Lobules in the mammary gland. Fatty lobule in the mammary gland ultrasound Fibroadenoma fatty lobule how to determine in the breast

The mammary glands are altered sweat glands with apocrine type of secretion. Glandular tissue is of ectodermal origin. By the time of puberty, the mammary glands reach full development, which reaches its maximum after the first birth of a full-term pregnancy. Under the influence of hormonal stimulation during pregnancy, there is a gradual increase in the number glandular lobules.

During the growth and development of the mammary gland, four types of glandular lobules . Lobules of the first type least differentiated and known as virgin lobules, since they represent immature female breast before menarche.

Lobules of this type have from 6 to 11 ducts.

Lobules of the second type evolve from lobes of the first type, glandular epithelium in them acquires extensive morphological differentiation, characteristic of glands in reproductive age outside of pregnancy. The number of ducts also increases, correspondingly about 47 per lobule.

Lobules of the third type evolve from lobules of the second type, have an average of 80 ducts or alveoli per lobule. These lobules are already formed under the influence of hormonal stimulation during pregnancy.

And finally fourth type of lobules is presented in women with lactation and reflects the maximum differentiation of the glandular component and the development of the mammary glands during lactation. There are about 120 ducts in the lobules of this type. These lobules are not found in women who have not been pregnant. After the end of lactation, the fourth type lobules regress into the third type lobules. After the onset of menopause, involutional changes occur in the mammary gland both in those who gave birth and in nulliparous women. This is manifested by an increase in the number of lobules of types 1 and 2. At the end of the fifth decade of life, the mammary gland of parous and nulliparous women consists mainly of type 1 lobules.

Normally, the main tissue elements of the mammary glands, with the help of which their role in reproductive function, represented by the combination epithelial and stromal fabrics.

Epithelial elements are represented by branching ducts that are associated with the functional units of the gland - lobules and nipple.

Stroma comprises various quantities adipose and fibrous connective tissue that forms the volume of the gland itself outside of lactation periods.

At birth, the epithelial component of the mammary gland is represented by a small number of rudimentary ducts located deeper than the nipple-areola complex. During the prepubertal period, these ducts slowly grow and branch, accompanied by an increase in the stromal component. In the postpubertal period, the endings of the ducts form sacular buds, with accompanying growth of the stroma, which increases the volume of the gland during this period. During pregnancy, many glands develop from each bud.

By the end of pregnancy, the glandular component increases to such an extent that the mammary gland consists entirely of glandular tissue, with a small amount of stroma.

After the end of lactation, atrophy of the glandular tissue is noted and the stroma again becomes the dominant component mammary gland.

After menopause, atrophy of glandular components occurs with a pronounced decrease in the number of lobules to such an extent that in some areas of the glands the lobules disappear completely and only the ducts remain. The connective tissue component of the stroma also decreases, while adipose tissue stroma increases in its content.

From this brief description changes in the epithelial and stromal elements of the mammary glands depending on the periods of the reproductive cycle, it clearly follows that the basis of all these rearrangements are physiological, but multidirectional processes proliferation and apoptosis, providing the final result with adequate changes in the structure and function of the glands in accordance with the tasks in each age period reproductive cycle.

, which in the predominant number of cases are based on cellular hyperplasia, form a rather heterogeneous group of disorders.

Regarding this pathology, the doctor usually decides two diagnostic tasks: firstly, exclude in a palpable formation malignancy, and secondly, when conducting a histological examination (according to indications), obtain useful information relatively morphological characteristics observed changes (Semiglazov V.F. et al., 1992).

In this regard, the tendency to consider clinically benign changes in the mammary glands in terms of assessment is indicative possible risk development of a malignant process in the future (which seems quite correct).

To illustrate what has been said here, it is appropriate to cite the jointly developed decision of the “Conciliation Commission,” which included forty prominent specialists from the American College of Pathologists on the problem of benign breast processes (October 3–5, 1985, New York, USA). The adopted document was based on the results of prospective observations carried out by W. D. Dupont and D. L. Page (1985) large group patients (1500 people). They underwent a biopsy for clinical benign neoplasms mammary glands, and their fate has been traced over a considerable period of time.

In accordance with the results obtained, all benign changes in the mammary glands were divided into three groups according to the relative risk of developing cancer.

1st group. Non-proliferative processes(no risk of malignancy).

Cysts.

Cystsarisefromfinalductslobes

Typically, the epithelium consists of two layers: the inner epithelial layer and the outer layer, represented by myoepithelial cells. In some cysts, the epithelium may be thinned or absent. In other cases, apocrine metaplasia is observed in the epithelium. Cysts often contain an amorphous protein secretion.

Apocrine metaplasia.

These changes in the mammary gland epithelium are characterized by the transition of cuboidal cells to cylindrical ones, in which round nuclei are defined, with abundant eosinophilic cytoplasm and apocrine secretion.

Moderatehyperplasiaepithelial lining of the ducts. Characterized by an increase in the number of epithelial cells in the ducts to more than two cells in the thickness of the duct, but not more than four. In this case, epithelial cells do not block the lumen of the duct.

Fibroadenoma.

The tumor is well demarcated from the surrounding tissues and consists of benign epithelial and stromal elements.

2nd group. Proliferative processes without atypia (slightly increased risk malignancy, 1.5–2.0 times).

Moderate or severe hyperplasia.

It is characterized by the fact that epithelial cells fill the lumen of the duct and even expand it. Nuclei vary in shape, size and orientation. The remaining free spaces of the ducts also vary in size and shape.

Intraductal papilloma.

The intraductal lumen is formed by a papillary formation. At high magnification, one can see that the papilla consists of a fibrovascular core (rod), which is covered with two layers of epithelial cells: the epithelial layer adjacent to the lumen of the duct and the myoepithelial layer lying on the core of the papilla.

Sclerosing adenosis.

It is represented by the proliferation of glandular structures and stroma located in the center of the mammary gland lobule. These glands can be compressed and change shape due to the fibrous stroma, sometimes forming the picture “ cancer with infiltrative growth».

3rd group. Atypical hyperplasia - moderately increased risk of malignancy (4–5 times).

Ductal atypical hyperplasia.

This kind epithelial structure has some but not all characteristics ductal carcinoma in situ. Near the center of the duct, a population of relatively round identical epithelial cells with regularly spaced nuclei is determined. Closer to the periphery of the duct, epithelial cells retain their orientation.

Variations in the size and shape of the remaining intraductal spaces are noted, as features intermediate between carcinoma in situ and ductal hyperplasia persist. These changes are referred to as " atypical ductal hyperplasia».

Lobular atypical hyperplasia.

This lesion is characterized by the proliferation of small identical cells in the acini, which are not stretched by them. Because this type proliferation has some but not all of the features of lobular carcinoma in situ, these changes qualify as “atypical lobular hyperplasia.”

Fat lobe, fibroadenoma and breast cyst are a type of tumor that belongs to the benign category. In order to determine the type of tumor as accurately as possible, puncture or histology is usually performed (most often in the form of tests). Although if you know how each of these diseases differs and carry out an additional examination, possible errors and unnecessary tests can be avoided.

Benign tumor – fibroadenoma

As practice shows, in nine out of ten cases, the formed breast tumor is a fibroadenoma. The disease is common to both men and women, although it is most common among the fair sex between the ages of 14 and 35 years. And this is perhaps one of the main differences between a fibroadenoma and a cyst and a fatty lobule.

Fibroadenoma of the mammary gland at a young age most often develops due to unnatural or abnormal growth of adipose tissue in the area chest. Other causes of diseases can be more accurately determined by puncture of the mammary gland. Among them may be:

• diseases associated with endocrine system person;
• hereditary predisposition and genetic characteristics;
• early pregnancy or the first months after the birth of a child;
• puberty in girls (young people in in this case can be excluded);
• stress, fatigue and constant nervous tension.

Characteristics of breast diseases, or rather, knowledge of it, will help you determine in the best way whether a cyst is found in your breast or one of the types of fibroadenoma. As for the latter disease, it is worth noting that fibroadenoma is a neoplasm of the mammary gland, one of the forms of mastopathy and a type of benign tumor. It has a focal nature of distribution, and cannot form in several places at once in one mammary gland. Moreover, the extensive practice of mammology allows us to determine with almost one hundred percent accuracy the exact location of the formation - the upper right quadrant of the breast.

Please note that breast fibroadenoma rarely causes painful sensation. The same cannot be said about such a benign tumor as a cyst. The disease is not associated with the epidermis, which means that puncture can determine not only the nature of the disease, but also its type.

Another nuance that distinguishes fibroadenoma from a fatty lobule or cyst is the absence of any clear contours, which is also determined by puncture.

Upon careful examination of the disease, you will notice that the fibroadenoma itself is enclosed in a capsule. It can roll around inside the mammary gland.

Cyst as a benign tumor

Breast cysts are equally common in both benign and malignant manifestations. The main difference between a cyst and a fibroadenoma is that the tumor can be single or multiple, and develop simultaneously in both mammary glands. Quite often, a cyst forms and subsequently develops in the milk ducts. The puncture can provide accurate information about the location of the spread of nodular neoplasms.

To the main characteristics cystic formation The following provisions may be included:

Cystic formations can be the cause of mastopathy that was not diagnosed in time. Doctors also identify a risk group, which consists of young girls under the age of 30 who have not yet been pregnant.

A cyst is almost always accompanied by painful sensations, unlike the same fibroadenoma. If you regularly perform self-examination of your mammary glands, you will probably be able to early stage discover nodular neoplasms to get rid of them in time.

Fat lobe

The fatty lobule of the mammary glands is most often detected by a diagnostic method such as puncture. Quite often, this type of disease is also referred to as fat necrosis, as a more medical and understandable term. Because it is the lobule that causes aseptic necrosis of the mammary glands.

So, a fat lobule is a neoplasm in both or only one mammary gland, which can be directly related to skin. You can often observe nipple retraction and painful condition areolas. Fat necrosis, although it is more likely a benign tumor, quite often, as puncture shows, it can develop into a malignant one. Moreover, when primary diagnosis It is extremely difficult to determine the nature of the fatty lobule tumor.

During the development of fat necrosis, a focus of the disease appears, which can be surrounded by a capsule with a dense wall. Note that similar characteristics are observed in both fibroadenoma and cyst.

The presence of a membrane around the filling site is evidence that fat necrosis is precisely benign tumor. Its absence is the reason for a puncture to exclude the possibility of malignancy.

The most informative diagnostic method is a biopsy. Often it is necessary, although it can be harmful. In advanced stages, the disease is treated with surgery.

Having considered the three most similar in appearance benign tumors, you can notice that they have a lot in common, for example, the characteristics of each type of disease. This is often the reason for an erroneous diagnosis, and, consequently, incorrect treatment. Carefully study the characteristics of each tumor and then the likelihood of error will be reduced to a minimum.

Good afternoon About 4 years ago, fibroadenoma was discovered. She was checked regularly, according to the ultrasound everything was stable, she was not growing, but at the next ultrasound a new formation of unknown origin was discovered in the other breast. And lots of cysts. Tell me what it could be and what to do. Ultrasound conclusion: in the right breast there are 2 hypoechoic formations with clear uneven boundaries, size 10x4x6 and nearby 6x4x4. In the left breast, in an annachogenic inclusion of 6x2.8 mm, a formation of increased echogenicity of 3.4x1.4 mm is determined. Increase or pathologist. Changes lymph nodes not found. Conclusion. An echographic picture of focal changes in the right breast with signs of benign. Character (fibroadenoma), focal formation in the left breast (intraductal papilloma? Cyst with dense contents?), simple cysts in both breasts

Ellona, ​​Armavir

ANSWERED: 06/03/2017

With the results of the ultrasound, you need to contact a mammologist in person for an examination and further examination. In terms of additional examination, an ultrasound of the pelvic organs, a study of blood hormone levels, a puncture biopsy and cytology of discharge (if any) are required. Further tactics after receiving the results.

Related questions:

A fat lobule in the mammary gland is detected quite often during an ultrasound examination. This pathology In medicine it is called fibroadenoma or benign breast tumor. The disease manifests itself as nipple retraction and pain on palpation of the breast.

In most cases, women feel the fatty lobule on their own. In its turn, this education consists of two types of tissue (fibrous and glandular tissue). If a fibroadenoma is detected, the patient is advised to consult a doctor as soon as possible. The further course of therapy will be determined by the attending doctor in each specific case.

Anatomy of the breast

Both women and men have mammary glands, but in the latter they do not develop physiologically.

The mammary glands in women are attached to pectoral muscle. In the lower middle of the breast there is a nipple with milk pores through which the milk ducts pass.

Women's breasts are surrounded by a layer of fatty tissue. In this case, lumps can develop in any part of the mammary gland. They are capable of being different types and arise due to both internal and external factors.

Photos of breast pathologies can be seen on medical portals.

Self-examination

Every woman should perform a breast self-examination every month. This will allow you to identify the pathology in time and immediately consult a doctor before the disease leads to dangerous consequences.

To perform a self-examination, which should be carried out on days 5-6 of the cycle, a woman should check her bra for discharge, compare the size and symmetry of her breasts, and also palpate the mammary glands for dimples, lumps, etc. This is best done standing or lying down. Axillary area It is also important to palpate.

It is important to note that the condition of the fat lobule can be influenced by hormonal background women. Because of this, it is capable of increasing and decreasing in size several times a month. So, during pregnancy and breastfeeding education will increase, while during menopause it will become smaller.

Indications for breast ultrasound

An ultrasound of the mammary glands is required in the following cases:

It is best to carry out this procedure during menstrual cycle from 7 to 14 days.

Also, women over 50 years of age should undergo regular testing, especially those who have not given birth or have had an age-related pregnancy.

Ultrasound of the breast: normal

The mammary glands contain three types of tissue: adipose tissue, connective tissue, and glandular epithelium. Using ultrasound, you can view all these tissues and identify even small pathologies in them.

Normally, the glandular epithelium should have narrow ducts. Adipose tissue should be a hyperechoic zone.

On ultrasound examination The mammary gland should have a homogeneous structure with clear contours.

What to do if a fatty lobule is detected on ultrasound

First of all, when a woman detects a lump in her breast, there is no need to panic. Today there are effective medications, as well as surgical methods treatment. Also good news is that a benign tumor can independently reduce its size and then completely dissolve in the tissues.

The diagnosis of hyperplastic fat lobules is important to keep under control. To do this, it is recommended that the woman be monitored regularly using ultrasound. This is necessary in order to monitor the size of the formation. As for the risk of the tumor becoming malignant, it is minimal.

Fibroadenoma as a benign tumor

According to statistics, every fifth breast tumor is a fibroadenoma. Women aged 15 to 35 years are prone to the disease. This is the main difference between a fibroadenoma and a cyst.

This disease develops at a young age (in most cases due to the pathological growth of adipose tissue in the chest area). Additional reasons tumors can be:

1. Endocrine diseases.
2. Individual hereditary predisposition.
3. Early pregnancy. As a rule, fibroadenoma is detected in the first or second trimester of pregnancy.
4. Early after childbirth (usually the disease is detected in the first three months after childbirth).
5. Chronic stress and fatigue. The development of the disease is also influenced nervous tension, depression, neurosis.
6. Puberty in girls.

Doctors characterize fibroadenoma not only as a benign tumor, but also as a type of mastopathy. It can form in several places on the chest at once.

It is also worth knowing that when palpated, such a disease rarely causes pain, unlike a cyst. Due to the fact that the tumor is not associated with the epidermis, puncture can reveal the type and nature of the disease.

Useful video

What is important to know about such education is told by a mammologist.

Cyst as a benign tumor

Breast cysts can be either benign or malignant. It differs from fibroadenoma in that the tumor can develop in both mammary glands at once.

Features of cystic formation are:

General rules and methods of treatment

Most often, puncture can confirm the presence of a fatty lobule. This formation is also often called aseptic necrosis mammary gland.

Before starting treatment, the patient should undergo a thorough diagnosis. To do this, you need to take blood and urine tests, perform an ultrasound, and, if necessary, a biopsy. Once the type of tumor is identified, which can be benign or malignant, therapeutic therapy is selected.

Benign formation requires long-term drug therapy and mandatory leakage control. If the tumor is large, it may be recommended to remove it surgically.

As for malignant tumors, they require a carefully selected course of treatment, which may include chemotherapy and hormonal treatment. Surgery is also often used.

A fatty lobule in the mammary gland is easily detected by ultrasound. In other words, it is a fibroadenoma (benign breast tumor). The fatty lobule may appear as nipple retraction and painful sensations in his area.

Usually, the woman herself discovers the fatty lobule during a self-examination in the form of a small pea. Fibroadenoma consists of 2 deformed tissues - fibrous and glandular. The state of the tumor is influenced by hormonal levels; under its regulation, the fat lobe can decrease and increase in size. Typically, during pregnancy and breastfeeding, the tumor becomes larger, and during menopause, on the contrary, it becomes smaller.

Normal breast ultrasound

There are 3 types of tissues in the mammary gland - connective, adipose and glandular epithelium. Normally, the skin should be represented by a hyperechoic area, the glandular epithelium should be an echogenic zone with narrow ducts, and adipose tissue should be a hyperechoic area. Any neoplasms can be clearly identified in these tissues if you know their norm. The fat lobule has a reduced echogenicity compared to other tissues. But, sometimes it happens that fibroadenoma can be a heterogeneous echostructure.

On ultrasound examination, the fatty lobule has a round shape with fairly clear contours. If you look closely, you can find small areas of calcification in the fibroadenoma. There is also a leaf-shaped form of fibroadenoma, which differs from the usual fatty lobule on ultrasound only in its larger size. For best diagnosis neoplasms in the mammary gland, an ultrasound examination should be performed on days 4-5 of the menstrual cycle.

What to do if a fatty lobule is detected on ultrasound

If a woman is diagnosed with fibroadenoma, then there is no need to worry and panic too much. There are conservative and surgical methods her treatment. It happens that a benign tumor itself begins to decrease in size and then disappears altogether.

It is unlikely that a fat lobule can develop into malignancy, but to prevent this from happening, it is advisable to monitor it using ultrasound examination. From surgical intervention many women refuse due to postoperative breast defects - changes in its shape and texture. But, if a fibroadenoma is detected on an ultrasound, it is better to listen to the doctor and go for the treatment method that he suggests.