Parametrium is a common type of breast development disorder in women. It is often an underdeveloped tissue, mostly resembling a baby’s breast, or with only a little skin pigmentation and a little skin growth in the center, resembling a small nipple. Some have only mammary glands, some have only nipples, but there are also complete breast bodies (nipples, areolas, glands) visible in the axillae. The areola and glands are larger. Before menstruation, the parametrium is also swollen and painful, and it is obviously enlarged when expecting, and there are nipples and even secretion of milk during the period of breastfeeding.
Normal breast development
In the 6th week of embryonic life, 6 to 8 pairs of ectodermal cells thicken along the anterior wall of the trunk from the axilla to the inguinal line (i.e., the breast line) to form the crest of the breast primordium, and most of these breast primordium begin to degenerate at 9 weeks, leaving the front pair to develop as normal breasts.
Formation of parametrium
If the breast primordia outside of the normal breast do not degenerate, they develop into parametrium or redundant breasts, with an incidence of 1% to 6%. They can occur in both men and women, more in women than in men (5:1), and are often hereditary. The parametrium can occur anywhere in the breast line between the upper and lower extremities, and is mostly located in the lower part of the breast and around the axilla, generally near the normal breast, but also reported to occur in the face, neck, buttocks and other parts of the vulva of the groin.
Clinical manifestations of parametrial breast
1. Patients who visit the clinic with a lump near the armpit, after taking a medical history, have painful swelling of the lump during menstruation, pregnancy and lactation, but the degree varies greatly. Parammary breast tissue hyperplasia causes painful symptoms and local pressure pain in the parametrium. However, it is important to note that some are associated with local lymphadenitis.
2. all axillary lumps on examination, with localized tenderness and no obvious nodules.
The lump at the axilla increases significantly during pregnancy or lactation. The nipple is found to be overflowing on close examination, and there is overflow from the nipple near the axilla.
3. accompanied by milk secretion.
4, paramammary fibroma.
5.Acute inflammation of the parametrium.
6. Chronic lymphadenitis, acute lymphadenitis.
Cases of paronychia with lymphadenitis accounted for 10.2% of the total cases and 80% of the patients who still had pain 1 week after surgery. Therefore, in the clinical treatment of paronychia, clinicians should pay attention to the fact that local pain in paronychia patients cannot be excluded due to local lymphadenitis. Therefore, clinicians should consider local lymphadenitis when treating parastomal breasts with painful symptoms in the future and provide treatment.
Pathological examination
Parametrium is a multiple breast deformity that is caused by the failure of the embryonic breast primordium to degenerate and is not uncommon in women.
The diagnosis of parametrial breast is easy to make with typical symptoms of nipple, localized lump with swelling and pain,
parametrium with lobular hyperplasia of varying degrees or with ductal epithelial hyperplasia of varying degrees.
as bilateral parametrium or unilateral.
Some of them have lymph node reactive hyperplasia, fibroid formation; malignant transformation.
Diagnosis of parametrial breast
In a small number of patients with no nipples and no obvious lumps, only pre-menstrual or axillary swelling and pain, the diagnosis of such patients is difficult and can be easily confused with the ipsilateral normal breast with menstrual swelling and pain. For such patients, our experience is to ask about the site of swelling and pain, examine the ipsilateral breast and exclude its lesion, carefully examine the anterior axilla or axilla, and supplement with ultrasound and other examinations.
Individual patients can be diagnosed clearly through several follow-up examinations.
In obese patients, attention should be paid to differentiate the lump from the subcutaneous fat, especially if the lump is not large, by careful palpation, the parametrial tissue is rougher and slightly harder than the subcutaneous fat and has a relative border.
Indications for surgery.
There are different opinions on whether and when it is appropriate to operate for parametrial breast. Some people believe that they do not need to be treated, while others advocate excision. It is generally believed that asymptomatic and soft parastomal breasts can be reviewed regularly without immediate surgical treatment. Surgery should be performed on those with the following manifestations.
1. The parametrium is a deformity of multiple breasts and affects the appearance; for larger anterior axillary parametrium that affects the aesthetics and dressing, and if the patient has an urgent need for surgery, surgery can be performed.
2. Surgery can be considered for those who have obvious hard nodes, fibroids of the parametrium, nipple overflow, obvious swelling and pain of the lump, and those who have a certain possibility of malignant change; the lump has recently increased significantly.
3, with obvious pain symptoms; pain symptoms affecting the patient’s life.
4. Those with parametrial fibroma or nipple overflow should undergo surgery.
5. If the diagnosis is unclear and other tumors cannot be excluded.