Thursday, January 29, 2015

Benign breast pathologies

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Benign breast pathologies

Cancer is most known breast pathology and the most feared by women. However, 90% of consultations related to the breast are due to diseases that turn out to be benign.
Benign breast pathologies can be divided into four groups:
· The developmental anomalies
· Inflammatory alterations
· Fibrocystic Mastopathy
· Benign tumors

Abnormalities of the breast development

The development of breast abnormalities are very rare and infrequent; occur by a bad breast development during the fetal period, and are already present at the time of the birth. We can divide them into two groups as the anomaly by default or by excess.

Abnormality of the breast by default

· Amastia: complete absence of the breast including the nipple and the areola; It is very rare and is associated with other malformations of the chest wall and the arms.
· Amazia: amastia that keeps the nipple and areola.
· Micromastia: lack of development of the mammary gland; It may be associated with syndromes such as Turner syndrome. Also it might be that breast tissue was damaged during childhood or puberty, due to trauma, surgery, infection or radiotherapy.
· Atelia: there is no nipple; It can be unilateral or bilateral.
· Microtelia: the nipple is smaller than usual.

Abnormality of the breast by excess

· Macromastia: moms are too big compared to the rest of the body; the patient tends to suffer spinal cord pathology. Breast reduction surgery is indicated.
· Supranumeraria mother: other normal breast in the breast line, which is a line that runs from the armpits to the English during the fetal period is able to develop primitive breast. The most frequent location of supranumerarias moms are underarm and under the breasts.
· Mama ectopic or polimastia: other breast more out of the breast line, without the nipple or areola. They are not functional, are aberrant, and tend to discover during a pregnancy. Both these as the supernumerary must be removed because they have a high risk of developing cancer.
· Gynecomastia: female breasts in a male. They can be an indication of another underlying disease (cancer of the testes, cirrhosis of the liver), being secondary to the consumption of medications (spironolactone, psychotropic substances), or physiological character during development (adolescent gynecomastia) pubertal. Is it solved by treating the underlying disease. In the case of physiologic Gynecomastia is should wait a year to intervene with surgery, although there are occasions in which adolescent psychological complex required to intervene before.
· Polymastia: more than one nipple; It is the most common anomaly. It is most common that is in the lower quadrants of breast, but it can arise anywhere in the breast line to the genitals.
· Macrotelia: oversized nipple; It is more common in males.
Another frequent malformation of breast is congenital nipple inversion. It occurs as a consequence of the insufficient development of the fibrous tissue under the nipple, which prevents the nipple is raised to develop the breast. There are more likely to develop infections in the nipple.

Mastitis or inflammatory disorders of breast

The most frequent breast benign pathology is mastitis, i.e., inflammation of the mammary gland and neighbouring areas. There are several types of mastitis according to the age of the patient and the severity of inflammation.

Mastitis of newborn

They are very rare. They appear in the newborn as a small infection causing fever for a few days. The treatment is antibiotic and has no major complications.

Postnatal or lactation mastitis

They arise when women breastfeed the baby after the birth. Occurs by an infection usually caused by bacteria Staphylococcus sp or Streptococcus SP. (the latter less frequently), that they penetrate through small cracks that form in the nipple. The symptoms are unbearable pain, high fever and redness of the breast. It is the most frequent mastitis. Early diagnosis and treatment make pathology banal, but a delay in treatment increases morbidity and mortality and makes that required the use of surgery again and again
The primary treatment of choice is: amoxicillin and clavulanic acid, are the most commonly used. You can add more potent antibiotics if the patient has some degree of immune deficit. Tetracyclines, chloramphenicol, or quinolones should never be given because they pass into breast milk. If the disease evolves may arise small breast abscesses that need to be drained with surgery. Lactation in principle is not suspended, because empty breast milk is beneficial for healing, but if the mastitis is extensive or affect the nipple and areola should stop immediately.

Mastitis Necrotizing

It occurs in pluripatologicas menopausal patients, i.e., those who suffer from various diseases known. It occurs after a trauma in the breast, where a hematoma that is infected is formed by a very infectious bacteria, of the class of beta-hemolytic Streptococcus . This bacterium is able to kill (cell tissue death) the entire gland; It is not very common but mortality is high. The treatment is the removal of the mammary gland. Another cause of this type of mastitis can be radiation, so it is frequent to occur in patients who have received radiotherapy after surgery for breast cancer; in these cases it should rule out a tumor recurrence.

Other mastitis

They are historically important tuberculous mastitis or syphilitic mastitis cases very uncommon today.

Breast fibrocystic Mastopathy

Also called adenosis, mammary dysplasia or fibrocystic condition. It is a set of natural changes of the contents of the breast; the cause is hormonal cycles that exist throughout the life of the woman. He is not considered a disease, are only changes in the breast that does not predispose to cancer. Various periods can be distinguished:

Deficit or hormonal period

Occurs between 15 and 30 years of age and always in two moms, who are undergoing hormonal changes, mainly estrogens increase or decrease of progesterone. The most characteristic is the breast pain or mastodynia, above all in the menstrual period, where the breasts hurt and seem to be filled. Physiological breast lumps or nodules may appear (for this reason should not explore the breasts during menstruation).

Proliferative period

It occurs between 35 and 40-45 years (at the beginning of menopause); hormonal alteration is the same, but begin to appear not painful indurations. They seem hard and fibrous plates ("peas or Buckshot plates") that are in both breasts and do not pose a risk for cancer.

Involutional period

The woman is not fertile-age, there is no new lesions and the previous evolve. Indurations form unique cysts and, in general, injuries no longer have to be bilateral.
There are external factors that can enhance all of these described changes, as the intake of saturated fats and stimulating drinks (caffeine, theine). In addition, some genetic basis that predisposes mothers to have this more or less accentuated fibrocystic condition is suspected. There is no treatment for this purpose; in principle pain relievers and anti-inflammatory medications will be taken if there is pain. You can also manage hormonal treatment in cases in which the hormonal changes are important.
This fibrocystic mastopathy has no single surgical treatment when scanning or mammograms appear suspicious images requires biopsy. If the fibrocystic mastopathy is profuse and the patient has a history of carcinoma of breast with high degree of phobia, can be evaluated the removal of the breast and the placement of a prosthesis.

Benign tumors of the breast

This group of breast lesions all includes injuries that cause the formation of lumps or nodules (rounded packages) in the breast, are or are not a product of cell multiplication (tumors or benign cancers). Other injuries already commented that also cause lumps, e.g. abscesses are excluded.

Fibroadenoma

The benign tumor of the breast for excellence is fibroadenoma. It is typical in young women, which represents 26% of mammary pathology; in the general population represents 10%. It is very strange that it malignice and rarely grows beyond 4 cm, although cases of fibroadenomas of 15 cm. made his debut as a painless breast nodule ovoid. Exploration the diagnosis arises: it is hard but elastic, not rigid, does not hurt to the touch and moves within the breast because it has no adherence to plans deep or higher (the skin is pinched over). Be confirmed with ultrasound, where you will see a single, well defined and solid lesion. If you want to refine the diagnosis a biopsy is performed by puncture. With this type of tumor, an expectant attitude should be and only recommended surgery in cases of sustained growth (exceeding 2 cm), breast pain or concern for the patient.

Adenoma

A very similar to the fibroadenoma tumor is adenoma. Externally there differences with fibroadenoma; It's the same type of nodule with the same features, only differs in the microscopic analysis and that is very rare. It is characterized by being a very well insulated tumor and it can be classified into several subtypes: tubular adenoma (which is pure adenoma), ductal adenoma, adenoma of breast feeding (develops during pregnancy) and apocrine adenoma.

Hamartoma or fibroadenolipoma

Also rare is the hamartoma or fibroadenolipoma, which is a well defined and encapsulated nodule resembling a fibroadenoma, which usually appears in 40-55 year-old women. It is formed by fat, muscle and fibrous tissue, which makes it difficult to feel because the consistency is similar to the breast tissue. Treatment is excision, but this is not always necessary, but obligatory in the case of doubt the diagnosis. Another rare tumor is a tumor phyllodes or filodes, only occurs in the 0'3-0' 9% of the cases of breast tumors. Years ago it was considered a malignant disease but microscopically cannot demonstrate, however, has a high frequency of recurrence after excision and sometimes originates distant metastasis (only labels as carcinoma if it gives them). It generally appears as a painless lump, smooth but with several lobes, is not moving as fibroadenoma, usually measure about 5 cm but this tumor can grow much and can deform the mammary gland. It appears from the 40 years and the image on mammography is a well-defined fibrous mass. The treatment is always surgical, if relapse not always indicate that it is malignant, distant metastases only catalogued it as such. This tumor never metastasizes in the nodes in the armpit, so never be removed. If relapses are frequent removal of the entire breast is shown.

Lipoma

More frequent than the previous ones, and it can be included in benign breast tumors, lipoma. This tumor appears as a well defined, soft, mobile node, is composed exclusively of fat and limited by a fibrous capsule, their size ranges between 2 and 10 cm and never deform the breast. It is more frequent to 40-50 years and may calcify as fibroadenomas. The treatment reduces the clinical control and only opt for surgical removal if the growth is rapid or women have breast cancer phobia.

Secretory tumors

In benign tumors we can point out a group of tumors that cause no lactic acid secretions by the nipple. It is the case of intraductal Papilloma; This type of tumor occupy the ducts where are secret milk just below the areola, may be a single large tumor or several small. It usually occurs in women who are around the age of menopause and originates a spontaneous blood the nipple discharge, usually only one breast.
Another lump that we can also add a comment within the pathologies that cause secretions through the nipple duct ectasiais. It consists of the expansion of the main ducts that carry milk to the outside, also under the areola. This expansion could reach 5 mm in maximum diameter and inside deals by grease and debris. It occurs in adulthood and, more frequently, in the period of menopause when the breasts begin to atrophy, at 40 - 60 years. In your home it does not cause symptoms, the first thing that appears is a spontaneous and intermittent stroke the nipple, of variable but usually greenish color, but that may be black or Brown, sticky consistency, and that goes through one or more holes in the nipple. Progressively, the spill becomes bloody, serous or blood clearly. Women feel itching, burning and tightness of the nipple; It can cause retraction of the nipple for the healing of the duct; that's when a tumor under the areola mimicking breast cancer since it can accompany as well as inflammation of the lymph nodes in the armpit is palpable. Better diagnostic testing is ultrasound showing dilatation of the ducts under the areola, in addition the spill will be analyzed through the nipple. If the duct ectasia is mild you don't need treatment, but when he is upset will be the removal of the affected ducts.

Breast cysts

Finally, another great group within the benign tumors are breast cysts. They are mammary tumors whose contents are liquid and its relationship with cancer is unknown, although it is suspected to be very scarce. They are lesions typical of mature women at the beginning of the menopause (40-50 years), although they can occur at any age; It is rare before the age of 20 and exceptional advanced menopause. They are well-defined tumors that are diagnosed by ultrasound. Treatment consists of puncture liquid being analyzed. Various types can be found:
· Simple cyst: consists of dilatation of deep milk ducts that are occupied by fluid of variable color whose analysis indicates if it is a simple Cyst (serous fluid of course), an abscess (pus) or a hematoma (blood). His presentation can be single or multiple varying sizes. They are characterized by being nodules that the patient see when its size exceeds 1 cm and which disappear after evacuadora puncture, although 30% appear again. They are round or oval, soft consistency and mobile form nodules, in which stress can be seen to exert pressure on them, and that are filled with fluid. Treatment consists of puncture to remove fluid and get air, not being indicated the removal by surgery in a single cyst.
· Galactocele: is a single cyst containing liquid or thick milk which is formed due to a dilatation of a milk duct. It is related to breastfeeding and often develop when this is abruptly interrupted. It is present as a nodule spherical, mobile, well insulated, of variable consistency that is tightening you may cause milk output by the nipple. It is not convenient to surgically remove a galactocele, the treatment of choice is the evacuadora puncture.
Article contributed for educational purposes
Health and Wellness

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