Mastopathy

Description:

The mastopathy combines big group various on a morphological structure, but the general on ethology and a pathogeny of the diseases of a mammary gland which are on the being dishormonal proliferata. The basis of classification of mastopathies joins functional disturbances, morphological changes and a clinical picture of a disease, also ethological factor is considered. However the majority of the available classifications is based on morphological researches. Most of authors distinguishes a fibrous and cystous mastopathy with dominance of development of fibrous fabric or cystic educations (without proliferation of an epithelium and with the expressed proliferation of an epithelium).

Mastopathy reasons:

Most of modern writers carry a mastopathy to dishormonal diseases, considering that this or that dysfunction of gonads is the cornerstone of a mastopathy. 75% of patients with a mastopathy have dysfunctions of gonads (an oligomenorrhea, a dysmenorrhea) and diseases of genitalias. Development of a mastopathy, as well as a breast cancer, is connected not only with the increased content of oestrogenic substances, but also with other endocrine disturbances. It is possible to assume that at disturbance of neuro and humoral regulyation there are considerable changes of steroid exchange. As a result of it the intermediate products which are not finding oestrogenic effect, but, perhaps, operating on a mammary gland can be formed. Pituitary factors – prolactin, FSG or a growth hormone also are necessary for implementation of influence of estrogen on a mammary gland. The mammary gland in various states can react differently to stimulation by hormones.

Mastopathy symptoms:

The fibrous and cystous mastopathy belongs to extremely widespread diseases. The essence of a disease consists in expansion of channels of a mammary gland with formation of cysts, growths of connecting fabric and the epithelium covering channels.
Distinguish two forms of a fibrous and cystous mastopathy: diffusion and knotty. Clinical symptoms of a fibrocystic mastopathy are various.
The main symptoms of a disease are mammary gland pains, emergence of diffusion or limited consolidation, sometimes allocations from a nipple. Pains happen various both on character, and on intensity and localization. Some patients complain of feeling of completeness, pressure and a raspiraniye in mammary glands, in other cases the stupid or pricking pains irradiating in a hand, a neck and a breast are noted. In the beginning pains arise in one gland, and in another; usually they appear or amplify in 5-7 days before periods, reach a maximum the day before x and then either at once, or gradually within 2-3 days begin to decline.
Consolidation in iron is localized most often in an upper outside quadrant.
At inspection in a mammary gland nodes of various size – from extremely small to the large sizes, not having a clear boundary are found slightly painful, moderately dense consistence. Nodes can be single and multiple, in one or, more often, both mammary glands, are symmetrized, is preferential in upper outside quadrants. Accumulation of big and small, nearby fibrous and cystous nodes reminds a bag with fraction.
The condensed sites clearly are felt if to take fabric of gland in cross the direction. At inspection of the patient in lying situation the condensed sites become flat and softer, decrease in sizes, and sometimes are not probed. With a pressure upon the condensed site of gland in certain cases from a nipple the secret which has various coloring is allocated: light yellow, yellowy-brown, chocolate, dark brown.
At contrast mammography expanded channels with cystous educations come to light.
In certain cases at a mastopathy the tumor having is found it is moderated a dense consistence, granular or even slightly hilly surface which is unsharply passing into gland fabric. Against the background of nodosity there is one site, more dense and less painful.
The knotty form of a mastopathy can be considered a precancerous disease in the sense that such center begins to stand apart from surrounding fabric, gets a node form, shows lines of autonomy of growth, especially if the mastopathy comes to light in one of mammary glands at their bilateral defeat. At the patient's research in horizontal position the tumor does not disappear and does not change a form, and the node pressure (a symptom of Keniga) is felt. At such situation there is a thought of a possibility of a malignancy of education.
Fibrosis and obstruction of large channels lead to their expansion with formation of cysts and a delay of a secret in which there can be chemical and hormonelike materials influencing an epithelium of channels and defiant hyperplastic changes.
The most threatened in sense of a possibility of transformation into cancer it is necessary to consider focal forms of a fibrous and cystous mastopathy with growths of an epithelium of solid type.
The diagnosis of a fibrous and cystous mastopathy sometimes represents great difficulties, and then there is a need of use of mammography, a cytologic research, and, at last, biopsies.
At a mastopathy it is in rare instances observed the isolated large "blue cysts". These retentsionny cysts have bluish coloring, round outlines. They are well limited and closed. The size reaches them 3-5 cm. Cysts can single or multiple, a surface their smooth, there is no spayaniye with skin. Most often they have dense and elastic a consistence. For specification of the diagnosis the puncture of a cyst and a cytologic research е contents is recommended; after a puncture it is possible to make contrast mammography.

Treatment of the Mastopathy:

Before starting treatment of a mastopathy, it is necessary to find out a cause of illness. Sometimes social conditions, family life, a mental injury, abnormal function of gonads exert impact on development of a mastopathy. Quite often it is necessary to observe how after changes of living conditions, elimination of the reasons promoting development of a mastopathy after treatment of the corresponding gynecologic diseases there occurs improvement and mastopathy signs disappear.
In cases of mastopathies with dominance of functional disturbances it is possible to achieve success by use of retromammary novocainic blockade, treatment of a thyrotoxicosis and a neurasthenia. In the presence of hormonal disturbances use of hormonal drugs is possible. The nature of hormonal therapy depends on incretory disturbances.
Hormonal therapy is appointed after definition of a hormonal profile of the patient – estrogen, a pregrandiol, 17 ketosteroids.
At oestrogenic insufficiency oestrogenic drugs are shown, at insufficiency of hormone of a yellow body - progesterone or Pregninum, at the increased oestrogenic function of ovaries apply small doses of androgenic hormones. Purpose of androgens found broader application at the beginning of the preklemakterichesky period when the corresponding researches find a hyperestrogenism. In process of fading of activity of ovaries reasonablly combined administration of estrogen and androgens.
It is reasonable to carry out treatment by hormones in approval of the endocrinologist and the gynecologist.
Appoint vitamins A, B1, E for the purpose of improvement of function of the liver which is taking part in an inanktivation of excess of estrogen.
At treatment of a mastopathy apply the sedative, desensibilizing and regulating exchange processes of means: bromic drugs, Calcium chloratum and others. Along with the carried-out treatment give the patient advice about normalization of sex life, about need to have pregnancy and childbirth.
The limited, knotty forms of mastopathies consisting of conglomerates of small cysts or one large, expanded channels of fibrozosoyedinitelny fabric are subject to operational treatment.