Mastopathy

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The term mastopathy a plurality is proliferative or degenerative remodeling processes of the mammary glands - parenchyma understood that mostly by hormonal imbalances between estrogens and progesterone are caused. Women between the ages of 30 and 50 are particularly affected. According to dissection statistics on the frequency of mastopathic changes, about 50% of the breasts examined, in the 8th decade even more than 80% changes in the sense of mastopathy. The transition between age-physiological and “real” mastopathic changes can be fluid and often cause problems in histopathological diagnosis. (Remmele, Pathologie, Volume 4, p. 185)

Pathogenesis

Mastopathy is based on a shift in the hormonal balance of estrogen and progesterone in favor of estrogen. Possible triggers for this are mentioned:

Under the influence of estrogen, there is increased proliferation of the glandular tissue, which can lead to stronger secretion and thus to duct widening and cyst formation .

Mastopathy is divided into three grades:

  • Simple mastopathy (grade I) - 70%, without epithelial changes
  • Simple proliferating mastopathy (grade II) - 25%, signs of activation and proliferation of epithelial cells
  • Atypical proliferating mastopathy (grade III) - 5%, moderate signs of anaplasia of the epithelial cells and strong cell proliferation

Symptoms

The appearance is mainly determined by the formation of lumps, premenstrual increased breast pain ( mastodynia ) and the (rather rare) secretion from the nipple .

Diagnosis

In addition to the anamnesis and the examination, the diagnosis of mastopathy is primarily made by sonography . The clinical diagnosis of fibrous-cystic mastopathy requires further clarification in order not to overlook proliferation in the sense of a precancerous condition . Breast cancer and benign breast tumors in particular should be excluded as differential diagnoses of mastopathy .

therapy

The therapy of mastopathy depends on the clinical picture; In the case of mild forms, the treatment of premenstrual pain and informative discussions are in the foreground. The use of gels containing progestin can lead to a subjective improvement in the pain. Androgen-containing gels or the systemic administration of gestagens can also be tried. In the case of mastopathy with lump formation, excision and histological examination should be considered. Repeated severe mastopathies may require complete removal of the mammary gland.

It is sometimes stated that the fibrous-cystic breast carries a risk of breast cancer in the long term. However, this essentially applies to those women with atypical hyperplasia , that is, with the formation of an excessive number of epithelial cells .

Individual evidence

  1. ↑ Thomas Weyerstahl, Manfred Stauber: Dual series gynecology and obstetrics. Thieme, 2013, ISBN 978-3-13-152604-5 , pp. 344-345.
  2. ^ Burkhard Paetz: Surgery for nursing professions. Georg Thieme Verlag, 2013, ISBN 978-3-13-152062-3 , p. 91.
  3. ↑ Ethel Sloane: Biology of Women. Cengage Learning, 2002, ISBN 0-7668-1142-5 , pp. 199-200.
  4. ↑ LM Marshall, DJ Hunter, JL Connolly, SJ Schnitt, C. Byrne, SJ London, GA Colditz: Risk of breast cancer associated with atypical hyperplasia of lobular and ductal types . In: Cancer Epidemiology, Biomarkers & Prevention: a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology . tape 6 , no. 5 , May 1997, pp. 297-301 , PMID 9149887 .
  5. ↑ DL Page, PA Schuyler, WD Dupont, RA Jensen, WD Plummer, JF Simpson: Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study . In: Lancet . tape 361 , no. 9352 , January 2003, p. 125-129 , doi : 10.1016 / S0140-6736 (03) 12230-1 , PMID 12531579 .