simple cyst of breast
Introduction
Introduction to simple cysts of the breast A simple cyst of the breast refers to a squamous epithelium lining the wall of the cyst, and the mass without obvious hyperplasia is a common breast disease. The clinical symptoms are single or multiple masses of the breast with pain as the main symptom, and various non-surgical treatments. The effect is not obvious. Because of its rapid growth, or bloody liquid in the sac, it is also suspected of malignant transformation. X-ray findings are similar to breast cancer. If the smooth wall changes, it may be a sign of malignant transformation. Therefore, the disease has important clinical significance. basic knowledge The proportion of illness: 0.005% Susceptible people: women Mode of infection: non-infectious complication:
Cause
Causes of simple breast cysts
(1) Causes of the disease
It is generally believed that the occurrence of this disease is related to the disorder of endocrine balance. The main manifestations are: reduced or lack of progesterone secretion, relatively high levels of estrogen, imbalance of progesterone and estrogen, and sensitivity of breast cells to hormone stimulation. Abnormal increase, the level of the two hormones in the human body is directly affected by pituitary hormones, so pituitary hormone metabolism disorders can cause estrogen and progesterone secretion disorders, abnormal hormones stimulate breast tissue, so that breast ductal epithelial hyperplasia, intraductal The cells increase, causing the catheter to elongate, distort, fold, and collapse. The wall of the tube is necrotic at the acute angle. The cells in the wall stop growing, and then the cyst and the wall are atrophied. The cyst is caused by epithelial cell residue and congestion, which may cause mild inflammation. .
(two) pathogenesis
The formation of simple cysts is mainly due to the high degree of expansion of the distal duct.
1. Pathological staging According to the literature, in 1965, according to the volume of cysts, the development of cysts was divided into three stages:
1 early stage; the cyst diameter is less than 5mm;
2 transition phase; at 5 to 7 mm;
3 late stage: cyst diameter of 7mm or more, also known as cyst disease, adenosis epithelial hyperplasia is much lighter than cyst disease, cyst is completely pathological, ductal epithelial hyperplasia in cyst disease is the source of breast cancer, cyst disease 84.7% of them had ductal epithelial hyperplasia, and some people said that only ductal dilatation and no epithelial hyperplasia were simple cysts.
2. Pathological morphology
(1) Gross morphology: clinically, the large cyst is isolated, or there are multiple small cysts near the large cyst. The capsule contains a pale yellow liquid or a brown bloody liquid. The capsule wall is thin, smooth, and has refraction.
(2) Histomorphology: microscopic cystic dilatation of the small duct, no obvious hyperplasia of the lining of the lining of the capsule wall, large cysts due to increased pressure in the sac, the lining epithelium becomes flat, and even all atrophy disappears, the sac wall is composed of granulation tissue Composition, common foreign body giant cell reaction or foam cell aggregation, the smaller cyst epithelium is cubic or columnar, the proliferation is not obvious, if the wall epithelium has papillary growth, it is called papillary cyst; the nipple can be no A simple interstitial nipple can also develop into a complex branched nipple with a fibrous vascular interstitial.
Prevention
Breast simple cyst prevention
1. At work, pay attention to reasonable diet, work and rest, avoid endocrine disorders caused by various reasons.
2. Women should have regular breast examinations, such as learning breast self-examination, and optional breast ultrasound examination, mammography, etc., to achieve early detection, early diagnosis, early treatment.
Complication
Breast simple cyst complications Complication
Can be complicated by breast pain.
1. Clinical manifestations:
The whole breast is full, hard and tender, and the original granule or nodule is more obvious.
2. Related inspections:
In the breast, the bumps with unclear borders, different sizes, hard and tough texture, and good activity are observed, and some of the masses are granular.
3, note:
When breast pain is severe, you should ask your doctor for a physical examination to rule out the cancer and follow up regularly. No treatment for mild pain, severe pain can be used according to doctor's advice.
Symptom
Breast simple cyst symptoms Common symptoms Cyst breast pain Breast lumps
Patients often inadvertently find breast lumps.
1. Breast lumps are common in double breast and multiple cysts. The ratio of multiple cysts to single cysts is 3:1. Dupont found that the incidence of single cysts and multiple cysts was 44.8% in 10542 breast biopsies. 55.2%, large isolated cysts are mostly round, with a diameter of several centimeters (Fig. 1); small and multiple cysts are mostly elliptical, with a diameter of several millimeters, the cyst edge is smooth, the boundary is clear, and the activity can be gradually increased. Large, increased, a single cyst has more serous or pale yellow liquid, if it is a bloody liquid, there is the possibility of intracapsular tumor, single cyst can also be due to necrosis in the capsule with brown bloody fluid, X-ray examination The density is higher due to hemosiderin.
2. The mass of the mass changes with the menstrual cycle. The cyst gradually increases with the change of menstrual cycle. If the liquid in the cyst increases slightly, the tension is not high. For some reasons, sometimes the cyst secretes more liquid in the short term, and the tension is obviously increased. High, postmenopausal cysts tend to shrink on their own and occasionally disappear.
3. Breast tenderness Before the menstrual cramps, breast pain, and the size of the breast did not change.
4. Rapid growth of single-shot cysts grows rapidly, and the patient complains of finding a breast lumps overnight. This is important in differential diagnosis and can be distinguished from slow-growing solid fibroadenomas.
Examine
Examination of simple breast cysts
Needle aspiration cytology is a routine examination item for this disease. A needle-like puncture can be seen as a serous or pale yellow, or brown bloody liquid. In addition to the glandular epithelial cells, cell smears can also see more foam cells. Its cell size is different, round, border is clear, the nucleus is small, round or elliptical, the nuclear chromatin is fine granular, the nuclear membrane is obvious, the cytoplasm is extremely rich, and it is filled with vacuoles of different sizes and foam. Puncture, puncture can be used for a positive diagnosis, and the size of the cyst can be correctly estimated.
X-ray inspection
(1) X-ray film of molybdenum target: the image shows a circular or elliptical shape with a complete edge and a dense shadow with uniform density. Because the cyst compresses the surrounding adipose tissue, a transparent halo is common around the wall of the cyst, and the density is in the capsule. Because hemosiderin is relatively high compared with normal tissue, the edge of the cyst is smooth and the boundary is clear. The large cyst is swollen in the subcutaneous tissue, which can make the skin bulge but the skin does not thicken. The wall can occasionally be an eggshell. "Sample or "spot"-like calcification can increase the brightness.
(2) X-ray angiography: puncture the cyst to exhaust the contents, inject the same amount of air (needle indwelling), perform cystic X-ray angiography; exhaust the air after the film, inject iodine water contrast agent (needle indwelling), shoot the second X-ray film, after the film, the contrast agent is exhausted to avoid the pain caused by the retention of the contrast agent. The angiography can understand the presence or absence of hidden cancer, papilloma or intracapsular epithelial hyperplasia in the cyst cavity.
2. Ultrasound examination of the simple cyst of the breast can be seen in the typical liquid level or liquid dark area. According to the echo waveform of the echo map and the sonogram, the location, size and extent of the cyst can be determined, and it can also be accurate under the guidance of B-ultrasound. The cyst is puncture and the cyst is diagnosed and treated.
3. MRI examination of plain breast cysts T1WI showed a low signal, T2WI showed a high signal, round or round, clear edge, enhanced scanning, lesions are not enhanced, such as co-infection, the wall and surrounding tissue mildly enhanced, when MRI showed a better display of small cysts than X-ray films when the accumulation of cysts of varying sizes was found.
Diagnosis
Diagnosis and differentiation of simple cysts of the breast
diagnosis
The disease can be diagnosed if the following conditions are met.
1. Short history, multiple cystic masses in the breast, often in the upper quadrant.
2. Oval-shaped intra-milk mass with clear boundary, obvious sac, and good activity.
3. Puncture with liquid extraction can confirm the diagnosis.
Differential diagnosis
1. Lipoma lipoma is easy to occur in fat-rich large breasts, but also in middle-aged women and post-menopausal women. However, simple cystic postmenopausal women are rare, lipoma is not sexy, and grows slowly. This can be distinguished from cysts.
2. Breast cancer breast cancer has irregular shape, hard texture, poor mobility, or axillary lymphadenopathy. It is not difficult to distinguish from simple cysts, but some cysts have bloody fluids, X-ray findings and Breast cancer is similar, so differential diagnosis should be made according to other clinical symptoms and signs and auxiliary examination. Generally, needle aspiration cytology can confirm the diagnosis, but it is worth noting that the liquid nature of the puncture is used to identify breast cancer and cysts. It can be identified as a single cyst or multiple cyst, or whether there is a tumor in the capsule.
