Gynecology and Mammology >>>> Mastopathy: symptoms - what you need to know. Part 2
Mastopathy: symptoms - what you need to know. Part 2.
Mastopathy manifests itself as changes in the tissues of the mammary gland of two types, according to which it is divided into: diffuse and nodular. Each of these types of mastopathy can take two forms of the course: proliferating and non-proliferating.
A non-proliferating form of mastopathy (without proliferation) proceeds in such a way that pathological changes occur within the lobule and cysts are formed in the region of the small ducts of the lobule, but can be combined with areas of fibrous tissue.
With the proliferating form of mastopathy , atypical or malignant changes may develop against the background of the manifestation of proliferative processes in the ductal epithelium and the "epithelium of the lining" of the cysts. This is a dangerous form of mastopathy and needs constant monitoring.
Atypical processes of proliferation of cells of ducts and lobules of the mammary gland occur in 4 stages.
- At the first stage, benign parenchymal dysplasia appears, but without epithelial proliferation.
- At the second stage, benign parenchymal dysplasia is observed already with epithelial proliferation, but without cellular atypia.
- The third stage is characterized by the course of the disease with parenchymal dysplasia and epithelial proliferation, and with moderate cellular atypia.
- At the fourth stage, there is a characteristic parenchymal dysplasia with proliferation of epithelial cells and atypia, similar to "carcinoma in situ".
Diffuse mastopathy is characterized by the presence of tissue seals in the gland with a scattering of small cysts of a round or oval shape and small soft nodules. The mammogram shows multiple shadows with indistinct borders. Ultrasound shows a pattern with multiple clearances (cysts) ranging in size from 0.3 to 6 cm or more.
Diffuse mastopathy has 4 types:
- the predominance of the fibrous component (tissue compaction);
- the predominance of the cystic component;
- the predominance of the glandular component ( adenosis );
- mixed form.
For nodular (lobular) mastopathy, in contrast to diffuse, single or multiple formations of compaction, nodes similar to a tumor and limited only by a lobule of the gland are characteristic. The nodes are mobile, not connected with the skin and nipple. The sizes of knots can reach up to 2 cm or more. Some nodules increase in size over time and raise the suspicion of a cancerous tumor.
Clinic (symptoms of mastopathy ) and diagnosis.
The general symptoms of the course of the disease are painful sensations of a different nature (burning, tingling, aching pain, dull pain, pulling pain); pain can be localized or radiate to the neck, arm, shoulder blade. But it is not uncommon for pain symptoms to be absent.
The next symptom to look out for is the thickening of the entire breast or its areas. Moreover, soreness and seals can increase in the premenstrual period. In some cases, there is an increase in the armpits of the lymph nodes and their pain sensitivity to palpation is possible. Diagnosis involves differentiating one type of mastopathy from another and is based on the analysis of symptoms, as well as manual and hardware studies.
The manual diagnostic method (palpation) is carried out with the patient in the vertical and horizontal position. Palpation makes it possible to determine the location of the problem area of the tissue, borders, consistency, size, mobility. Lymph nodes in the armpits are also palpated. It is necessary to examine the gland by palpation 2-3 days after the end of menstruation.
To date, the hardware study of the mammary glands is diverse.
Mammographic diagnostics is indicated for women after 40 years of age, since in young women the mammary gland has a denser structure and against this background the nodes and tumors are difficult to distinguish. Mammography is advisable to carry out 7-12 days from the beginning of the menstrual cycle.
But against the background of mastopathy, it is quite difficult to detect a tumor using mammography. Therefore, it is necessary to clarify mammographic data using ultrasound diagnostics (ultrasound).
Ultrasound diagnostics also has its drawbacks:
- inability to consider the entire organ;
- poorly distinguishable contrast between adipose and tumor tissue;
- it does not make sense to use it for screening (a set of research methods in risk groups to detect pathology in case of suspected breast cancer);
- analysis of the ultrasound image can be subjectively interpreted.
Magnetic resonance imaging (MRI) is considered to be a successful research method with a high density of mammary glands and unclear results of mammography and ultrasound. The fact is that the MRI method makes it possible to obtain a high-resolution image of the soft tissues of the breast. It allows you to identify tumors up to 2 mm in size and differentiate mastopathy and malignant formations, as well as see and differentiate cicatricial changes from malignant ones.
Today it is possible to obtain a color image of blood flow using Doppler sonography. It is indicated for women under 30–35 years of age with suspicions of formations of an unclear nature, found on palpation and questionable ultrasound data, as well as for the diagnosis of fibroadenomas.
Auxiliary diagnostic methods:
- .Puncture biopsy - makes it possible to study the degree of proliferative changes and forms of atypia of structural tissues of the mammary gland using cytological studies. The procedure is simple: a suspicious area is punctured with a syringe, cellular material is sucked in and its contents are examined.
- Pneumocystography - allows you to diagnose fibroadenomatosis. The method consists in performing a puncture of the cyst, evacuating its contents and then introducing 10 ml of air into the cyst cavity. Then X-ray is taken and the structure of the cyst walls is studied for pathology.
- Ductography method - diagnoses non-palpable tumors in the breast ducts.
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