Tuberculosis of mammary glands – the extra pulmonary form of specific tubercular process proceeding with defeat of chest glands. It is shown by consolidation and a hypertrophy of the affected mammary gland, skin hyperaemia, fluctuation, increase in axillary lymph nodes. Tuberculosis of mammary glands is diagnosed by means of studying of anamnestichesky data, carrying out mammography, a punktsionny biopsy with cytology, tuberkulinodiagnostik. Treatment of tuberculosis of mammary glands includes purpose of antitubercular himiopreparat; in some cases performance of a sectoral resection is shown.
Tuberculosis of mammary glands
Tuberculosis of a mammary gland in a mammology and phthisiology meets exclusively seldom that is caused by relative resistance of fabrics of glands to mikobakteriya. As a rule, tuberculosis of a mammary gland has secondary character and is a consequence of pulmonary tuberculosis. In structure of tuberculosis of other localizations the share of mammarny defeat makes about 0,1%. In exclusive observations tuberculosis of a mammary gland is noted at men.
With an identical frequency tuberculosis the left and right mammary gland is surprised; more rare, in 3% of cases, – both are at the same time. In 60% the tubercular center settles down in the top and lower external sectors of mammary glands; more rare – tsentrichno with involvement mamillar a complex and internal sectors. Tubercular damage of all mammary gland is in rare instances noted. Are most predisposed to tuberculosis of mammary glands of the woman of the reproductive status, however the disease can also meet at advanced and senile age.
Classification of forms of tuberculosis of a mammary gland
Allocate several clinical forms of tuberculosis of a mammary gland: opukholevidny (nodal), abstsediruyushchy, ulcer , disseminirovanny and skleroziruyushchy. Most often nodal defeat of gland meets development of opukholevidny kazeozny education (knot), increase and deformation of a breast, local inflammatory changes and an ulceration of skin. In a breast painful plotnoelastichesky small knots decide on indistinct borders by Palpatorno; dense, moderately painful regionarny lymph nodes.
At merge of small knots the uniform conglomerate at which softening and a nagnaivaniye there is tubercular abscess (abstsediruyushchy tuberculosis of a mammary gland) is formed. The clinical picture at this form reminds mastitis.
Opening of abscess is followed by emergence on a breast of ulcers or fistulas from which purulent separated expires. If the ulcer is localized in a mamillar areolyarnoy of area, the clinical picture ulcer forms of tuberculosis of a mammary gland resembles Pedzhet's cancer superficially. Differential diagnostics in this case allows to conduct a research of a purulent secret in which tuberculosis mikobakteriya are found.
The Disseminirovanny form of tuberculosis of a mammary gland is characterized by existence of the multiple drain centers with kazeozy. The mammary gland at the same time is considerably condensed. The Skleroziruyushchy option of tuberculosis of a mammary gland is observed mainly at elderly women. At this form fibrous changes prevail; processes of kazeozny regeneration are expressed poorly or completely are absent. At a palpation of a breast the dense hilly knots with indistinct contours soldered to skin are defined; retraction of a nipple is quite often observed.
Reasons of tuberculosis of a mammary gland
At primary tuberculosis intra pro-current infection in the period of a lactation when mikobakteriya get into tissues of a mammary gland on lacteal channels when feeding of the infected child takes place. At secondary tuberculosis of a mammary gland spread of an infection hematogenic or limfogenny, from a root of a lung, edges, a pleural cavity or lymph nodes. Direct transition of a tuberculosis infection can be observed at break of kazeozny abscess of an edge or pleura.
The isolated forms of tuberculosis of a mammary gland are rare. Most often specific damage of mammary glands is combined with tuberculosis of ekstramammarny localizations: genital tuberculosis, tuberculosis of lungs, intestines tuberculosis, tuberculosis of bones, backbone tuberculosis etc. Sometimes in the anamnesis the diseased has an instruction on contact with TB patients.
Symptoms of tuberculosis of a mammary gland
The general displays of tuberculosis of mammary glands include weight loss, appetite oppression, weakness, temperature increase of a body, perspiration, etc. symptoms of tubercular intoxication. Local changes are shown by a hypertrophy of a mammary gland due to existence in it of the pathological center: from small mobile knot to the big tumoral conglomerate soldered to a chest wall. Puffiness and hyperaemia of skin over consolidation, fluctuation of the center are typical for tuberculosis of a mammary gland.
The tubercular knot at first progresses in sizes, causing pains, then is softened in the course of kazeozny disintegration and, at last, is opened with formation of fistulas. In case of spontaneous closing of fistulas on skin the involved hems are formed. Involvement and retraction of a nipple at tuberculosis of a mammary gland happens seldom. Development of regionarny lymphadenitis is characteristic of tuberculosis of a mammary gland. Axillary lymph nodes increase, become plotnoelastichesky, painful, soldered with each other, forming sometimes large conglomerates.
Diagnosis of tuberculosis of a mammary gland
Recognition of tuberculosis of a mammary gland presents difficulties in connection with variety of clinical options of a current and a high onkonastorozhennost. Differential diagnostics at tubercular defeat is required with fibroadenomy, actinomycosis of a mammary gland, abstsediruyushchy mastitis, an armor-clad form of a breast cancer.
At specification of the anamnesis on reception at the mammologist it becomes clear whether the patient contacted to a batsillovydelitel or the TB patient, whether had in the past tuberculosis of any localization, in particular, pleurisy of a tubercular etiology which is followed by damage of intra chest lymph nodes. Data of ultrasonography of mammary glands allow to consider internal structure of knot, to reveal the svishchevy courses, to check puncture accuracy.
When performing mammography, KT or MRT of mammary glands on roentgenograms and tomograms the focal calcifications or blackouts having not homogeneous character and uneven contours ("tongues of flame") that directly testifies to tuberculosis of a mammary gland can come to light. At a disseminirovanny form the radiological picture is similar to an edematous and infiltrative breast cancer; at skleroziruyushchy option in structure of fabric of gland fibrous changes prevail.
Establishment of the authentic diagnosis is promoted by carrying out a punktsionny (aspiration) biopsy and a cytologic research of a punktat from a mammary gland. In a case release of pus from svishchevy openings the microbiological research of separated is made. At tuberculosis of a mammary gland in material specific tubercular granulomas and huge cells of Pirogov-Langkhansa come to light. Carrying out a tuberkulinodiagnostika (test to Mant) finds positive reaction – the increased papule with sharply expressed and persistent hyperaemia towering over skin level.
Treatment and prevention of tuberculosis of a mammary gland
Treatment of tuberculosis of a mammary gland can consist in purpose of specific antitubercular chemotherapy and removal of single kazeozny knots from chest gland. Therapy by tuberkulostatichesky medicines is made under control of the phthisiatrician. In antitubercular courses rifampicin, an isoniazid and are used. At an early initiation of treatment specific therapy leads to full regression of tuberculosis of a mammary gland and recovery. In case of lack of success surgical intervention is undertaken.
Optimum operational volume is the sectoral resection of the mammary gland affected with tuberculosis. After excision of tubercular infiltrate medicamentous protvotuberkulezny therapy, physiotreatment is carried out (ultrasound, an electrophoresis, UVCh, magnetotherapy, an induktotermiya, Ural federal district, etc.). Treatment of tuberculosis of a mammary gland is carried out is long, from 6 months to 2 years in the conditions of a hospital, sanatorium and a clinic.
Questions of the prevention of tuberculosis of mammary glands are closely connected with the general antitubercular prevention and include vaccination, regular screening inspections of the population on tuberculosis (fluorography), medical examination of the patients who had tuberculosis and contact persons. The patients who recovered from tuberculosis of a mammary gland are under observation of the phthisiatrician and mammologist. If necessary it conducts antirecurrent courses of chemotherapy.