Fatty necrosis of a mammary gland – focal aseptic necrosis of fatty cellulose of a breast with its subsequent replacement with cicatricial fabrics. The fatty necrosis is characterized by emergence of the dense painful education deforming a mammary gland; retraction of skin and change of its coloring that first of all forces to think of tumoral processes. Diagnostics includes a palpation of a mammary gland, performing ultrasonography, mammography, tonkoigolny biopsy. Treatment of a fatty necrosis demands performance of a sectoral resection of a mammary gland.
Fatty necrosis of a mammary gland
The fatty necrosis of a mammary gland (an oleogranulem, a lipogranulem, a steatogranulem) belongs to the non-enzymatic necroses most often caused by various injuries of a breast. According to clinical observations which are carried out by a modern mammology, the fatty necrosis makes 0,6% of cases of all nodal formations of mammary glands. The fatty necrosis of mammary glands meets at patients with a makromastiya more often, than at women with a small breast.
As the injuring factors casual bruises and blows in life or transport, medical manipulations, sports trainings can act. Bystry loss of weight or performing radiation therapy becomes more rare the reason of a fatty necrosis of a mammary gland. Formation of a fatty necrosis at the patients who transferred a reconstructive mammoplastika own fabrics after a mastectomy is in some cases noted.
Damage of capillaries can lead to loss of blood supply of the local site of fatty cellulose. Further changes are characterized by development of a jet inflammation on the damaged site with formation of the demarcation zone delimiting the become lifeless fabric. After subsiding of an inflammation process of a fibrozirovaniye - replacement of necrotic masses with cells of connecting fabric begins. In these cases on the place of a necrosis cicatricial fabric is formed. Further on the site of a fatty necrosis of a mammary gland calcium salts can be laid, causing calcification (petrifikation) of the center of necrosis; processes of an ossifikation are in certain cases noted.
Symptoms of a fatty necrosis of a mammary gland
Development of a fatty necrosis is preceded in most cases by traumatic impact on a mammary gland. On the place of a trauma there is a painful tumor soldered to skin, having rounded shape and a dense consistence. Further the area of a fatty necrosis of a mammary gland can lose sensitivity.
Skin over a tumor of a breast can have tsianotichny or red coloring. At formation of a fatty necrosis of a mammary gland in the field of an areola retraction of a nipple is possible. Unlike mastitis, at a fatty necrosis of a mammary gland, body temperature, as a rule, remains normal.
Dense infiltrate, deformation of a mammary gland, emergence of "dimples" on skin, increase in lymph nodes gives to a fatty necrosis external similarity with a clinical picture of a breast cancer. In adverse cases development of a fatty necrosis of a mammary gland can proceed with septic fusion of the center and sequestration.
Diagnostics of a fatty necrosis of a mammary gland
At diagnostics of a fatty necrosis of a mammary gland the instructions of the patient on a recent injury of a breast are important. In the course of a palpation of a mammary gland the mammologist without effort defines painful consolidation with indistinct contours, sometimes – fluctuation. Ultrasonography of a mammary gland does not allow to reveal characteristic distinctive signs of a fatty necrosis.
Carrying out survey mammography, KT or MPT of mammary glands reveals nodal education with non-uniform structure, tyazhisty uneven contours. The radiological, tomographic and ekhografichesky picture at a fatty necrosis often reminds that at a breast cancer. Later, when there is a calcification, the center of a fatty necrosis of a mammary gland looks on mammograms in the form of a spherical kaltsinat like "an egg shell" that allows to exclude a process zlokachestvennost.
For differential diagnostics carrying out a biopsy of a mammary gland (punktsionny tonkoigolny or trepanobiopsiya) with the subsequent cytologic and histologic research of the received samples is shown. The biopsy of a mammary gland is recommended to be carried out under ultrasonic or x-ray control.
Treatment and prevention of a fatty necrosis of a mammary gland
Considering irreversible focal changes in fatty cellulose, and also the organ-preserving sectoral resection - removal of a part (sector) of a mammary gland is shown to difficulty of differential diagnostics at a fatty necrosis.
Only the post-operational histologic research of macromedicine allows to exclude oncological process. Microscopically fatty necrosis of a mammary gland is presented by nodular growths of granulyatsionny fabric from epitelioidny cages, multinuclear huge lipofaga and ksantomny cages around fat inclusions. One of components lipogranuly are fatty cysts - the thin-walled cavities filled with oily and serous liquid.
For prevention of a fatty necrosis it is necessary to avoid injuries of mammary glands, and also to address in due time the mammologist if damage nevertheless happened. In case of traumatizing a mammary gland it is necessary to give it the raised situation with the help of a bandage.