Adenoz of a mammary gland – the form of fibrous and cystous mastopathy which is followed by growth of ferruterous tissue of breast. It is shown by pains and a nagrubaniye of a breast, formation in it dense sites, emergence of allocations from a nipple. Diagnostics of an adenoz is based on collecting complaints and the anamnesis, data of survey and a palpation of a breast, additional methods of a research (ultrasonography and a X-ray analysis of mammary glands, determination of the level of hormones, a cytologic research separated from a nipple and a biopsy). Treatment of a disease depends on its form and includes conservative therapy (purpose of hormones) or surgery.
Adenoz of a mammary gland
Adenoz treats good-quality formations of mammary glands of hormonal and dependent character that is confirmed by emergence of symptoms in the second phase of a cycle. Synonyms of an adenoz are "fibroziruyushchiya ", "a giperplaziya a mioepiteliya" or "a lobulyarny sclerosis". Women of reproductive age suffer from Adenoz – prevalence of a disease in age group of 30-40 years makes 30–70%. At women with gynecologic diseases the frequency of an adenoz increases to 100%. This state can develop at girls during establishment of periods and women in the first trimester have pregnancies that is considered physiologic as all manifestations of an adenoz disappear independently after a while, after stabilization of a hormonal background.
Reasons of an adenoz of a mammary gland
The hormonal imbalance – a lack of progesterone and excess of estrogen is the main and only reason of pathology. Treat the etiologichesky factors causing hormonal failure:
- Obesity. Fatty tissue synthesizes estrogen. With an excessive weight production of estrogen increases that leads to a relative giperestrogeniya (level of progesterone remains normal).
- Spontaneous and artificial abortions. Termination of pregnancy, especially on big terms (15–22 weeks), provokes sharp hormonal reorganization and failure of compensatory mechanisms. Level of sex hormones returns to normal not at once that the adenoza gives an impetus to development of endocrine problems, in particular.
- Late pregnancy. At women 35 years of function of ovaries are more senior die away. The occurred pregnancy speeds up work of ovaries that causes postnatal failure in synthesis of estrogen and progesterone and hormonal failure.
- Postnatal agalaxia. The agalaxia testifies to a lack of progesterone which is responsible for development and a differentiation of cages of a parenchyma of mammary glands, and excess of estrogen. At a giperestrogeniye expands Strom of glands, the lack of progesterone leads to the uncontrolled growth of a ferruterous epithelium.
- Refusal of feeding by a breast. Increase in concentration of Prolactinum against the background of lack of feeding by a breast causes stagnation of milk in channels. There is their obstruction and expansion that leads to structural changes - to formation of cysts.
- Uncontrolled reception COOK. Reception of hormonal tablets without specific features and observance of the scheme causes a hormonal imbalance and development of displastichesky processes in a breast.
Adenoz of chest glands arises at patients more often with gynecologic pathology (an endometrium giperplaziya, tumors of ovaries, uterus myoma, endometriosis) which also develop against the background of a giperestrogeniya. As the triggers starting hormonal violations somatic diseases (arterial hypertension, diseases of a pancreas and a liver), chronic stresses, sexual frustration, the broken ecology, smoking can act.
In chest glands there are cyclic changes which are regulated by hormones: hypothalamuses-rileasing-factors, FSG and LG, estrogen, Prolactinum, horionichesky gonadotrophin, androgens, glucocorticoids, progesterone, hormones of thyroid and pancreatic glands. Adenoz is followed by an absolute and relative giperestrogeniya which is combined with deficiency of progesterone. Estrogen provides growth of the lacteal courses due to excess proliferation of cages and a stroma giperplaziya by activation of fibroblast. Decrease in number of estrogenovy receptors on cellular membranes and reduction of influence of estrogen by target organs (a breast, a uterus) belongs to functions of progesterone.
At a lack of progesterone the differentiation of the cages of a ferruterous epithelium and collagen formed in a significant amount decreases, blocking of proliferative processes is slowed down. As a result cell fission becomes uncontrolled, process of braking of proliferation in fabrics of glands is broken. It leads to structural and morphological reorganizations: to growth and hypostasis of vnutridolkovy connecting fabric, activation of proliferation of a ferruterous epithelium in the dairy courses that causes their obstruction, expansion and formation of cysts.
In a mammology uniform classification of an adenoz of a breast is applied. Systematization of educations is carried out on the area of defeat of fabrics of gland and a histologic structure of an adenoz. On prevalence of pathological education allocate 2 forms:
- Focal (local). In iron mobile large formation of a spherical or disk-shaped shape is formed. The knot has the fibrous capsule and consists of segments.
- Diffusion. In a mammary gland there are several sites of consolidations which form and borders are washed away. Education expands beyond all bounds and settles down unevenly.
As the expanded cages of an epithelium of a parenchyma of gland distinguish:
- Skleroziruyushchy . Is followed by proliferation of atsinus (sites of segments of glands) with preservation of integrity of their epitelialny and mioepitelialny layers. Despite a sdavleniye of atsinus fibrous fabric, their configuration remains.
- Apokrinovy . It is characterized by an apokrinovy metaplaziya of an epithelium (transition of kuboidalny epitelialny cages in cylindrical with the advent of apokrinovy secretion). On a histologic structure apokrinovy it is similar to infiltruyushchy cancer, but the nature its good-quality.
- Pro-current . Differs in expanded dairy channels which are limited to epithelium cages with a cylindrical metaplaziya. It is similar to a skleroziruyushchy adenoz.
- Mikroglandulyarny . Is followed by diffusion and chaotic growth of small channels. The sclerosis and a sdavleniye of fabrics of glands are absent.
- Adenomioepitelialny . This form meets very seldom and is combined with formation of an adenoepitelioma of a breast. Is a focal adenoz.
Symptoms of an adenoz of a mammary gland
The symptomatology of an adenoz is similar to a clinical picture of mastopathy. Depending on a form of a disease expressiveness of these or those signs differs. The mastodiniya (morbidity, a nagrubaniye of glands, their hypersensibility), pains amplifying on the eve of periods, emergence separated from nipples, morbidity of a breast at a palpation belong to the general symptoms of an adenoz.
At a local form of pathology in iron the dense, mobile consolidation with lobular structure which is not soldered to surrounding fabrics and having a clear boundary is probed. Pain during a palpation, the expiration of slime/milk from a nipple, deformation of skin and increase in axillary lymph nodes are not observed. The poured morbidity of gland (pain covers all gland) is characteristic of a diffusion form of a disease, the breast bulks up before periods, from a nipple yellowish or colourless separated appears. Diffusion it is characterized by education in iron of several small knots of the different size which have no clear boundary and a certain form. Nearby the located nodular educations merge that creates illusion of a tumor of the considerable sizes. The palpation of a breast is painful, regionarny lymph nodes are not increased.
Late diagnostics and therapy of an adenoz increase risk of emergence of complications (inflammatory diseases of a breast, deformation of gland, formation of cysts in tissues of a breast and papillomas in lacteal channels). According to the latest scientific data, communication of a disease with a breast cancer which probability increases at an adenoza by 5 times is proved. Frequency of an ozlokachestvleniye of a new growth depends on extent of proliferation of epitelialny cages. Not proliferative forms malignizirutsya in 0,86%, in case of moderate proliferation breast cancer develops in 2,5%, with heavy extent of proliferation of cages is transformed to a malignant tumor in 32% of cases.
Consultation of the mammologist is necessary for diagnostics of an adenoz. The doctor makes collecting the anamnesis and complaints, specifies existence of the accompanying somatic and gynecologic diseases, carries out fizikalny survey and a palpation of a breast. If necessary the gynecologist, the oncologist and the endocrinologist are involved in inspection of the woman. At suspicion on tool and laboratory methods of diagnostics are appointed:
- Mammography. Allows to define process localization, its prevalence and borders. On the roentgenogram are visible multiple, with indistinct borders and irregular shapes of a shadow, corresponding to sites of the expanded segments.
- Ultrasonography of mammary glands. Helps to establish an arrangement of an affected area of gland, its border, a consistence and the sizes. By means of ultrasonography the increased density of glands at young women comes to light, the cysts of the small sizes (to 3 mm) formed at obstruction of channels the condition of regionarny lymph nodes is estimated.
- Hormonal researches. Content of sex hormones, Prolactinum, FSG, LG is defined. According to indications concentration of hormones of a thyroid gland and adrenal glands is investigated.
- Histologic, cytologic research. It is carried out the tsitogramm separated from gland, a punktsionny biopsy of the suspicious site of a breast. In dab existence/lack of atypical cages is defined, in biopsiyny material extent of proliferation of cages of education is estimated.
Also clinical blood tests and urine, blood biochemistry (sugar, hepatic enzymes and other) for the purpose of detection of somatic pathology are appointed. Differential diagnostics of an adenoz is carried out with other displastichesky processes of a mammary gland (adenoma, fibroadenomy, a cyst) and breast cancer.
Treatment of an adenoz of a mammary gland
Tactics of treatment of an adenoz (conservative therapy or surgical intervention) is defined by its form and character of a course of disease. At a diffusion form of pathology conservative treatment which includes reception of sedatives, vitamins (And, E, ascorbic acid, P, groups B), minerals and hormonal medicines is appointed. At an easy form of a disease the monophase combined oral contraceptives by a course for 6 months are used. At the expressed symptomatology of an adenoz reception of gestagen for not less than 3 months is shown.
Patients are recommended to reconsider a food allowance: to limit animal fats, carbohydrates, to increase consumption of fresh vegetables and fruit. At an inactive way of life it is necessary to increase physical activity and to normalize weight, whenever possible to avoid stressful situations. In case of a focal form of an adenoz the sectoral resection of gland – excision of education within healthy fabrics with an urgent histologic research of knot is carried out. With the cosmetic purpose the section of a breast is carried out around a nipple areola, after healing of a wound there is a hardly noticeable hem.
Forecast and prevention
When performing early diagnostics and a timely initiation of treatment the forecast for life and a disease favorable. Prevention of an adenoz includes the prevention of abortions, competent selection of hormonal contraceptives, treatment of gynecologic and endocrine diseases, preservation of the first pregnancy and to a lactation is not less than 6 months, refusal of addictions and maintaining a healthy lifestyle. Also it is regularly necessary to carry out self-inspection of a breast, each half a year to visit the gynecologist, to adhere to healthy nutrition, to plan the first pregnancy up to 30 years.