Lipoma of a mammary gland — the benign tumor of a breast coming from fatty tissue. Usually growth of a neoplasia is not followed by pain or other discomfortable feelings. The lipoma comes to light incidentally in the form of roundish, smooth, elastic, painless volume education. It is diagnosed with use of methods of ultrasonography, mammography and the cytologic analysis of the material received by means of an aspiration biopsy. In the absence of clinical symptoms observation in dynamics is shown. Big and fast-growing tumors delete surgically by an enukleation, aspiration or a sectoral resection.
Lipoma of a mammary gland
Lipomas (fatty tumors, fatty tumors) of mammary glands can be both an independent disease, and manifestation of a lipomatoz — multiple defeat of the organism similar neoplaziya which usually have hereditary character. Lipomas make up to 10% of cases of the volume educations revealed in a breast. More often pathology is diagnosed for women after 40 years which entered the period of involute changes. At 94-95% of patients the tumor is located superficially and differs in the small sizes (no more than 2 cm). At patients of reproductive age fatty a neoplasia have a different histologic structure, in the climacteric period reveal lipomas with fibrous elements more often.
Reasons of a lipoma of a mammary gland
Formation of a fatty tumor of a breast — polietiologichesky process which can be caused as internal (genetic, metabolic and hormonal), and external factors. Though experts in the sphere of a mammology did not come to final conclusions about the causes of lipomas, several theories of an origin of these new growths were offered. The main of them are:
- Genetic. Good-quality growth of fatty tissue in a mammary gland can be display of the hereditary pathology arising at defect of a gene of HMG I-C and some other sites of chromosomes. Usually in such cases of a lipoma are multiple and serve one of clinical manifestations of the inherited lipomatoz: Verneuil-Potena, Gram, Derkum, Roche-Leri's syndromes.
- Hormonal. As the disease is revealed more often at women 40-45 years are more senior, some authors with vyazyvat its origin with the hormonal reorganization happening at climacteric age. Formation of a lipoma can become result of failure of processes of natural involution of a mammary gland or a metabolic menopausal syndrome.
- Exchange. At a part of patients with a breast lipoma in blood concentration of LPNP (lipoproteid of low density) is increased. Badly getting through endoteliya of vessels, such fats collect in fabrics and are encapsulated. The LPNP level increases at a hypodynamia, excess consumption of animal products, defects of fermental systems.
- Exogenous. Physiologic distribution of cells of fatty tissue is run by thin mechanisms of internal self-control. Can lead the local damaging factors to their failure and local accumulation of fat in mammary glands: breast injuries, thermal influences (burns, freezing injuries), cuts at plastic surgeries, wearing inconvenient linen.
It is the most probable that formation of lipomas in tissues of a mammary gland happens at a combination of several called reasons. Some researchers point to a role of observance of rules of personal hygiene in developing of pathology of fatty tissue because of accumulation of the so-called skin fat produced by sebaceous glands of skin. However in development of fatty tumors of chest glands this reason is not the leader.
The main mechanism of formation of lipomas in chest glands is the opukholevidny growth of education without emergence of an atipiya of cages. According to numerous histologic researches, in most cases the fatty neoplasia comes from one cambial cage as a result of which cloning (reproduction) all population is formed. As confirmation of this hypothesis of pathogenesis serves the lobular structure of many lipomas and identification of cages in them with high mitotic activity. Except adipocytes muscular, vascular and fibrous cellular elements can be a part of such new growths.
When determining like lipoma of a mammary gland estimate its histologic structure, localization, otgranicheniye degree from surrounding fabrics. The neoplasia sizes in classification usually do not consider. Key criterion of reference of a new growth to a certain look — a ratio of fatty, fibrous, muscular and vascular elements in its structure. Respectively distinguish:
- The classical lipomas presented by exclusively fatty cages (adipocytes).
- Lipofibroma, consisting of fatty and connecting tissue with prevalence of the first.
- Fibrolipoma as a part of which soyedinitelnotkanny elements prevail, but there is also a fat.
- Angiolipoma, containing a significant amount of blood vessels in fatty tissue.
- Miksolipoma which fatty cages produce the slime collecting in a new growth.
- Miolipoma, the fatty segments and gladkomyshechny fibers uniting in structure.
Miolipoma and a miksolipoma in fabric of chest glands meet extremely seldom, the main form of a disease are classical lipomas and fibrolipoma. Usually good-quality fatty a neoplasia of mammary glands happen single, is more rare — paired and symmetric or multiple. For assessment of the forecast and the choice of medical tactics it is important to define how the tumor is delimited from other fabrics and where it is. Taking into account these criteria allocate:
On otgranicheniye degree:
- Nodal lipomas — well created new growths with the capsule from connecting fabric.
- Diffusion lipomas — seldom meeting a neoplasia which get into surrounding fatty cellulose.
- The hypodermic lipomas which are not getting into a parenchyma of chest gland.
- The Intramammarny lipomas which are localized between breast segments.
- The deep lipomas located behind a mammary gland.
Symptoms of a lipoma of a mammary gland
Usually slow growth of lipomas is not followed by pain and discomfort therefore the new growth incidentally independently comes to light the woman at achievement of the sizes of 1,5-2 cm or it is found during preventive inspection of a breast. Extremely seldom the neoplasia causes cosmetic defect due to achievement of the big sizes — to 5 and more than a cm in the diameter. The greatest of the found lipomas had diameter of 12 cm and weighed about 500 g. Pain arises only at deep volume educations which can sprout in a fastion and fibers of the subject pectoral muscle. Often lipomas are located hypodermically in a verkhnenaruzhny quadrant of one or both chest glands.
When probing the fatty tumor painless, has the round or oval form, a smooth surface, accurate contours, soft a consistence. If as a part of a neoplasia there are a slime and vessels, it is palpated as pasty or jellylike knot. Lipofibroma and a fibrolipoma are more dense. At lobular structure of a new growth skin over it can stretch at the expense of what there is a small relief in the form of cave-in (deepenings). Hypodermic types of lipomas are well displaced in relation to tissues of a mammary gland, intramammarny are less mobile, deep and diffusion tumors do not manage to be probed practically.
Usually lipomas of a breast cause only cosmetic inconvenience. There are no confirmed statistical data on a frequent malignization of such new growths – it is considered that fatty tumors are a little inclined to regeneration in liposarky. The risk increases in cases when the neoplasia has the big sizes and is regularly exposed to traumatic influences. New growths with connecting fabric in the structure are sometimes inclined to a kaltsifikation, at the same time due to consolidation and pressure upon nervous fibers there can be painful feelings. One of rare complications of lipomas is their suppuration or a necrosis owing to blood supply violation.
As the lipoma of a mammary gland has no specific symptomatology, tool and laboratory researches become the main diagnostic methods. With their help it is possible to define precisely localization of a neoplasia, its sizes, a form and a histologic structure. It allows to exclude other types of new growths and to choose optimum medical tactics. For diagnosis are most informative:
- Ultrasonography of mammary glands. Education has accurate contours, is from - or giperekhogenny. The increased density of fabrics is characteristic of neoplaziya with a fibrous component.
- Mammography. In a picture the lipoma is presented by X-ray transparent (gray) education with an accurate contour and the X-ray contrast capsule. By such method it is difficult to reveal diffusion tumors.
- Punktsionny biopsy of a breast. The most reliable way allowing to define precisely structure of a neoplasia. Usually material for a cytologic research is received by an aspiration method.
Differential diagnostics of a lipoma is carried out with nodal forms of mastopathy, a fibroadenomama and other benign tumors of mammary glands, breast cancer, liposarkomy, involution of chest glands on lipo-fibrous or fibrous cystous to type. If necessary in addition appoint MPT, KT, a research of level of onkomarker of blood (CA 15-3 glycoprotein, etc.). The oncologist-mammologist can be involved in diagnosis.
Treatment of a lipoma of a mammary gland
In most cases at the confirmed diagnosis of a good-quality lipoma dynamic observation is recommended to patients with small new growths and absence of pain. Such women 1-2 times a year have to have examination at the mammologist and mammography. Effective conservative methods of treatment of fatty tumors do not exist. Some experts report about a rassasyvaniye of educations with a diameter up to 2 cm after introduction to them of glucocorticoid medicine of a diprospan. However such approach was not widely adopted, the sufficient massif of reliable data about its effectiveness is meanwhile not saved up. At acceleration of growth of a tumor, existence of rough cosmetic defect, considerable pain surgical removal of a neoplasia is recommended. The way of performance of operation and volume of intervention are defined with lipoma type:
- Enukleation of a tumor with the capsule. It is shown at nodal new growths. Vylushchivaniye of a neoplasia with the cover surrounding it allows to prevent a recurrence. Intervention is carried out in the traditional way by means of a scalpel, with use of the laser or radio wave device.
- Aspiration of contents of a tumor. Fatty tissue is removed through a puncture of skin of a mammary gland and the capsule of a new growth. There is no hem left after such intervention. A lack of a method is the impossibility to remove a lipoma cover. In the subsequent it can lead to a recurrence of tumoral process.
- Sectoral resection of a breast. Operation is shown at diffusion forms of a lipoma, big tumors and suspicion on malignant character of a new growth. The neoplasia is excised within healthy tissues of a breast on the contours put under ultrasonography control.
Forecast and prevention
The forecast is favorable. The tumor grows very slowly and usually does not bring unpleasant feelings. At correctly carried out surgery the disease is not inclined to a retsidivirovaniye. Primary prevention of lipomas of a breast assumes an exception of the factors promoting neogenesis, first of all traumatic and other damages. Rational reception of hormonal medicines, limited performance of the interventions capable to provoke disgormonalny states, sufficient physical activity and healthy food is recommended. A problem of secondary prevention is timely detection of a tumor and an exception of malignant character of a new growth.