Breast adenoma is a benign breast tumor originating from the cells of the glandular epithelium. It usually occurs at a young age, after 40-45 years it is practically not diagnosed. The alleged cause of development is hormonal imbalance. Breast adenoma is an elastic, mobile spherical or spherical formation, usually located near the surface of the gland. It can be single or multiple, localized in one or both mammary glands. The diagnosis is established on the basis of an external examination, ultrasound, MRI and biopsy results. The treatment is surgical.
D24 Benign breast neoplasm
Breast adenoma is a benign tumor formed from the cells of the glandular epithelium. It is a type of mastopathy. As a rule, it is diagnosed at the age of 15-35 years. It often occurs during pregnancy. In the preclimacteric and menopausal period, existing tumors are reduced, new ones are not formed. It is detected less frequently than fibroadenoma (a benign neoplasm consisting of fibrous and glandular tissue).
Breast adenoma is not prone to malignant degeneration. It belongs to the group of hormone-dependent tumors, undergoes certain changes depending on the phase of the menstrual cycle, as well as during pregnancy and lactation. Diagnosis and treatment of breast adenomas are carried out by specialists in the field of oncology and mammology.
Reasons of breast adenoma
The main cause of development is hormonal imbalance. Experts point to the importance of progesterone deficiency in combination with an excess of estrogens. An increase in prolactin levels may play a certain role in the occurrence of breast adenoma. The imbalance of these and some other hormones in combination with changes in the mammary glands during gestation and a large functional load during lactation creates conditions conducive to the proliferation of glandular epithelium and the appearance of breast adenoma.
Women with this disease often have other endocrine disorders, in particular, a decrease in the level of thyroid hormones and diabetes mellitus. In addition, the list of factors contributing to the development of breast adenoma includes:
- hereditary predisposition;
- taking oral contraceptives;
- diseases of the reproductive system;
- stresses provoking peak increases in corticosteroid levels;
- disorders of the liver involved in the breakdown of various hormones.
In the preclimacteric and menopausal age, the mammary glands undergo involutive changes. The cells of the glandular epithelium are gradually replaced by fatty and fibrous tissue, so after 40-45 years, adenomas practically do not occur.
Classification of breast adenoma
In the latest WHO classification , there are two types of nipple adenoma and five types of breast adenoma:
- Nipple adenoma. It is formed in the ducts and the periarticular zone. Accompanied by the appearance of multiple foci of proliferation of cylindrical epithelium and myoepithelium. In some cases, malignant degeneration is possible.
- Syringomatous adenoma. It occurs in the subcostal zone, develops from the epithelium of the sweat glands. A distinctive feature is the lack of clear boundaries with non-invasive growth.
- Tubular adenoma. It is a tumor with clear boundaries, consisting of densely lying tubular structures lined with two layers of cells – myoepithelial and epithelial.
- Lactating adenoma. During pregnancy and lactation, the tumor epithelium undergoes certain secretory changes, the tubular adenoma turns into a lactating one.
- Apocrine adenoma. It resembles a tubular one, but differs from it by apocrinization of the epithelium.
- Pleomorphic adenoma. It is an analogue of the eponymous benign tumor of the sweat and salivary glands.
- Ductal adenoma. It is an expanded duct, in the lumen of which an adenomatous (glandular) polyp protrudes.
The last two types of adenomas are extremely rare.
Symptoms of breast adenoma
As a rule, breast adenoma is asymptomatic and is detected during the next preventive examination or self-examination. Palpation reveals a small elastic spherical or spherical formation with clear contours. The surface of the breast adenoma is usually smooth, less often bumpy. The skin above the tumor is not changed, has a normal color. The adenoma is elastic to the touch, mobile, not soldered to the surrounding tissues, usually painless.
It is often located closer to the surface. Increases in size before the onset of menstruation, and then decreases again. It usually happens alone, however, multiple breast adenomas are also possible, localized on one or two sides. It is not prone to rapid growth, but in some cases, under the influence of adverse circumstances, it can quickly increase in size. During gestation, rapid growth is more often observed, followed by a decrease after the end of lactation. Sometimes during pregnancy, the breast adenoma resolves.
The adenoma of the nipple is manifested by edema, hyperemia, serous or succulent secretions. The surface of the nipple may ulcerate and become covered with crusts. When palpation in the thickness of the nipple reveals a node of soft-elastic consistency, not soldered to the surrounding tissues. The skin around the nipple is not changed, has a normal color. Pathological wrinkling and the “orange peel” symptom are absent. Regional lymph nodes are not enlarged.
The diagnosis is established by a mammologist or mammologist-oncologist on the basis of complaints, external examination data and the results of additional studies. When palpating in the standing and lying position of a woman, the doctor discovers a single mobile tumor-like formation or several formations resembling a ball or a pea. A patient with suspected breast adenoma is referred for breast ultrasound and mammography.
If endocrine disorders, somatic diseases and diseases of the reproductive system are suspected, consultations with an endocrinologist, therapist and gynecologist are indicated. The plan for further examination is determined taking into account the revealed pathology. The final diagnosis of “breast adenoma” is made based on the results of a biopsy. In the process of diagnosing nipple adenoma, cytological examination of secretions, breast MRI, ductography (radiography using a contrast agent injected into the ducts of the gland) and biopsy are used.
Atypical cells are found in the separated. According to MRI data, the structure and size of the tumor are evaluated, during ductography, intra-current formations are detected. Ultrasound and mammography in this pathology are not informative enough. The final diagnosis, as with breast adenoma, is made based on the results of a biopsy.
Treatment of breast adenoma
Drug therapy is ineffective. For small tumors, dynamic observation is shown. With an increase in the size of the adenoma, suspected malignant degeneration, the appearance of pain and the presence of a cosmetic defect, surgical intervention is required. Depending on the size and course of the breast adenoma, enucleation or sectoral resection is performed. Enucleation (exfoliation) is a small operation during which the tumor is removed within healthy tissues. It is indicated in the absence of suspicion of malignancy.
Sectoral resection is a larger-scale surgical intervention, during which a breast adenoma is cut out along with 1-3 centimeters of healthy tissue. It is indicated in the presence of suspected malignant degeneration. After enucleation of a small tumor, there is usually no cosmetic defect. After sectoral resections and peeling of large adenomas, a defect may appear, which will require cosmetic surgery to eliminate.
With an adenoma of the nipple, surgical intervention is necessary. Depending on the size of the tumor, local excision is performed (excision within healthy tissues with a deviation from the edge of the adenoma by 1-2 mm) or sectoral resection. Operations to remove the nipple adenoma and breast adenoma are performed as planned. In the postoperative period, antibiotics are prescribed. The stitches are removed for 9-10 days. Additional drug therapy is not required. The prognosis for breast adenoma is favorable.