Diffuse changes in the mammary gland

Tissues of the mammary glands undergo constant natural changes due to the peculiarities of the functioning of the reproductive system of the female body (telarche, menarche, pregnancy, lactation, menopause). However, certain structural modifications, common in the glandular and fibrous (fibrous) tissues of the breast, can have a pathological character, causing various qualitative and quantitative disorders of diffuse changes in the mammary gland. Experts estimate that at least 45% of women of childbearing age have such changes.

These pathologies have a code for the ICD 10: a class of diseases - XIV (diseases of the genitourinary system); N60-64 Mammary gland disease.

[1], [2], [3], [4], [5], [6], [7]

Causes of the diffuse changes in the mammary gland

Diffuse breast changes affect the parenchyma - the main functional epithelial-glandular breast tissue with the alveoli and fibrillar fibers of the milk ducts, the stroma - the surrounding ducts and the lobes that connect the fibrous tissue, as well as the adipose tissue that protects the parenchyma.

The increase in the number of cells of the mammary gland tissues (proliferation), their decrease and, of course, the developmental disorder (dysplasia) have exclusively hormonal pathogenesis.

The causes of diffuse changes in the breast can be related:

• with chronic inflammation (adnexitis) or an ovarian cyst (which produce estrogen),
• with diseases of the thyroid gland (which synthesizes the metabolic regulating hormones thyroxine and triiodothyronine),
• with the pathologies of the adrenal glands (the cortex of which glucocorticoids are synthesized),
• with pituitary insufficiency (the pituitary is responsible for the production of luteotropic hormone and prolactin),
• with diseases of the pancreas (disrupting the production of insulin),
• with obesity (leading to an increase in the level of estrogen).

An important role in the occurrence of diffuse changes in the mammary gland is given to gynecologists such factors as violations of the monthly cycles, repeated abortions, the first pregnancy after 35 years, lack of lactation after childbirth, late climax, and genetic predisposition. Although the pathogenesis of all the adverse effects of these factors is still associated with hormonal disorders.

It should be borne in mind that changes occur in healthy mammary glands. So, estrogen provides the development of stroma, the growth of ducts and the deposition of fat cells; progesterone, balanced with estrogen, promotes the growth of glandular tissue, lobular structures (lobules), clearance and secretory changes in the alveoli. In women of reproductive age during the menstrual cycle - at the end of the luteal phase - under the action of progesterone, a part of the epithelial cells of the ducts and alveoli of the mammary glands undergoes replication and apoptosis (natural physiological dying). But excessive estrogen levels and progesterone deficiency can disrupt this process, provoking a diffuse-fibrous change in the mammary gland.

During pregnancy, chorionic gonadotropin (hCG), placental lactogen and prolactin stimulate the development of alveoli and milk ducts; prolactin, cortisol, somatropin and oxytocin regulate lactation and the secretion of milk after delivery.

When there is an imbalance of hormones, the natural processes in the tissues of the female breast are disturbed. As experts note, most often begins pathological proliferation of some cells and their replacement by others. In mammology, such structural changes in tissues are defined as dyshormonal diffuse changes in the mammary glands.

[8], [9], [10], [11], [12]

Symptoms of the diffuse changes in the mammary gland

The first signs of such changes can be felt in the form of an increased feeling of discomfort in the chest and its hypersensitivity before the onset and during menstruation. Most women do not pay attention to this, because after the end of the next menarche, unpleasant sensations pass.

Specialists in the field of mammology note the most characteristic symptoms of diffuse changes in the breast, such as:

• severity and tension in the glands, often accompanied by puffiness or "nagging";
• burning in the mammary gland, itching in the nipples and their increased sensitivity;
• small mobile nodular seals in the texture of breast tissue that can become more palpable during menstruation;
• tenderness of the mammary glands;
• aching pains of varying strength (intense pain can irradiate into the area of the armpit, shoulder or scapula;
• transparent discharge from the nipples (with pressure on them).

Many do not have any of these symptoms, and seizures in the chest are detected by chance, as manifestations of signs of diffuse changes in the breast are often periodic and associated with the menstrual cycle.

Possible complications of dyshormonal diffuse changes in the mammary glands are the formation of benign tumors of various sizes, and the most dangerous ones are the malignancy of these tumors.

Despite the benign nature of this pathology, if blood relatives of cancer tumors of the organs of the reproductive system (uterus, ovaries, mammary glands) are present, the consequences can be the most serious and require the intervention of oncologists.

In general, the prognosis is positive, but the possibility of developing breast cancer should be taken into account, which, with diffuse changes in the breast, occurs more often than in the absence of such changes.

[13], [14], [15], [16], [17], [18]

Forms

In medicine, diffuse processes in the tissues of various organs imply not a single clearly localized structural change, but multiple inclusions in a continuous array of one tissue elements (foci or nodes) of another tissue that has a different cellular structure and function (diffusio - in Latin "spreading, spreading ").

When a diffuse fibrous change in the mammary gland is diagnosed, this means that proliferation of cells of fibrous (connective) tissue has occurred. These can be diffuse changes of the parenchyma of the mammary glands (diffuse fibromatosis), as well as lobules of the gland (fibroadenosis).

Doctors can identify multiple diffuse changes in the glandular layer of the mammary glands (parenchyma) in the form of clear and dense fibroepithelial nodes to the touch, and then the diagnosis is either diffuse focal changes in the breast, or diffuse mastopathy, or nodular dyshormonal dysplasia.

If the structural type of pathology is accurately established (which can be glandular, fibrous, cystic and combined), then either diffuse-cystic changes in the mammary gland or diffuse fibrocystic breast changes will be determined.

This terminological diversity we have already discussed in articles Fibrosis of the breast and Diffuse fibro-adenomatosis of the mammary glands.

If the mammologist says that the patient has mild diffuse changes in the mammary glands, then this means an average degree of diffuse mastopathy.

Separately it is necessary to note so-called diffuse involutive changes of mammary glands. What it is? This is a natural age (involutio in Latin "coagulation") structural changes in breast tissue in women during the postmenopause - when the synthesis of sex hormones decreases and the reproductive function of the female body fades. Such changes are characterized by an increase in the volume of adipose tissue in the mammary glands due to a reduction in the glandular part, as well as a decrease in the lobular structures of the breast and the consolidation of their fibrous membranes. See also - Involution of mammary glands.

[19], [20], [21], [22], [23], [24]

Diagnostics of the diffuse changes in the mammary gland

Diagnosis of diffuse changes in the mammary gland by mammalian physicians is carried out, which are performed to examine patients and by examining the mammary glands and nearby lymph nodes by palpation.

After the examination, an instrumental diagnosis of mammography (x-ray of the mammary glands) is mandatory.

To determine the general state of health and determine the level of hormones it is necessary to pass tests: a general blood test and an analysis for the level of hormones in the blood plasma (for maximum reliability of the results, the analysis is given in view of the phase of the menstrual cycle). By the way, the levels of not only sex hormones (estrogen, progesterone, prolactin, etc.) are determined, but also hormones of the thyroid and pancreas. And if their level does not meet the standards, endocrinological examination may be required.

Usually used instrumental diagnostics includes ultrasound of the mammary glands, a rarer x-ray with the introduction of contrast material in the thoracic ducts (doktografiya) and thermography. Computer tomography (CT) may be required, and color Doppler sonography to determine the state of the blood vessels of the mammary glands.

To exclude oncology (in the presence of the threat of malignancy) differential diagnostics is required, which is carried out by fine needle aspiration biopsy of the modified tissue and cytological examination of the obtained sample.

[25], [26], [27], [28], [29], [30]

Treatment of the diffuse changes in the mammary gland

Currently practiced etiologic treatment of diffuse changes in the breast does not have one scheme for all cases and is assigned only individually - based on the results of the examination.

As a rule, treatment includes reception:

• antioxidant vitamins (A, C, E), vitamins B6 and P;
• iodine-containing preparations;
• preparations based on phospholipids, in particular linoleic acid or lecithin, which promote the regeneration and stabilization of cell membranes.

In cases of diffuse fibrotic changes in the breast, hormonal drugs are often used:

• Dydrogesterone (Duphaston) is an analog of progesterone (taken for 1 tablet 14 days during each monthly cycle);
• Medroxyprogesterone acetate (Methylgesten, Provera, Klinovir, Luteodion, etc.) acts as an endogenous progesterone and is used in the deficiency of this hormone;
• Toremifene (Fareston) - acts on the estrogen receptors in the tissues of the breast and blocks the effect of this hormone;
• Diferelin (Decaepeptil) analogue of endogenous gonadorelin (a hormone of the hypothalmus), suppresses the function of the ovaries, reducing the synthesis of estrogen; is administered intramuscularly.

When the menstrual cycle is disturbed and the diffuse-fibrous proliferation of cells of the parenchyma of the mammary gland - to reduce the level of prolactin and eliminate the imbalance of sex hormones - homeopathy offers medicines based on the fruit of the tree-like shrub Vítex agnus-castus (Cyclodinon and Mastodinon) form of tablets or drops for oral administration.

Alternative treatment of diffuse breast changes

Among the alternative methods that are used in the treatment of diffuse pathological changes in breast tissue, it is worth noting external means and herbal treatment in the form of decoctions for ingestion

The first category includes compresses from infusions of such medicinal plants as clover, red clover, wormwood, cuff and St. John's Wort. And although the first two plants have phytoestrogens in their composition, as they act in the form of compresses, it is unclear.

In addition, alternative treatment with compresses from raw grated beets, cabbage leaves, propolis lard, honey with aloe (it is necessary to put compresses on the breast for the night) is popular.

Treatment with herbs includes recommendations to drink calming infusion of Valerian roots (5 g per 200 ml of boiling water), a decoction of a mixture of equal quantities of motherwort and peppermint (a tablespoon of the mixture to a glass of water), and a decoction of fennel and cumin seeds (1: 1) 100 ml twice daily. Fennel is usually used for bloating and flatulence, and its use in this pathology can be explained by the presence in its fruit of essential oils consisting of unsaturated fatty acids, including linoleic and oleic. Used for the improvement of digestion, the fruits of fennel-related cumin are also rich in oils, phenolcarbonic acids and terpenic compounds.

Surgical, that is, surgical treatment of multiple formations is not carried out: only single fibrous-cystic nodes can be excised or removed by nucleation (and not in all cases), and if oncology is suspected. In case of diffuse changes, conservative therapy and monitoring of the mammary gland status are appointed - with an outpatient registration at the mammologist and with examinations every six months.

[31], [32], [33], [34]

Prevention

Prevention consists of regular (once a month) examination and palpation of women's mammary glands, and when identifying seals - referring to a doctor. There are no other methods yet, although one can find recommendations (obviously very old ones) that clearly do not take into account the fact that diffuse changes in the mammary gland have a hormonal etiology.

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