase).When palpation is determined by a moving seal of a clear, regular shape with a dense consistency. To confirm the diagnosis, ultrasound examination of the mammary glands and axillary lymph nodes may be required as they increase, which sometimes happens with sclerosing adenosis. Also, a clinical study, biochemical analysis, TSH, LH, FSH, etc., can be performed. Mammography can give the wrong result when there is a great similarity of sclerosing adenosis with breast cancer.

Treatment is performed surgically using sectoral resection. Operative manipulation is performed under general or local anesthesia. The choice of anesthesia depends on the number of nodes, their size, the age of the patient and the presence of such diseases in which the use of an anesthetic is prohibited.

During the resection, from a cosmetic and aesthetic point of view, many surgeons make a cut along the margin of the areola, regardless of the location of the node. The resected node during the operation can be sent for urgent histological examination in order to clarify the nature of education for further tactics of conducting the operation in the case of determining atypical cells.

After the operation( already the next day), the patient is released home with the appointment of analgesics to ease the pain syndrome in the postoperative period. In the presence of a single node or nodes without a tendency to increase, sclerosing adenosis is not treated. A woman once in six months to undergo an examination mammologist and ultrasound of the mammary glands.

Treatment of adenosis of the breast

Treatment of adenosis of the breast, in the first place, depends on its shape and the nature of the course of the disease.

In case of diffuse adenosis, conservative treatment with hormonal therapy is indicated. Therapy consists in the use of combined oral contraceptives and progestogens. With mild forms of adenosis, oral contraception is used for at least six months.

Lyndinet 30 belongs to the drugs of choice due to the proven positive effect on glandular adenosis, which reduces its clinical manifestations. In patients during the first two months, the clinical signs of adenosis of the breast and the normalization of menstrual function were eliminated.

Gestagens are prescribed with more pronounced clinical manifestations of adenosis, especially worse before menstruation. Assign Norkolut 5 mg / day, Pregnin 0.02 g 3p / day, Duphaston 10 mg 2p / day, Progesterone oil solution 1% 1ml / day. These drugs are prescribed in the luteal phase( from 16-25 days of the menstrual cycle).The positive effect of gestagens can be noticed already two months after the initiation of therapy. Patients are reduced engorgement of the mammary glands, there is a decrease in pain syndrome, discharge from the nipples, until their termination.

The progestogen therapy should be performed for at least 3-6 months. In some cases, oral contraceptives such as Jeanine, Genegest, Silhouette with a component of dienogest in a dosage of 2 mg can be prescribed. It is also possible to use similar contraceptives in the treatment of gynecological diseases( endometriosis).It should be noted that dienogest has only a small similarity with natural progesterone, but its activity is the same high, only it is more synthetic.

Some specialists can prescribe homeopathic remedies( Mastodinone), but in practice they have only a temporary effect in the treatment of adenosis of the mammary glands. Mastodinone can be used in conjunction with hormone therapy. Independently it can be prescribed to patients of young age, nulliparous women or in the presence of mild phenomena of mastodynia in adenosis of the breast.

Focal adenosis is treated surgically. It is known that the nodes with local adenosis can not be regressed even after successful hormonal therapy. The surgical method consists in excising( resecting) the pathological node. In some cases, if a tumor is suspected of a malignant process( sclerosing adenosis, fibroadenomatosis, etc.), an excisional biopsy with an urgent histological examination of the tissue can be used. In addition to drug therapy, the treatment of adenosis of the breast is supplemented with the prescription of vitamins B9, B1, B2, A, C, E, P and diets high in fiber.