The mammary glands are modified sweat glands with an apocrine type of secretion. Glandular tissue is of ectodermal origin. By the time of puberty, the mammary glands reach full development, which reaches its maximum after the first birth of a full-term pregnancy. Under the influence of hormonal stimulation during pregnancy, there is a gradual increase in the number glandular lobules.
During the growth and development of the mammary gland, four types of glandular lobules . Lobules of the first type least differentiated and known as virgin lobules, since they represent immature female breast before menarche.
Lobules of this type have from 6 to 11 ducts.
Lobules of the second type evolve from lobes of the first type, glandular epithelium in them acquires extensive morphological differentiation, characteristic of glands in reproductive age outside of pregnancy. The number of ducts also increases, correspondingly about 47 per lobule.
Lobules of the third type evolve from lobules of the second type, have an average of 80 ducts or alveoli per lobule. These lobules are already formed under the influence of hormonal stimulation during pregnancy.
And finally fourth type of lobules is presented in women with lactation and reflects the maximum differentiation of the glandular component and the development of the mammary glands during lactation. There are about 120 ducts in the lobules of this type. These lobules are not found in women who have not been pregnant. After the end of lactation, the fourth type lobules regress into the third type lobules. After the onset of menopause, involutional changes occur in the mammary gland both in those who gave birth and in nulliparous women. This is manifested by an increase in the number of lobules of types 1 and 2. At the end of the fifth decade of life, the mammary gland of parous and nulliparous women consists mainly of type 1 lobules.
Normally, the main tissue elements of the mammary glands, with the help of which their role in reproductive function, represented by the combination epithelial and stromal fabrics.
Epithelial elements are represented by branching ducts that are associated with the functional units of the gland - lobules and nipple.
Stroma consists of varying amounts of adipose and fibrous connective tissue that form the volume of the gland itself outside of lactation periods.
At birth, the epithelial component of the mammary gland is represented by a small number of rudimentary ducts located deeper than the nipple-areola complex. During the prepubertal period, these ducts slowly grow and branch, accompanied by an increase in the stromal component. In the postpubertal period, the endings of the ducts form sacular buds, with accompanying growth of the stroma, which increases the volume of the gland during this period. During pregnancy, many glands develop from each bud.
By the end of pregnancy, the glandular component increases to such an extent that the mammary gland consists entirely of glandular tissue, with a small amount of stroma.
After the end of lactation, atrophy of the glandular tissue is noted and the stroma again becomes the dominant component mammary gland.
After menopause, atrophy of glandular components occurs with a pronounced decrease in the number of lobules to such an extent that in some areas of the glands the lobules disappear completely and only the ducts remain. The connective tissue component of the stroma also decreases, while the adipose tissue of the stroma increases in its content.
From this brief description changes in the epithelial and stromal elements of the mammary glands depending on the periods of the reproductive cycle, it clearly follows that the basis of all these rearrangements are physiological, but multidirectional processes proliferation and apoptosis, providing end result adequate changes in the structure and function of the glands in accordance with the tasks in each age period of the reproductive cycle.
, which in the predominant number of cases are based on cellular hyperplasia, form a rather heterogeneous group of disorders.
In relation to this pathology, the doctor usually solves two diagnostic problems: firstly, exclude in a palpable formation malignancy, and secondly, when conducting a histological examination (according to indications), obtain useful information regarding the morphological characteristics of the observed changes (Semiglazov V.F. et al., 1992).
In this regard, the tendency to consider clinically benign changes in the mammary glands in terms of assessment is indicative possible risk development of a malignant process in the future (which seems quite correct).
To illustrate what has been said here, it is appropriate to cite the jointly reached decision of the “Conciliation Commission,” which included forty prominent specialists of the American College of Pathologists on the problem benign processes breast (October 3–5, 1985, New York, USA). The basis adopted document were based on the results of prospective observations carried out by W. D. Dupont and D. L. Page (1985) large group patients (1500 people). They underwent a biopsy for clinical benign neoplasms mammary glands, and their fate has been traced over a considerable period of time.
In accordance with the results obtained, all benign changes in the mammary glands were divided into three groups according to the relative risk of developing cancer.
1st group. Non-proliferative processes(no risk of malignancy).
Cysts.
Cystsarisefromfinalductslobes
Typically, the epithelium consists of two layers: the inner epithelial layer and the outer layer, represented by myoepithelial cells. In some cysts, the epithelium may be thinned or absent. In other cases, apocrine metaplasia is observed in the epithelium. Cysts often contain an amorphous protein secretion.
Apocrine metaplasia.
These changes in the mammary gland epithelium are characterized by the transition of cuboidal cells to cylindrical ones, in which round nuclei are defined, with abundant eosinophilic cytoplasm and apocrine secretion.
Moderatehyperplasiaepithelial lining of the ducts. Characterized by an increase in the number of epithelial cells in the ducts to more than two cells in the thickness of the duct, but not more than four. In this case, epithelial cells do not block the lumen of the duct.
Fibroadenoma.
The tumor is well demarcated from the surrounding tissues and consists of benign epithelial and stromal elements.
2nd group. Proliferative processes without atypia (slightly increased risk of malignancy, 1.5–2.0 times).
Moderate or severe hyperplasia.
It is characterized by the fact that epithelial cells fill the lumen of the duct and even expand it. Nuclei vary in shape, size and orientation. The remaining free spaces of the ducts also vary in size and shape.
Intraductal papilloma.
The intraductal lumen is formed by a papillary formation. At high magnification, one can see that the papilla consists of a fibrovascular core (rod), which is covered with two layers of epithelial cells: the epithelial layer adjacent to the lumen of the duct and the myoepithelial layer lying on the core of the papilla.
Sclerosing adenosis.
It is represented by the proliferation of glandular structures and stroma located in the center of the mammary gland lobule. These glands can be compressed and change shape due to the fibrous stroma, sometimes forming the picture “ cancer with infiltrative growth».
3rd group. Atypical hyperplasia- moderately increased risk of malignancy (4–5 times).
Ductal atypical hyperplasia.
This type of epithelial structure has some but not all of the characteristics ductal carcinoma in situ. Near the center of the duct, a population of relatively round identical epithelial cells with regularly spaced nuclei is determined. Closer to the periphery of the duct, epithelial cells retain their orientation.
Variations in the size and shape of the remaining intraductal spaces are noted, as features intermediate between carcinoma in situ and ductal hyperplasia persist. These changes are referred to as " atypical ductal hyperplasia».
Lobular atypical hyperplasia.
This lesion is characterized by the proliferation of small identical cells in the acini, which are not stretched by them. Because this type proliferation has some but not all of the features of lobular carcinoma in situ, these changes qualify as “atypical lobular hyperplasia.”
Fat lobule in the mammary gland, ultrasound is quite easy to detect. In other words, it is fibroadenoma ( benign tumor mammary gland). The fatty lobule may appear as nipple retraction and painful sensations in his area.
Usually, the woman herself discovers the fatty lobule during a self-examination in the form of a small pea. Fibroadenoma consists of 2 deformed tissues - fibrous and glandular. The state of the tumor is influenced by hormonal levels; under its regulation, the fat lobe can decrease and increase in size. Typically, during pregnancy and breastfeeding, the tumor becomes larger, and during menopause, on the contrary, it becomes smaller.
Normal breast ultrasound
There are 3 types of tissues in the mammary gland - connective, adipose and glandular epithelium. Normally, the skin should be represented by a hyperechoic area, the glandular epithelium should be an echogenic zone with narrow ducts, and adipose tissue should be a hyperechoic area. Any neoplasms can be clearly identified in these tissues if you know their norm. The fat lobule has a reduced echogenicity compared to other tissues. But, sometimes it happens that fibroadenoma can be a heterogeneous echostructure.
On ultrasound examination the fat lobule has a round shape with fairly clear contours. If you look closely, you can find small areas of calcification in the fibroadenoma. There is also a leaf-shaped form of fibroadenoma, which differs from the usual fatty lobule on ultrasound only in its larger size. For best diagnosis neoplasms in the mammary gland, an ultrasound examination should be performed on days 4-5 of the menstrual cycle.
What to do if a fatty lobule is detected on ultrasound
If a woman is diagnosed with fibroadenoma, then there is no need to worry and panic too much. There are conservative and surgical methods her treatment. It happens that a benign tumor itself begins to decrease in size and then disappears altogether.
It is unlikely that a fatty lobule will develop into malignancy, but to prevent this from happening, it is advisable to monitor it using ultrasound. Many women refuse surgical intervention due to postoperative breast defects - changes in its shape and texture. But, if a fibroadenoma is detected on an ultrasound, it is better to listen to the doctor and go for the treatment method that he suggests.
Fat lobule, fibroadenoma and breast cyst are a type of tumor that is classified as benign. In order to determine the type of tumor as accurately as possible, puncture or histology is usually performed (most often in the form of tests). Although if you know how each of these diseases differs and carry out an additional examination, possible errors and unnecessary tests can be avoided.
Benign tumor – fibroadenoma
As practice shows, in nine out of ten cases, the formed breast tumor is a fibroadenoma. The disease is common to both men and women, although it is most common among the fair sex between the ages of 14 and 35 years. And this is perhaps one of the main differences between a fibroadenoma and a cyst and a fatty lobule.
Fibroadenoma of the mammary gland at a young age most often develops due to unnatural or abnormal growth of adipose tissue in the area chest. Other causes of diseases can be more accurately determined by puncture of the mammary gland. Among them may be:
- diseases associated with the human endocrine system;
- hereditary predisposition and genetic characteristics;
- early pregnancy or the first months after the birth of a child;
- puberty in girls (young people in in this case can be excluded);
- stress, fatigue and constant nervous tension.
Characteristics of breast diseases, or rather, knowledge of it, will help you determine in the best way whether a cyst is found in your breast or one of the types of fibroadenoma. As for the latter disease, it is worth noting that fibroadenoma is a neoplasm of the mammary gland, one of the forms of mastopathy and a type of benign tumor. It has a focal nature of distribution, and cannot form in several places at once in one mammary gland. Moreover, the extensive practice of mammology allows us to determine with almost one hundred percent accuracy the exact location of the formation - the upper right quadrant of the breast.
Please note that breast fibroadenoma rarely causes painful sensation. The same cannot be said about such a benign tumor as a cyst. The disease is not associated with the epidermis, which means that puncture can determine not only the nature of the disease, but also its type.
Another nuance that distinguishes fibroadenoma from a fatty lobule or cyst is the absence of any clear contours, which is also determined by puncture.
Upon careful examination of the disease, you will notice that the fibroadenoma itself is enclosed in a capsule. It can roll around inside the mammary gland.
Cyst as a benign tumor
Breast cysts are equally common in both benign and malignant manifestations. The main difference between a cyst and a fibroadenoma is that the tumor can be single or multiple, and develop simultaneously in both mammary glands. Quite often, a cyst forms and subsequently develops in the milk ducts. The puncture can provide accurate information about the location of the spread of nodular neoplasms.
To the main characteristics cystic formation The following provisions may be included:
Cystic formations can be the cause of mastopathy that was not diagnosed in time. Doctors also identify a risk group, which consists of young girls under the age of 30 who have not yet been pregnant.
A cyst is almost always accompanied by painful sensations, unlike the same fibroadenoma. If you regularly perform self-examination of your mammary glands, you will probably be able to early stage detect nodular tumors in order to get rid of them in time.
Fat lobule
The fatty lobule of the mammary glands is most often detected by a diagnostic method such as puncture. Quite often, this type of disease is also referred to as fat necrosis, as a more medical and understandable term. Since it is the slice - aseptic necrosis mammary glands.
So, a fat lobule is a neoplasm in both or only one mammary gland, which can be directly related to skin. You can often observe nipple retraction and painful condition of the areola. Fat necrosis, although it is more likely a benign tumor, quite often, as puncture shows, it can develop into a malignant one. Moreover, when primary diagnosis It is extremely difficult to determine the nature of the fatty lobule tumor.
During the development of fat necrosis, a focus of the disease appears, which can be surrounded by a capsule with a dense wall. Note that similar characteristics are observed in both fibroadenoma and cyst.
The presence of a membrane around the filling site is evidence that fat necrosis is a benign tumor. Its absence is the reason for a puncture to exclude the possibility of malignancy.
The most informative diagnostic method is a biopsy. Often it is necessary, although it can be harmful. In advanced stages, the disease is treated with surgery.
Having examined the three most similar types of benign tumors, you can see that they have a lot in common, for example, the characteristics of each type of disease. This is often the reason for an erroneous diagnosis, and, consequently, incorrect treatment. Carefully study the characteristics of each tumor and then the likelihood of error will be reduced to a minimum.
Breast fibroadenoma is a benign tumor and is one of the main signs of nodular mastopathy. The nodes are mobile; upon palpation, you can notice how they move freely under the skin. Seals begin to be felt as soon as their dimensions reach 0.2 mm and can grow up to 7 cm in diameter. With the pathological growth of connective and glandular tissues, breast fibroadenoma is formed.
Structure of the mammary gland
The female breast consists of adipose, connective and glandular tissue. These organs are attached at the level of the 3rd and 7th ribs on the anterior surface of the chest symmetrically.
Adipose tissue consists of individual lobules separated by layers connective tissue– ducts are formed from glandular tissue, through which milk comes out during lactation.
The growth of adipose tissue can be accelerated by abundant nutrition; the amount of connective tissue depends on the functioning of the endocrine glands.
The mammary gland is a dense convex disk of 15-20 cone-shaped lobules, which in turn consist of alveoli. The lobules are arranged radially around the nipple. Blood supply comes from the internal mammary and lateral mammary arteries.
Information about the neoplasm
Symptoms of breast fibroadenoma appear when it reaches a relatively large sizes. In this case, you may feel heaviness, slight swelling in the chest, aching pain during the menstrual cycle.
Small nodes do not show themselves.
In mature women, tumors are dense to the touch and have clearly defined edges. Immature neoplasms feel soft and elastic to the touch.
Types of fibroadenoma differ in location and histological structure:
- If the tumor is located inside the ducts, the tumor is intracanalicular;
- around the ducts - pericanalicular;
- covering the channels and the surrounding area - mixed;
- in adipose tissue – leaf-shaped.
Tumors form when adipose tissue is replaced by glandular and connective tissue. Leaf fibroadenoma may degenerate into a malignant formation.
Causes of breast fibroadenoma - internal factors: hormonal disbalance and endocrine changes that occur as the body matures, during pregnancy, and due to processes occurring in the body under the influence external influences. The frequency of formation of neoplasms is influenced by the environmental situation, poor nutrition, and stressful situations.
Diagnosis and treatment of the disease
Diagnosing the appearance of a compaction is quite simple - a preliminary diagnosis is established during examination. It is subsequently confirmed by mammography and ultrasound examination.
During a biopsy, the neoplasm is differentiated from other similar diseases: cyst, cancer, cystadenopapiloma. Treatment for breast fibroadenoma is selected based on the clinical picture and histological assessment of the compaction.
If the causes of fibroadenoma formation include endocrine diseases, then treatment begins with them. No work adjustments endocrine system it is impossible to stop the formation of compactions.
If the neoplasm is small in size, then in most cases a decision is made to conservative therapy. Although rare, small tumors resolve on their own.
Whether or not to remove breast fibroadenoma is decided by the doctor after monitoring the tumor’s dynamic condition.
In some cases, it is considered appropriate to prescribe hormonal and non-hormonal drugs to resolve the tumor or stop its enlargement.
Mandatory removal of breast fibroadenoma is necessary if there is a suspicion of degeneration into a malignant tumor, during its growth and during pregnancy planning. Transformation is impossible to predict - it can begin for absolutely no apparent reason.
If the neoplasm appeared during pregnancy against the background hormonal changes, then it is not removed if there is no risk of developing a malignant process. If malignant degeneration is suspected, the operation is performed after the 1st trimester, when the main organs and systems of the fetus have already formed.
Surgery
It is possible to completely get rid of fibroadenoma only through surgery; there is no drug that causes the reverse process - the degeneration of glandular and connective tissue into adipose tissue.
Before the operation, a mandatory study is carried out - you need to accurately determine whether there are atypical cells. If they are identified, then surgical intervention is performed using the sector resection method.
Not only the tumor itself is excised, but a nearby sector within a radius of 2 cm is excised to eliminate the risk of degeneration. The excised fragment is sent for histological examination, and a further treatment strategy is precisely developed. If there is suspicion of malignant process confirmed, then treatment will have to be continued. What it will be, chemotherapy or treatment with radioactive isotopes - the doctor decides.
When there is no suspicion of breast cancer, the enucleation method is used. This kind surgical intervention most often performed under local anesthesia, the tumor is isolated without affecting the surrounding tissue through a small incision. The aesthetic appearance of the breast and its functionality are preserved.
The exfoliated tissue is also subjected to histological examination to rule out any risk of malignancy.
After surgery to remove a tumor from the mammary gland, therapeutic measures, whose goal is normalization hormonal levels and improving immune status.
Can be used: vitamins, immunocorrectors, antiviral and anti-inflammatory drugs. In some cases, it is advisable to use hormonal drugs.
After surgery, the tumor may appear again - removal of the tumor is not a guarantee that hormonal imbalance will not recur.
Traditional medicine in the treatment of mammary glands
Herbal treatment of breast fibroadenoma should be discussed with your doctor. To normalize hormonal levels official medicine often “combined” with folk methods.
The following decoction stops the growth of tumors.
You need to take the following components:
- 1 part each – wormwood, St. John’s wort, pine buds, yarrow, St. John's wort, rose hips;
- 4 parts chaga mushroom, cognac, aloe juice;
- 6 parts honey.
First, you need to grind the dried mushroom into powder, then wrap it in cheesecloth, add the rest of the plant ingredients, add enough water to make a thick puree, and simmer the mixture over low heat for about 2 hours. It is very convenient to make medicine in a slow cooker in the “stew” mode.
After the mixture has been thoroughly stewed, it is wrapped in a warm scarf and left to infuse for a day at room temperature.
1. Fibroadenoma has a rounded shape, clear contours, a smooth smooth surface, and is not fused to the surrounding tissues. Its palpation is painless. When palpating the mammary gland in a lying position, the tumor does not disappear. The mammogram shows a round shadow with clear contours. Ultrasound is more informative, as it allows you to identify the cyst cavity and thereby help differential diagnosis between a cyst and a fibroadenoma. In elderly women, calcium deposits can be detected in fibroadenoma against the background of severe fibrosis. Histological examination reveals different components increased risk malignancy, especially in young women.
Fibroadenoma (adenofibroma) is a benign breast tumor, most often found at the age of 15-35 years, mainly (90%) in the form of a single node. Some researchers classify fibroadenoma as dyshormonal dysplasia.
There are pericanalicular, intracanalicular and mixed fibroadenoma.
symptoms are a single formation. In 10-20%, fibroadenomas are multiple, often bilateral. In approximately half of cases, the tumor is located in the upper outer quadrant. The size of fibroadenoma usually does not exceed 2-3 cm. Its shape is often oval.
Echographically, fibroadenoma is a solid formation with clear, even contours. When compressed by the sensor, a symptom of “sliding” is noted - displacement of the tumor in the surrounding tissues, which confirms the expanding nature of the growth of fibroadenoma. Depending on the size of the fibroadenoma, the ultrasound picture has its own characteristics. Thus, with sizes up to 1 cm, a regular rounded shape and a homogeneous internal structure of reduced echogenicity are noted. The contours are smooth, clear or fuzzy. A hyperechoic rim along the periphery is observed in approximately 50% of cases. Breast fibroadenoma symptoms - more than 2 cm often have an irregular round shape, a clear even or uneven contour. The larger the size and duration of existence of the fibroadenoma, the more often a hyperechoic rim is determined, caused by degeneration of the surrounding tissues. In more than half of the cases, heterogeneity of the internal structure is noted against the background of a general decrease in echogenicity. In 25% of cases, micro- and even macrocalcifications are observed. Liquid-containing inclusions are often detected. A fibroadenoma larger than 6 cm is called a giant one. This tumor is characterized by slow development and the appearance of large coral-shaped petrificates with a pronounced acoustic shadow. According to echogenicity, fibroadenoma can be hypoechoic, isoechoic and hyperechoic. The detection of fibroadenomas using echography depends on the echogenicity of the surrounding tissues.
Hypoechoic fibroadenoma is poorly differentiated in the mammary gland with increased content adipose tissue. At the same time, a well-demarcated hypo- or isoechoic fat lobule that stands out from the surrounding tissues can imitate fibroadenoma.
A circumscribed area of fibrosis or sclerosing nodular adenosis may also mimic fibroadenoma.
An ultrasound image of a breast fibroadenoma can mask, especially in young people, a well-circumscribed malignant tumor (usually medullary cancer).
Degenerative changes in the structure of fibroadenoma in the form of acoustic shadows behind calcifications, heterogeneity of the internal structure, uneven contours can imitate the symptoms of breast cancer in older women.
Fibroadenomas in the presence of large calcifications are well differentiated by X-ray mammography. In the absence of calcifications, X-ray mammography cannot distinguish the symptoms of a breast fibroadenoma from a cyst.
Important diagnostic criterion echography can assess the vascularization of the tumor. Vascularization is detected in approximately 36.0% of fibroadenomas ( average age women was 38.5 years old). The identified vessels were located along the periphery of the nodes in 67.0-81.1%, throughout the node - in 13.6%, uneven distribution of vessels was detected only in one case (4.6%).
Treatment. The tumor is usually removed along with a pronounced capsule and a small amount of tissue surrounding the mammary gland. In young women, care should be taken regarding the cosmetic outcome during surgery. It is recommended to make an incision along the edge of the areola. The tissue is then tunneled several times to access and remove the adenoma. When removing it, a minimum of healthy tissue is simultaneously removed to obtain a good cosmetic result. Sutures are not placed deep into the wound. In Europe, if the diagnosis is certain, small fibroadenomas are not removed. Large fibroadenomas (about 5 cm in diameter), sometimes observed in young women, must be removed and undergo urgent histological examination. According to clinical data, fibroadenoma is almost impossible to distinguish from hamartoma. In such cases, the tumor must be removed.
2. Leaf-shaped tumor breast is a type of pericanalicular fibroadenoma. It has a characteristic layered structure, well demarcated from the surrounding tissues, but does not have a real capsule. It is often fused to the skin and quickly increases in size. If the tumor is large enough, thinning and bluishness of the skin above it appears. Leaf-shaped fibroadenoma sometimes undergoes malignant transformation and metastasizes to the bones, lungs and other organs.
Treatment. Surgical intervention is the main method of treatment. The extent of the operation depends on the size of the tumor. For small sizes, a sectoral resection is performed; for tumors with a diameter of more than 8-10 cm, a simple mastectomy is performed. The removed tumor is subject to urgent histological examination. In case of malignant degeneration, a radical mastectomy according to Patey is performed. Further treatment determined by histological examination of removed lymph nodes.
3.Adenoma, hamartoma mammary glands are rare. Both tumors are dense, round in shape, and difficult to distinguish from fibroadenoma. The adenoma is clearly demarcated from surrounding tissue mammary gland. Clarification of the diagnosis is possible only after histological examination of the macroscopic specimen. hamartoma is a rare benign breast tumor. It can be located both in the gland itself and at a distance from it. Ultrasound image hamartomas are very variable and depend on the amount of fat and fibroglandular tissue in the form of hypoechoic and echogenic areas. The effect of distal pseudoenhancement or attenuation is determined depending on the tumor structure. X-ray mammography reveals a well-circumscribed encapsulated formation with a heterogeneous structure
3.Bleeding breast. Pathological discharge Bloody contents from the nipple are observed with intraductal papilloma, which can occur both in large ducts associated with the nipple and in smaller ones.
Clinical picture and diagnostics. The main symptom of the disease is the discharge of yellowish-green, brown or bloody fluid from the nipples, sometimes accompanied by severe pain in the mammary gland.
Ductography makes it possible to detect filling defects in the ducts and accurately determine the location of papillomas. Filling defects have clear contours and rounded outlines.
The final diagnosis is made based on the data cytological examination extraction from the nipple and histological examination of the removed central (subareolar) area of the mammary gland.
4.Lipoma- a benign tumor developing from adipose tissue, usually located above the breast tissue and in the retromammary space. The tumor is of soft consistency, lobular structure. It occurs more often in older women. On a mammogram it appears as a clearing with clear, even contours against the background of denser glandular tissue. True lipomas are a node of mature adipose tissue surrounded by a connective tissue capsule. Upon palpation, a soft, mobile formation is determined in the mammary gland. The ultrasound picture of a lipoma resembles adipose tissue mammary gland - hypoechoic, homogeneous, compressible. In the presence of fibrous inclusions, the structure of the lipoma is less homogeneous, with hyperechoic inclusions, and a hyperechoic rim may be detected. Lipoma can be difficult to isolate in breasts with a high content of adipose tissue. During echography, a lipoma must be differentiated from a fibroadenoma, with a very contrasting fatty lobule or other fatty inclusions.
Adenolipoma, fibroadenolipoma are a variant of fibroadenoma and are an encapsulated tumor consisting of fatty, fibrous tissue and epithelial structures. Adenolipomas can reach large sizes. When echography is performed, adenolipomas have a heterogeneous structure with hypo- and hyperechoic inclusions.
Fibroangiolipoma can be very echogenic. In elderly women, a transparent formation is detected in a dense fibrous capsule. The absence of a capsule does not allow the lipoma to be differentiated from the surrounding fatty tissue. The tumor can reach large sizes.
Treatment. Removal of the tumor.
4. Papilloma
Papillomatosis is a neoplastic papillary growth within the milk duct. These papillary growths represent a benign proliferation of certain ductal epithelial cells. Most often they appear at the age of 40-45 years in the form of a single inclusion inside the terminal duct or in the lacteal sinus. Most solitary intraductal papillomas are benign. Single intraductal papillomas appear as formations that are difficult to differentiate from fibroadenoma. They are rarely more than 1 cm.
The echographic image of intraductal papilloma can be of four types:
o intraductal;
o intracystic;
o solid;
o specific (multiple and speckled image).
An ultrasound image of an intraductal type of papilloma can be in the form of an isolated expansion of the duct or a solid rounded formation, of varying echogenicity, without the effect of distal weakening against the background of an isolated expansion of the duct.
The intracystic type can be represented by an ultrasound image of a cyst with solid inclusions along the internal contour. The solid component can be of various sizes and echogenicity. The solid type is characterized by the presence of the formation of a solid structure of small sizes (maximum size - 9 mm) with a connecting or closely located dilated milk duct. Most solid lesions have posterior enhancement; there is never an acoustic shadow. Characterized by high ratios of P and PZ.
Diffuse intraductal papillomatosis is characteristic of lesions of the terminal and peripheral milk ducts. Being a disease of young women, it has a second name - juvenile papillomatosis. In 40% of cases it is accompanied atypical hyperplasia epithelial cells of a suspicious histological nature. That is why with diffuse papillomatosis there is a high risk of breast cancer. Sonographic picture of juvenile papillomatosis
characterized by the presence of a poorly demarcated heterogeneous mass without distal attenuation, with small anechoic areas at the edges or around the mass. During an ultrasound examination, it is necessary to evaluate the evenness and clarity of both the external and internal contours, and if cystic expansion is detected, the agitation of the contents. Mammography is not informative. Galactography is the main method for visualizing intraductal formations. By introducing contrast it is possible to detect not only obstruction, but also very small defect duct walls. Data have appeared on echogalactography with ultrasound assessment
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