Anatomical and functional basis mammary glands are lobules capable of producing a special secretion for feeding a newborn baby: in the postpartum period, glandular tissue in the breast ensures milk production. Breast adenosis is a condition in which the tissue structure is dominated by an increased number (hyperplasia) of glandular lobules in the absence of lactation. The disease most often occurs in young women who delay childbearing and refuse breastfeeding.
Diffuse mastopathy with a predominance of the glandular component
Any variant of the hyperplastic process can become the basis for precancer. , in which adenosis occurs in the breast (an increase in the glandular part of the tissue), is a risk factor for diffuse forms of neoplasia of the mammary glands.
Any of the variants of mammary gland adenosis is a borderline state between normal and pathological, occurring in young women (age from 16 to 30 years). It is important to detect the problem in a timely manner in order to prevent the development of dangerous conditions in the chest: best prevention adenosis and – pregnancy and prolonged breastfeeding.
Area of adenosis in the mammary gland - what is it?
Mastopathy with a predominance of adenosis is in most cases a hormone-dependent condition: hyperplasia of the milk lobules occurs against the background of prolonged action of estrogen hormones. Pathology in the breast can be local: a node in the mammary gland in a young woman is a limited area of overgrown lobules.
Adenosis can be focal, which can become the basis for nodular mastopathy. Many small foci-nodules belong to, but can become a cause for the formation of a tumor large size. Diffuse variants increase the risk of developing cancer, but only in the absence of treatment and refusal to bear children.
Variants of mammary adenosis
Hyperplasia of glandular tissue can occur at any age and manifests itself in various forms of pathology. The following types of mastopathy with a predominance of adenosis are distinguished:
- diffuse;
- sclerosing;
- fibrosing;
- focal;
- local;
- small-knotted.
The disease can be bilateral, when changes occur in both glands. It is not always that a woman detects changes on her own: typical signs of the disease are similar to the usual manifestations of a premenstrual state.
Hello. I was diagnosed with adenosis type. Should you be afraid of breast cancer? Alevtina, 28 years old.
Hello, Alevtina. FCM with a glandular component (adenosis) is a common disease in young women. With timely detection and treatment, the risk of cancer is minimal. The optimal form of breast cancer prevention is pregnancy, birth and long-term breastfeeding.
Detection of pathology - signs and diagnosis according to ICD-10
Every woman should have her breasts assessed monthly, in the first days after the end of menstruation. It is important to notice the initial signs of pathology:
- painful engorgement of the mammary glands, occurring 7-10 days before the expected period;
- change in breast sensitivity – touch causes discomfort or pain;
- aching or nagging pain 2-5 days before the onset of menstruation;
- heaviness and increase in the size of the glands;
- palpation identification of small nodular lesions;
- liquid discharge from the nipples when pressing on the chest.
Some women perceive these symptoms as manifestations of a premenstrual state, refusing to visit a doctor. The presence of typical signs of pathology requires the following studies:
- ultrasound scanning of the mammary glands (young women under 35 years old);
- (X-rays are performed after the age of 35);
- tomography (CT or MRI) at the slightest suspicion of cancer;
- aspiration biopsy (if a node is present).
The mammologist will prescribe diagnostic tests, on the basis of which the specialist will make a diagnosis in the form of an ICD-10 code. Possible conclusions could be:
- N1 diffuse form of mastopathy
- N2 fibroadenosis of glandular tissue
- N3 fibrosclerosis in the chest
- N9 unspecified form of benign mastopathy
For any type of benign changes in the mammary glands, it is important to strictly and consistently follow the doctor’s instructions. Best option treatment of diffuse forms of mastopathy with adenosis - conception of the desired baby, pregnancy and birth of a child with long-term lactation for at least 1 year.
Diffuse adenosis
Hyperplasia of the glandular tissue of the milk lobules in all parts of the breast is a standard form of the disease. Features of this form of the disease include:
- diffuse distribution in both glands;
- absence of clearly demarcated nodes (both on palpation and on ultrasound);
- connection with menstruation - an increase in pain and engorgement before critical days.
Diffuse adenosis is typical for young women who, for various reasons, postpone the birth of a child, and manifests itself with typical premenstrual symptoms. Lack of treatment or complete refusal of pregnancy can cause precancerous conditions to develop in the glandular tissue of the breast.
Sclerosing adenosis
Fibrosclerosis is typical for women over 35 years of age. The main reason is hormonal imbalances caused by age-related changes. Sclerosis is an increase in the thickness of interlobular fibrous tissue in the presence of hyperplasia of the glandular structures of the milk lobules. Symptoms of the disease include:
- nagging or aching pain in the chest, associated or unrelated to the menstrual cycle;
- palpation of small seals without identifying clearly demarcated nodes;
- no nipple discharge.
Sclerosing adenosis is one of the variants of age-related restructuring of the mammary glands, against the background of which it is necessary to constantly monitor the condition of the breast so as not to miss the occurrence of a tumor.
Hello. How dangerous is sclerosing adenosis of the mammary glands during menopause? Is it possible to develop into cancer? Irina, 51 years old.
Hello, Irina. With the advent of menopause, an age-related restructuring occurs in the mammary glands, during which the number of glandular lobules decreases and adipose tissue increases. Adenosis refers to unfavorable variants of diseases in menopause, but sclerosing and fibrosing types, being a benign pathology, rarely become malignant. It is necessary to be observed by a mammologist to prevent the situation from worsening.
Fibrosing adenosis
The replacement of glandular and muscle tissue with fibrous tissue is typical for older women. Fibrosing adenosis is a typical situation during menopause: the need for glandular lobules disappears, which leads to. Age-related changes are manifested by the following signs:
- local and intermittent chest pain;
- detection of a soft-elastic lesion in the mammary gland of small size;
- palpation of small nodules in the thickness of both glands.
A typical ultrasound picture (minimal amount of glandular tissue, predominance of fibrous strands and islets against a background of adipose tissue) indicates standard benign changes. Apart from observation by a doctor, no therapeutic action is required.
Focal adenosis
Growths of glandular tissue can be in the form of nodes - single or multiple. Having discovered a tumor-like formation, you need to consult a doctor and conduct a full examination to confirm the benign nature of the process. It is advisable to remove a large adenous lesion, proven by a biopsy, because the node can become the basis for malignant degeneration. Mastopathy with a focal form of hyperplasia of glandular tissue includes:
- localized adenosis;
- small nodular adenosis.
In both cases, a woman may be bothered by premenstrual pain, the presence of lumps and heaviness of the mammary glands. Treatment and observation by a mammologist will help prevent dangerous species diseases.
Treatment of mammary adenosis
Correction of breast pathology is selected individually for each woman. Adenosis of the mammary glands requires surgical intervention only in nodular forms of the disease, when there is a real risk of tumor formation. For diffuse forms, the mammologist will prescribe the following treatment measures:
- lifestyle changes with mandatory abandonment bad habits and diet correction;
- cyclic vitamin therapy (optimal for young girls under 20 years old) - taking vitamins determined by the doctor in different phases of the menstrual cycle;
- hormone therapy (correction of endocrine imbalance that provokes changes in glandular tissue) using herbal or synthetic drugs;
- long-term use of sedative herbal preparations.
After consulting with your doctor, you can use folk remedies, of which good therapeutic effect provide the following infusions:
- from horse chestnut;
- from walnut partitions;
- based on boron uterus;
- from burdock roots.
Hello. Is it possible to see adenosis of the mammary glands on an ultrasound? Or is it better to do? Inna, 35 years old.
Hello, Inna. Experienced doctor Ultrasound diagnostics will detect disease in the chest based on typical signs (increased thickness of glandular tissue, dilation of ducts, appearance of small cysts in the chest). Ultrasound of the mammary glands is performed for women under 35 years of age in phase 1 of the cycle (from 7 to 11 days). Mammography helps to make an accurate diagnosis in patients over 35 years of age. It is better for you, Inna, to do an ultrasound scan, but if there is any doubt about the diagnosis, you can additionally perform a mammogram.
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Breast disease that occurs as a result of hormonal imbalance is called adenomatosis. This is one of the forms of mastopathy. Depending on the nature of changes in the structure of the breast, as well as the assessment of the attending physician, diffuse and localized forms of this disease are distinguished.
Adenomatosis of the breast is also called Reclus' disease (in honor of the doctor who first described this disease). The course of the disease is characterized by the formation of multiple small formations in the breast tissue.
Throughout the entire reproductive period, monthly changes occur in the breast tissue of a healthy woman caused by the influence of sex hormones (estrogens and progesterone).
If, for some reason, hormonal metabolism is disrupted in the breast tissue, pathological changes begin to occur, which can lead over time to the development of first diffuse and then nodular adenomatosis.
In some cases, sclerosing adenosis of the mammary gland develops, which is caused by excessive synthesis of the pituitary hormone prolactin. Normally, the production of this hormone increases during pregnancy and lactation, since prolactin affects the production breast milk. If increased production of prolactin is observed outside of these periods, sclerosing adenosis may develop.
Risk factors that can lead to disruption of hormonal metabolism and the development of diseases such as mammary adenosis:
- constant stress and nervous tension;
- bad habits (especially smoking);
- abortions;
- heredity;
- metabolic disorders due to hypothyroidism, diabetes mellitus, obesity and a number of other pathological conditions;
- chest injuries (deformation, bruises);
- late onset of menopause;
- short or long lactation period;
- disease of the reproductive system;
- intestinal dysbiosis;
- early onset of menstruation;
- uncontrolled use of oral contraceptives.
Species
Breast adenosis can be diffuse or localized. Diffuse is divided into fibrous (when growth is observed only connective tissue) and fibrocystic adenosis of the mammary gland (when, in addition to the proliferation of connective tissue, cysts form in the breast).
Localized adenosis of the mammary gland is distinguished by the fact that pathological changes are observed in a limited area of the gland. If this form of the disease is detected, a biopsy is indicated to exclude breast cancer.
Types of adenosis
Symptoms
The main clinical signs of adenomatosis are a feeling of discomfort and heaviness in the mammary gland, when the patient feels as if the breasts are “expanding.” In addition, chest pain is observed, which usually appears a few days before the onset of menstruation and disappears with the onset of menstruation.
At the initial stages, when only the glandular tissue of the mammary gland grows, compactions are formed that have clear boundaries and can be easily felt during palpation.
When, after some time, the connective tissue begins to grow, palpation reveals multiple compactions, which are a sign that sclerosing adenosis is observed.
In the fibrocystic form of the disease in the mammary gland, in addition to tissue proliferation and the formation of compactions, the formation of cysts is observed, which look like oval or round nodules filled with fluid.
Diagnostics
The main research methods used to diagnose mammary adenomatosis are:
- mammography (is one of the most informative methods for diagnosing breast diseases; it allows identifying small lumps that are not visible when examining the mammary glands and cannot be felt when palpating them);
- Breast ultrasound.
If indicated, the doctor may prescribe additional tests such as:
- biopsy of affected tissues followed by histological examination (carried out to exclude breast cancer);
- ductography (milk ducts are examined);
- blood and urine tests;
- thermography;
- examination of nearby lymph nodes;
- CT or MRI of the breast.
Such a complete diagnosis helps the doctor make the correct diagnosis and develop an adequate treatment regimen for the disease.
Treatment
Breast adenosis is treated by normalizing the hormonal levels in the patient’s body. In order for the treatment to be adequate and effective, it is necessary that it be developed by a specialist (this could be a gynecologist, endocrinologist, or mammologist).
If the cause of adenomatosis is increased production of estrogen, the prescription of drugs that reduce the effect of these hormones on the mammary gland (Fareston, Tamoxifen) is indicated.
To normalize the cycle, oral contraceptives are prescribed (which are chosen depending on the hormonal status).
To treat adenomatosis, which is caused by a dysfunction of the thyroid gland, drugs are used that normalize the production of thyroid hormones.
In addition to hormonal drugs for the treatment of adenomatosis, the use of vitamin complexes, which contribute to the normalization of metabolic processes in the patient’s body.
Together with system medicines use progesterone preparations that have a local effect on breast tissue, as well as homeopathic preparations.
If breast cancer is suspected, or if conservative treatment adenomatosis does not produce results, surgical intervention is indicated, which consists of partial or complete resection of the affected gland.
Prevention
In order to reduce the likelihood of developing adenomatosis to a minimum, the following rules and recommendations must be followed:
- eat right;
- observe the work and rest schedule;
- give up bad habits;
- Avoid stress and nervous tension if possible;
- prevent abortions;
- give birth to your first child in a timely manner (before 30 years of age);
- after the birth of the baby, breastfeed him for at least six months, and do not transfer him to artificial nutrition;
- have regular sex life;
- Perform breast self-examination on a regular basis;
- If possible, avoid exposure to adverse environmental factors;
- promptly treat all diseases of the reproductive system;
- be regularly examined by a mammologist if there is a history of breast cancer in the family.
In conclusion, I would like to remind you once again that if you detect any changes in the functioning of the mammary glands, you must immediately consult a doctor, because with timely diagnosis, even such a serious disease as breast cancer can be treated.
In which the ferrous component predominates. The development of the disease begins with the proliferation of connective tissue followed by the formation of small nodules and cords. The main cause of the disease is disruption of the endocrine system, which is responsible for hormonal levels.
The pathological process refers to benign neoplasms and is considered a precancerous condition. As a rule, when adjusting lifestyle, nutrition and emotional state in pregnant women, the pathology goes away on its own without the use of drug therapy. In other cases, the lack of timely treatment can lead to the degeneration of a benign tumor into a malignant one.
Types of mammary adenosis and their signs
Depending on the form of the disease, a clinical picture is distinguished, characteristic of a specific area of tissue involved in the inflammatory process.
How does the diffuse form of mammary adenosis manifest?
This type of pathological process is characterized by the following signs:
- the formation of nodes is observed throughout the entire area of the mammary gland, not prone to growth in a certain part of the female organ;
- the growth does not have clear contours or boundaries;
- as a result of the progression of the pathology, the involvement of healthy tissue structures surrounding the compaction in the process is noted;
- quite often a complication appears in the form of damage to the mammary duct, which entails the formation of papillomas on the skin; Visually, papillomas resemble small growths in the form of papillae protruding above the skin.
How to recognize local breast adenosis?
The local form of adenosis manifests itself as follows:
- at the beginning of the pathological process, compacted formations of a lobular structure appear;
- upon palpation, large lobules of overgrown tissue can be easily distinguished;
- each element is located in a fibrous capsule;
- when diagnosing the disease using instrumental methods, a yellow tint is clearly visible between the formed lobules, which represents myoepithelial cells;
- the neoplasm develops in a certain area of the organ and does not have a tendency to grow over the entire area of the chest;
- an increase in the size of the lymph nodes in the armpits and above the collarbones.
How does nodular adenosis of the breast manifest?
Methods for preventing breast adenosis
The main preventive measures consist of maintaining the first followed by one, which should last at least six months.
Refusal of medical abortions and taking contraceptives prescribed only by a qualified specialist will avoid disorders of the hormonal system.
One of the main preventive methods is to conduct a self-examination of the breasts and visit a gynecologist at least once a year.
Many have never heard of such a pathological condition as “mammary adenosis.” Your doctor will tell you what it is and how to treat the disease. Unfortunately, many women at different ages were forced to face this problem.
Sclerosing adenosis of the mammary gland, as a rule, affects the breasts of women over 35 - 40 years old. However, cases have been recorded where the pathology was diagnosed in fairly young girls. Occasionally, changes begin at the time of pregnancy (the first trimester of pregnancy).
Any processes of proliferation or development of glands like hyperplasia are called adenosis. Some experts use a similar term to designate pathological conditions of any tissue that resembles glandular formations.
Diffuse or focal adenosis of the mammary glands is always associated with pathological transformations of the myoepithelium. Lobules develop or glandular tissue grows, similar to fibrocystic changes.
Location and form of pathology
Depending on where the inflammatory reactions are observed, there are two types of adenosis:
- Local (only one specific area is affected);
- Diffuse (neoplasms are located chaotically throughout the gland).
There are also forms of the disease, each of which will have its own impact on the patient’s well-being, as well as the occurrence of key symptoms:
- Tumor-like type. There is a single compaction, fairly mobile, of small size. The structure is usually lobular or disc-like. There are no allocations. The skin is not hyperemic, lymph nodes not enlarged or swell within the normal range;
- Damage to the terminal ducts, which is expressed by groups of lobules formed not in accordance with the anatomical norm. The ducts steadily begin to expand, epithelial formations fill the space. It is often possible to identify internal papillomas. The apocrine epithelium also undergoes a number of pathological transformations. Pathology manifests itself painfully. Adenosis of the sclerotic type or focal, which is represented by pathological formations of flows without lobules, is also classified as this form;
- Apocrine adenosis. The appearance of nodes located along each lobule is observed. The epithelial tissue contains cellular formations with large nuclei or nucleoli, which are supplemented with granules with eosinophils;
- Tubular adenosis. The flows are rich in microcalcifications and two layers of epithelium;
- Adenomyoepithelial type. An extremely rare form of pathology. Duct structures of different shapes are lined with columnar epithelium. The formations are located chaotically. The epithelium grows. Metaplasia can be identified in places.
Adenosis of the mammary glands as an option diffuse mastopathy is a common pathology.
However, its main danger lies in the fact that there is an increase in proliferative activity (cells begin to rapidly divide), and the coordination relationship between the epithelial and connective tissue components in the mammary gland is disrupted. These 2 processes create the prerequisites for the development of more serious mammological pathologies, incl. and breast cancer. Therefore, the question is what should be the correct treatment for mammary adenosis? , very relevant for women. First of all, it worries those patients who have already encountered this diagnosis, and secondly, those who have the prerequisites for its appearance (complicated heredity, disrupted hormonal levels, etc.).
General Treatment Approaches
To choose the most rational treatment for mammary adenosis, the doctor takes into account three main circumstances:
· type of pathological process, i.e. it is nodular (for example, a cyst) or diffuse (affects the entire length of the breast tissue);
· causes and predisposing factors that led to the development of mastopathy (adenosis);
· predominant histological variant, i.e. which tissue (connective or epithelial) in the breast has undergone the greatest changes.
From a practical point of view, treatment of mammary adenosis is divided into 2 types:
1. hormonal - it is basic (fundamental, pathogenetic);
2. non-hormonal - regarded as an addition to the main therapy.
Non-hormonal treatment of mammary adenosis
Non-hormonal therapy for Mabustin adenosis is a set of measures that are ultimately designed to normalize the hormonal profile of a woman’s body.
Therefore, it is based on the following rules:
· changing food habits (organization of dietary nutrition);
· correction of psycho-emotional status (exclusion of stressful situations);
· normalization of the functional activity of the liver, in which all hormones of the human body are metabolized (inactivated), and due to which they bind in the blood to inactivating proteins (they are synthesized in the liver;
· use of drugs that remove excess fluid from the body (they are called diuretics or diuretics);
· selection of adequate herbal medicine, which enhances the effect of pharmacological drugs, incl. and hormonal;
· taking immunocorrective drugs, which are indicated for identified defects in the immune system;
· pharmacological improvement of microcirculation in the mammary gland.
Hormonal treatment is the most common option
Hormonal therapy is considered basic therapy, because The development of this pathology is based on disrupted endocrine relationships, primarily between estrogens and progesterone. According to statistics, gynecologists and mammologists within hormone therapy Most often, gestagens are prescribed. According to literature sources, their effectiveness in the treatment of adenosis can reach 70%. But not in all cases, which is why there are other classes of drugs used for mastopathy.
Currently, various gestagens are used. Their division is based on the active substance. So, it could be:
· Norethisterone. It can exhibit androgenic activity, therefore it is mainly prescribed to patients who have crossed the 40-year-old barrier. Preparations containing norethisterone are the cheapest of the gestagens. One of its representatives is Norkolut.
· Dydrogesterone. Compared to norethisterone, it is more similar to physiological progesterone produced in female body. This gestagen can also be prescribed to young patients, because does not have androgenic activity and other undesirable effects affecting fertility (the ability and ability to bear children). The representative containing dydrogesterone is Duphaston.
· Progesterone. Like dydrogesterone, it is close to the natural hormone, but costs less than the first. The pharmacological drug is also called Progesterone. If a woman has liver problems, then this remedy can be prescribed in the form of intravaginal suppositories.
But there are categories of women who have been diagnosed with mammary adenosis, whose treatment must necessarily include the administration of gestagens. These patients include those who, in addition to mastopathy, suffer from:
· adenomyosis (a disease in which the cells of the inner layer of the uterus affect its entire body, i.e. are found in the muscular and serous layer);
· uterine fibroids;
· hyperplastic processes in the internal uterine layer.
Recently, a gel based on Progesterone has been developed, which is applied directly to the mammary gland affected by the pathological process. Its advantage is that there are no system side effects gestagens. This applies primarily to liver failure. This gel is called Progestogel.
Hormonal treatment - rare options
In addition to traditional gestagen therapy, other drugs that alter endocrine levels in the body can be used to treat mammary adenosis. These include:
1. antigonadotropins;
2. gonadoliberin receptor agonists;
3. antiestrogens;
4. monophasic (during the entire administration, all tablets have the same concentration of synthetic hormones, in contrast to biphasic and triphasic) combined contraceptives for oral use (tablets).
The first two groups of drugs from this list began to be used for the first time in Europe in the 90s of the last century. They showed good results, so they became widespread. Their significant drawback is their high cost.
Antiestrogens (for example, Tamoxifen) began to be used earlier - in the 70s. They demonstrate high efficiency, reducing weight up to 80-90% depending on the clinical situation. These drugs have many contraindications, which limits their use. But with a correct assessment of the therapy, it is possible to cure adenosis of the mammary glands.
Oral contraceptives cannot be considered as the main drug for basic therapy in the case of already developed mastopathy. However, they are an excellent preventive measure against mammary adenosis. The risk of developing this pathology is reduced by 50-75%.
Antiprolactins
Antiprolactin drugs (Bromocriptine, Dostinex) are not indicated for all patients for the treatment of mastopathy. They are recommended if available:
· mastalgia - severe pain syndrome localized in the mammary glands;
· galactorrhea - the release of milk from the breast when pressed or spontaneously.
Treatment of diffuse mastopathy with gestagens >>>
However, to prescribe them, it is necessary to conduct a laboratory test to determine the level of prolactin in a woman’s blood. In these two specified conditions, it is usually sharply increased. The administration of antiprolactin drugs allows it to be normalized, and therefore to relieve pain and stop the secretion of milk (colostrum and other secretions) from the breast.
