Cystic hyperplasia of breast

Introduction to cystic hyperplasia of the breast Cystic hyperplasia of breast (cystichyperplasiaofbreast) is characterized by cysts formed by hyperplasia of small breast lobe, small catheter and terminal catheter, accompanied by diseases of breast dysplasia, also known as chronic cystic breast disease, cystic epithelial hyperplasia. Disease, fibrocystic breast disease, etc. Compared with simple breast hyperplasia, the breast hyperplasia and dysplasia coexist, and there is a risk of malignant transformation, which is the difference. It should be considered as a precancerous lesion. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: breast cancer

Causes of cystic hyperplasia of the breast

Endocrine factors (65%)

The occurrence of this disease is related to the stimulation of ovarian endocrine. Coormaghtigi and Amerlinck have proved that in 1930, ovariectomized rats can produce cystic disease of the breast after injection of estrogen. In humans, estrogen can not only stimulate breast epithelial hyperplasia, but also cause glandular gland. Tube expansion, the formation of cysts, recent studies indicate that hyperprolactinemia is an important cause of cystic hyperplasia of the breast, foreign scholars report that postmenopausal women with cystic hyperplasia of the breast, often the result of inappropriate use of estrogen replacement therapy.

Body factor (25%)

Because the ductal epithelium, the dilated duct, and the cystic epithelium are proliferated to varying degrees, the epithelial level of the epithelium is increased, and the squamous squamous squamous, or reticular or sieving, solid, adenoid, cystic epithelium Active hyperplasia, common dysplasia or variability, may develop into cancer.

Pathogenesis

The pathological changes of cystic hyperplasia of the breast are:

1. There are cystic nodules or masses of different sizes on one side or both sides of the breast tissue. The cysts are different in size. The large cysts can reach 1-5 cm in diameter, which is grayish white or blue. It is called a blue dome capsule or a blue-top cyst. Small cysts are more common around the large capsule. The diameter is only 2mm. It is not visible to the naked eye. It can only be seen under the microscope. The large cyst can be seen to show the cyst content is clear and colorless, serous. Or brownish yellow liquid, sometimes a bloody liquid containing protein, hormones (prolactin, estrogen, androgen, human chorionic gonadotropin, human growth hormone, follicle stimulating hormone, luteinizing hormone, etc.), sugar, ore Substance and cholesterol, the cut surface is honeycomb-like, the wall of the capsule is thick, tarnished, and there may be granular or papillary tumor-like objects protruding into the cyst cavity.

2. Histological morphology can be seen in 5 different lesions.

(1) Cyst: end catheter and acinar hyperplasia, small duct dilatation and extension, end catheter cyst formation, terminal duct epithelial abnormal proliferation multi-layered, papillary growth from the tube wall to the lumen, occupying most of the lumen, resulting in The lumen is blocked, the secretions are retained and expanded, and cysts are formed. The cysts can be divided into simple cysts, only cystic dilatation, and no epithelial hyperplasia; the other is papillary cysts, cystic epithelial hyperplasia is papillary.

(2) Breast duct epithelial hyperplasia: the dilated duct and the cystic epithelium have different degrees of hyperplasia, the epithelial level of the lighter is increased, the severe one is papillary, or connected to each other in a mesh or sieve shape, solid, adenoid, If the cyst epithelial hyperplasia is active, common atypical hyperplasia or variability may develop into cancer.

(3) papillomatosis: on the basis of cystic dilatation of papillary cysts, multiple epithelial cells of the wall are papillary hyperplasia, forming papilloma, depending on the extent of papillary disease, papillary density and epithelial cells The degree of hyperplasia can be divided into mild, moderate and severe papilloma, which is clinically useful.

(4) glandular adenosis: lobular duct or acinar duct metaplasia and hyperplasia, hyperplastic epithelial cells are solid mass, fibrous tissue has different degrees of hyperplasia, and ductal dilatation and cyst formation is not obvious, called gland The disease is formed.

(5) apocrine glandular metaplasia: the cyst wall covered with epithelial metaplasia is high columnar, rich in cytoplasm, including eosinophilic granules, like apocrine gland cells, the appearance of such cells, often benign signs, in addition to the wall, catheter The fibrous tissue around the acinus proliferates, and the fibrous cord is formed to squeeze the surrounding catheter to cause obstruction, resulting in secretion retention, which in turn causes the catheter to twist or expand.

3. Pathological diagnosis standard cystic hyperplasia of the breast has the above five kinds of lesions, they do not exist at the same time, among which papilloma, glandular adenosis and cyst are the main lesions, the incidence of various lesions and the location of the tissue According to the amount of material taken, if 3 kinds of 5 kinds of lesions or 2 kinds of 3 main lesions can be seen in the section, it can be diagnosed.

In 5 kinds of lesions, cystic ductal epithelial hyperplasia, papilloma, atypical hyperplasia caused by glandular adenosis, easily lead to cancer.

Prevention of cystic hyperplasia of the breast

Breast cystic hyperplasia is a precancerous lesion that should be closely monitored after diagnosis and treatment: breast self-examination once a month; mammography once a year; clinical breasts every 4 to 6 months Check, etc., establish a complete follow-up monitoring plan for each patient, and strive to explore more valuable diagnosis and treatment techniques in clinical practice, and improve the prediction of the prevalence of precancerous diseases to facilitate early detection of breast cancer.

1. Regular medical examination:

Because cystic hyperplasia is a precancerous lesion, it should be closely monitored after diagnosis and treatment: breast self-examination once a month; mammography once a year; clinical once every 4 to 6 months Breast examination, etc. A complete follow-up monitoring program is established for each patient. In clinical practice, efforts are made to explore more valuable diagnostic techniques and to improve the prediction of the predisposition to premalignant disease, in order to facilitate the early detection of breast cancer.

2, pay attention to personal hygiene:

Especially the hygiene of the breast during menstruation and puerperium. Do not pass through the tight bust, often clean the nipple to prevent infection.

3. Enhance physical fitness and improve self-immunity:

Pay attention to the combination of work and rest, participate in physical exercise, and eat more fresh fruits and vegetables rich in vitamins.

Complications of cystic hyperplasia of the breast Complications

A malignant lesion has occurred.

Symptoms of cystic hyperplasia of the breast Common symptoms Breast painless single hair... Breast gland upper gland thickening Breast tingling Breast cystic hyperplasia Milk secretion reduces nodular back pain cyst nipple discharge

Lump

Breast mass is often the main symptom, one side of the breast can occur, it can also occur in both sides of the breast, but the left breast is more prominent, the mass can be single or multiple, its shape is different, can be a single knot Section, can also be a plurality of nodules, a single nodule is often spherical, the boundary is not clear, can be freely pushed, there is a sac sexy; multiple nodules often involve double or whole milk, nodules vary in size, cyst The activity is often limited, and the hardness is moderate and tough. The larger cyst is often located on the near surface and can be touched by the sac; the sac is distributed along the milk duct, and the diameter of the nodule or cord is 0.5 to 3 cm.

According to the range of the distribution of the mass, it can be divided into diffuse type, that is, the mass is distributed in the whole breast; or mixed type, that is, several different types of masses, such as flaky, nodular, strip-like, granular scattered in whole milk.

2. Lactation

The disease is not obvious, and it is not closely related to the menstrual cycle. Occasionally, there are many kinds of pain, such as pain, tingling, chest pain, and upper limb pain. Some patients are depressed, sad, and in a bad mood. And tired, when the weather is bad, the mass becomes bigger, harder, and the pain is aggravated. After the menstrual cramps or after the mood is improved, the mass becomes softer and smaller. The clinical experience suggests that the change is mostly benign, if the mass increases rapidly and Hard texture, suggesting that malignant possible.

3. Nipple discharge

About 5% to 15% of patients may have nipple discharge, mostly spontaneous nipple discharge, often grassy yellow serum, brown serum, serous blood or bloody discharge, if the discharge is serous or bloody, often marks There are intraductal papilloma.

Examination of cystic hyperplasia of the breast

1. Fine needle aspiration cytology examination of cystic hyperplasia of the breast is mostly bilateral, multi-tumor, the progress of various tumor lesions are different, take a multi-point fine needle to absorb cytology, often fully reflect The condition or nature of each mass, especially in cases of cancer, can provide early diagnosis, and sometimes the final diagnosis should also depend on the pathological biopsy.

2. Nipple cytology examination A small number of patients have nipple discharge, mostly visible serous, serous blood, blood, smear microscopic examination of ductal epithelium, foam cells, red blood cells, a little inflammatory cells and fat, protein and other invisible Things.

3. Molybdenum target X-ray mammography showed that the lesion showed cotton clusters or frosted glass, and the density of the edges was blurred, or the cord-like connective tissue was seen through it, accompanied by cystic irregularities. Enhance the shadow with a round translucent shadow, cystic hyperplasia of the breast, need to be differentiated from the breast cancer, the former no increase in blood supply, skin thickening and burr and other malignant signs; if there is calcification, more scattered, unlike breast cancer So dense.

4. B-ultrasound examination In recent years, B-ultrasound diagnosis technology has developed rapidly, and the diagnostic rate has been continuously improved. The examination of this disease often shows an uneven hypoechoic area and an echogenic cyst area without a mass.

5. Near-infrared mammography scan This disease shows scattered spots on the near-infrared mammary gland scan screen, flaky gray shadow, or strip-like, cloud-like gray shadow, increased blood vessels, thickening, mesh, dendritic changes, etc. On the basis of the common, the honeycomb is unevenly transparent.

6. Magnetic Resonance Imaging (MRI) The typical MRI findings are mammary duct dilatation, irregular shape, unclear boundary, and the signal intensity of the dilatation catheter is lower than the normal glandular tissue on the T1-weighted image; the lesion is confined to a certain area. It can also be diffusely distributed throughout the region or throughout the mammary gland, and the MRI features of the disease are usually characterized by symmetry changes.

Diagnosis and differentiation of cystic hyperplasia of the breast

diagnosis

According to the medical history, clinical symptoms and signs, it is generally possible to make a clinical diagnosis. If there is any doubt, it is feasible to assist the diagnosis.

Differential diagnosis

Latex pain

More common in young women aged 20 to 30, older unmarried or married, undeveloped, poorly developed small breasts, bilateral breasts with periodic pain, breast masses are not obvious or only limited thickening or fine granular, and It is called fine granular small breast.

2. Breast adenosis

More common in women aged 30 to 35 years, breast pain and mass are mostly periodic, the mass is mostly nodular, multiple scattered, the size is consistent, no cystic sexy, generally no nipple discharge.

3. Breast fibroadenomas

More common in young women, often a painless mass, mostly single, a small number of multiple, the mass of the mass is obvious, moving well, no tenderness, but sometimes cystic hyperplasia of the breast can coexist with fibroadenomas, difficult to distinguish.

4. Intraductal papilloma of the breast

More common in middle-aged women, clinically common nipple single hole discharge, the tumor is often located in the areola, the pressure of the discharge of the discharge, X-ray mammography, showing filling defects, often can be diagnosed.

5. Breast cancer

Common in middle and old women, the breast is often a single painless mass, the fine needle aspiration cytology examination, can find cancer cells, sometimes cystic hyperplasia of the breast with dysplasia, often difficult to distinguish when cancerous, A pathological biopsy is needed to confirm the diagnosis.

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