Breast tissue hypertrophy

Introduction Women from birth to old age, breast organs affected by sex hormones, to experience changes in infancy, early childhood, adolescence, pregnancy and lactation, menopause, and old age. Premenstrual or menstrual period due to physiological congestion of the breast, acinar hyperplasia and duct Tissue changes such as dilatation make breast tissue hypertrophy. The acinar and lobular ducts in the breast during breastfeeding were significantly increased and dense, the ductal dilatation was enlarged, the interlobular tissue was significantly reduced, the acinar epithelium was actively secreted, and some of the epithelium was changed from cubic to columnar. It also makes the breast tissue thick.

Cause

The breast is the target organ of a variety of endocrine hormones. Therefore, the growth and development of the breast and its various physiological functions depend on the joint effects of various related endocrine hormones. If one or more of these hormones are disordered, or the balance between various hormones is imbalanced, it will directly or indirectly affect the condition of the breast and its physiological functions. A series of changes in the breast during lactation are due to the synergy of prolactin and other related hormones.

1. Hormones that have a direct effect on the mammary gland:

1, estrogen (estrogen, e): estrogen on the formation of mammary lobules and mammary gland maturation, can not play a separate role, must have a complete control of the pituitary system. Estrogen can stimulate the synthesis and release of prolactin in the anterior pituitary, thereby promoting the development of the mammary gland; while large doses of estrogen can compete with the prolactin receptor, thereby inhibiting the lactation of prolactin. Exogenous estrogen can proliferate the mammary gland of ovariectomized animals, and its cell proliferation index is significantly higher than that of normal breast tissue. Estrogen also causes the blood vessels of the breast to expand and increase in permeability.

2, progesterone (progesterone, p): the most physiologically active progesterone is progesterone, its main role is to promote the development of breast lobules and acinar, on the basis of estrogen-stimulated mammary duct development, so that the mammary gland is fully development. Large doses of progesterone inhibit the lactation of prolactin. The effect of progesterone on mammary gland development requires not only the synergistic effect of estrogen, but also the complete pituitary function system. Experiments have shown that in ovariectomized rats with pituitary resection, the mammary gland completely lacks response to progesterone. Progesterone may act to stimulate the development of the mammary gland by stimulating the secretion of prolactin from the pituitary gland or by increasing the reactivity of the mammary epithelial cells to prolactin.

3, prolactin (prlac): a protein hormone secreted by the anterior pituitary eosinophils. Its main role is to promote the growth and development of the mammary gland, and to initiate and maintain lactation. Prolactin binds to the prl receptor of mammary epithelial cells, producing a series of reactions, including stimulation of alpha-lactalbumin synthesis, uracil nucleotide conversion, conversion of mammary gland na ⁺ ions, and fatty acid synthesis, stimulating mammary gland development And promote the formation and secretion of milk. During puberty, prolactin can promote the development of the mammary gland under the joint action of estrogen, progesterone and other hormones. During the pregnancy, the mammary gland can be fully developed, and the terminal duct of the mammary gland can be developed into a small acinus for breastfeeding. Be prepared.

A large number of estrogen and progesterone during pregnancy inhibited the lactation of prolactin; after delivery, the levels of estrogen and progesterone decreased rapidly, which relieved the inhibition of prolactin, and the secretion of prolactin also increased, and the mammary gland began to lactate. Thereafter, with the establishment of regular breastfeeding, the baby continuously sucks the nipples to produce a reflection, stimulating the prolactin secretion from the anterior pituitary, so that lactation can last for several months to several years. Prolactin secretion is regulated by hypothalamic prolactin inhibitors and prolactin releasing factors and other hormones. Drugs such as levodopa and bromocriptine can inhibit the secretion of prolactin; thyroid stimulating hormone, serotonin and certain drugs (such as reserpine, chlorpromazine) can promote the secretion of prolactin; small doses of female Hormones and progesterone can promote the secretion of prolactin from the pituitary, while large doses of estrogen and progesterone can inhibit the secretion of prolactin.

Second, hormones that play an indirect role in the mammary gland

Follicle-stimulating hormone (fsh): secreted by the anterior pituitary. The main role is to stimulate the ovary to secrete estrogen, which plays an indirect role in the regulation of mammary gland development and physiological functions.

Luteinizing hormone (lh): secreted by the anterior pituitary. The main role is to stimulate the production of lutein, which plays an indirect role in the regulation of mammary gland development and physiological functions.

Oxytocin: secreted by the posterior pituitary. It has the effect of promoting milk excretion during lactation.

Androgen: Secreted by the adrenal cortex in women. When it is small, it can promote the development of the mammary gland; when it is large, it can inhibit it.

Other hormones, such as growth hormone (gn), adrenocortico-hormo ne, thyroxine, and insulin, have an indirect effect on mammary gland development and various functional activities.

an examination

Related inspection

Chest B-ultrasound

Self-examination:

Self-examination plays a decisive role in the discovery of breast disease, and it is especially important for female friends to understand some of the breast self-examination. Self-examination time should be performed one week to two weeks after menstruation. The self-examination method for breast hyperplasia is as follows:

Vision: Stand in front of the mirror with your hands hanging down or hands on your hips. Carefully observe whether the bilateral breasts are symmetrical, whether the skin and nipples are sunken or eczema, whether there is redness or swelling, or abnormal protrusions.

Touch: Lift the left hand or akimbo, check the left breast with your right hand, press the breast gently with your fingertips, touch the hard block, start the circular clockwise direction from the nipple, touch the palm when you are flat, the four fingers close together, use the index finger The middle finger of the middle finger and the ring finger gently tap the outer upper, lower outer, inner lower, inner upper area of the breast in order, and finally the nipple and areola area in the middle of the breast. Do not grasp the breast tissue with your fingers during the examination, otherwise the grasped breast tissue will be mistaken for a lump. If you find a breast mass or a nipple discharge, seek medical advice and avoid delays.

Auxiliary inspection

1. B-ultrasound examination: It has become a commonly used examination method in clinical practice because of its advantages of convenience, economy, non-invasiveness and painlessness. With the development of ultrasound imaging, the application of high-frequency ultrasound greatly improves the resolution of ultrasound and can be found. The small lesions in the breast, especially the identification of cystic and solid tumors, are difficult to replace with other imaging studies.

2, mammography: mammography is an important means of finding early cancer and micro-cancer, but it is not necessary to check repeatedly in a short period of time, especially in the puberty, pregnancy and lactation mammary gland is sensitive to X-ray, excessive exposure will increase The incidence of breast cancer. Generally, a molybdenum target test should be performed at least once before the age of 30, once every 2-3 years at 30-40 years old, and once every 1-2 years after 40 years old. The examination for microcalcification is unmatched by other imaging examinations.

3, breast nuclear magnetic examination: breast nuclear magnetic examination with high sensitivity and medium specificity. Because of its relatively high price, long inspection time and relatively small space, it is not popular at present. It has great advantages for breast cancer with negative mammography and ultrasound, postoperative reexamination, prosthesis implantation or injection of breast enlargement, nipple discharge, screening for high-risk groups.

Differential diagnosis

Differential diagnosis of breast tissue hypertrophy:

1, breast hyperplasia type of breast hypertrophy: manifested as hyperplasia of breast tissue, hypertrophic breasts, breast lobular hyperplasia, often tenderness. During the menstrual cycle, there is often spontaneous pain, accompanied by sagging breasts, and more often in women who are married.

2, obese breast hypertrophy: the appearance of the entire breast is called hypertrophy. In the organizational structure, the fat in the breast is called hyperplasia, fat cell hypertrophy; in the surgery can be found in the breast subcutaneous fat hyperplasia, between the breast tissue, there is also fat hyperplasia and infiltration. This type of breast hypertrophy is often accompanied by systemic obesity. Although hypertrophied breasts may be associated with varying degrees of sagging breasts, they are milder than hyperproliferative breast hypertrophy.

3, youthful breast hypertrophy: is a progressive increase in the breast found in puberty, and over-development, breast tissue hyperplasia, hypertrophy. The breasts are characterized by a symmetrical fat, and the breasts are not sag. These patients sometimes have a family history. The acinar and lobular ducts were significantly increased and dense, the ductal dilatation was enlarged, the interlobular tissue was significantly reduced, the acinar epithelium was actively secreted, part of the epithelium was changed from cubic to columnar, and the cytoplasm was rich in secretions and transparent, and the nucleus was round and located at the base. Department; part of the glandular cavity is highly dilated.

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