Dishormonal hyperplasia of the diffuse type

Adanos, or metaplasia - morphologically almost unchanged breast tissue saved structure. This form is characterized by multiple functional disorders. According to our clinic, developed by N. W. Nigmanova, 53% of 552 of women surveyed suffered menstrual function (anovulatory cycles, dysmenorrhea), 41,2% of patients were not married, did not give birth and are not pregnant, 50,6% had abortions (from 1 to 16, on average, 2.8), 32,85% marked disorders of sexual function. Clinically Adanos manifested in the form of various (which takes up half of all cancer) sealing elastic consistence with granular surface, fuzzy boundaries, painful during feeling, blending with the normal tissue of the breast. Sometimes these seals were barely noticeable, sometimes expressed more clearly. A number of patients in all the iron was diffuse swollen and very painful. Most sufferers metaplasia (according to our data, 69,7%) complained of pain, sometimes very hard and intensive, radiating to the shoulder, arm, shoulder girdle, and on the feeling of bloating and burning. Voltage tissue cancer and the pain has changed depending on the phase of the menstrual cycle.
X-ray (Mamma - and xerographic), the picture was mixed: from alternating ill-defined focal and mazevyh seals, occupying one or more quadrants cancer, until homogeneous seals throughout the tissue with polycyclic outer loop, without differentiation trevogo picture.
When thermography there was an increase of the total temperature cancer and increased vascular pattern associated with the menstrual cycle. Needle biopsy when such processes are highly desirable, because on the basis of its results, you can answer a question about the presence of proliferative processes in the alveoli and ducts. As shown below, it is this characteristic of a condition of the gland tissue is essential not only at the decision of the medical questions, but first of all when assigning patients to the risk group. Experience of treatment of patients with adenotomy or metaplasia indicates a normal condition after childbirth, feedings and eliminate sexual disorders (termination of pain, the disappearance syndrome tension mammary glands etc). Only some patients require medication (in particular, hormonal therapy.

In considering dishormonal hyperplasia and their treatment of precancer and cancer of mammary gland, we can not ignore the idea of the so-called intraepithelial, or preinvasive, cancer (CA in situ). The term "cancer" as if already determines the place of such tumors that are not recognized either clinically or macroscopically, and which is the accidental discovery histological examination. According to I. A. Yakovleva and B. G. Kukute (1973), and many other, non-invasive cancer morphologically no doubt in his tumor nature, although localized only within the epithelial layer of cells and doesn't invade its own membrane. The lack of infiltrative and destructive growth allows many (e.g., Bazhenova A. P., Chakhunashvili, N., 1977) to doubt the fundamental toiletries these cellular changes to cancer, but still consider them true precancer. However, there is no doubt that patients with these forms of the disease should be under constant control, as multicentricity of these tumors is not possible to exclude malignant growth in some of them. So when serial sections often found lots of invasion. This is why most doctors are prone to radical surgical interventions detection CA in situ and very reluctant to agree to a passive monitoring of such patients.
Quite right D. I. Golovin (1972), indicating that it is hardly possible to doubt the value of dishormonal hyperplasia as one of the links in the chain of events leading to cancer (for example, normal tissue - dysplasia - a non-invasive carcinoma invasive cancer). However, this sequence of morphogenesis optional (or it cannot be identified). The second or third link may fall. Cancer may develop, bypassing the stage of CA in situ. Yet, according to D. I. Golovin (1972), no dishormonal predecessor in the Genesis of cancer is rather an exception than a rule. From this perspective, the presence of structures of non-invasive cancer requires the Clinician special attention to the sick and unconditional attributing it to the risk group.
In conclusion, it should be recalled that the final judgment of precancerous the meaning of the various dishormonal hyperplasia of possible only with long-term observation of patients and counting the frequency of cancer in their background. We have such data. In table. 3 results of monitoring 1104 patients, operated at the Institute of Oncology about the various forms of fibroadenomatosis 1955 and 1974, and traced after the operation from 5 to 20 years. Here, of course, not included data on patients with metaplazii usually treated conservatively (with hormones) or only had under observation. They are considered separately (see below). In all operated patients, reflected in the table, apparently identified tumor or infiltration, the nature of which seemed unclear and demanded histological clarification.
As seen from table. 3, compared with the frequency of cancer in the General population (which to some extent can be judged by sick last column - "cancer of other organs") when knotted (adenoma, fibroadenoma) and cystic dishormonal processes without proliferation risk of cancer increases by about 5 - 6 times. The existence of other non-productive forms of fibroadenomatosis (for example, lobular, fibrous forms, plazmocitomom mastitis, doctorate) no effect on the increase in the frequency of breast cancer. The ratio of metaplasia, agenosov, fibroadenomatosis to malignant tumors of the body considered an employee of our clinic N. W. Nigmanova: 121 sick, carefully examined and treated with androgen drugs S. A. Holminum and C. M. Popova in 1954, was traced 20 years or more. It turned out that the development of breast cancer in this cohort is not outside the normal parameters in normal populations (only one out of 121 patient, i.e. 8,2:1000) and this disease is found as often as tumors of other organs (also one of 121 patient). The same data (8: 1000) leads I. P. Rogovtseva (1974), who studied the incidence of cancer in 609 patients with various forms of dishormonal hyperplasia. She comes to the conclusion that a diffuse form of the so-called fibrocystic mastopathy (according to the description, it is about metaplasia) do not apply to pre-cancerous processes, and such patients will be only conservative treatment.
Thus, metaplazii (adenose, adenolipomatosis), knotty and cystic fibroadenomatosis cannot be attributed to truly be precancerous processes, although they can be considered as a factor which affect the subsequent risk of cancer. Quite different is regarded intraductal hyperplastic processes (including cystadenocarcinoma, intraductal papillomas, expressed doctoring of proliferaci), which can be considered obligate precancerous. As shown above, the absolute precancer are patterns CA in situ, even if at the moment histology after sector resection still no signs of their transition into invasive stage.
According to our observations (see table. 3), if doctoring and lobular of proliferative the rate of cancer in comparison with other forms of fibroadenomatosis increases not less than 5 times as compared with the population of healthy women risk of cancer of the breast when expressed productive forms of fibroadenomatosis (especially when cystadenocarcinoma and intraductal papilloma) increases almost in 30 times.