There is no specific treatment for mastocytosis, and there is no medicine that can “cure” mastocytosis. Most patients with mastocytosis do not need treatment after medical history, physical examination and imaging, and after excluding breast cancer and other related diseases. Regular follow-up and review of breast hyperplasia patients is a key measure to avoid missing the diagnosis of breast cancer, and it is recommended to review every six months to a year. For pain that significantly affects life and workers, treatment is needed. There is no particularly effective treatment for mastocytosis, but mainly symptomatic treatment to relieve pain and other discomfort. It is difficult for treatment to restore the histological changes of mastocytosis, but if applied properly a significant proportion of women can delay the progression of the disease. The main methods include the following.
1, the usual frequent self-examination of the breast, timely detection of emerging breast lumps.
2.Choose a suitable bra.
3, pain is obvious, can be under the guidance of experienced doctors dialectical use of breast fetish elimination, breast health tablets, small gold pill, breast nucleus internal elimination liquid and other drugs to regulate.
4, keep a cheerful mood, eliminate unnecessary doubts. Appropriate physical exercise, quit smoking and alcohol, diet regulation such as low-fat, light diet, etc. are conducive to the treatment of mastocytosis.
5, for married women, a good and satisfactory sex life to reduce breast enlargement is also helpful.
6, surgical treatment. The main purpose of surgical treatment is to avoid missing or misdiagnosing breast cancer, or to remove suspicious lesions. Therefore, the indications for surgery include: breast lumps found by physical examination and imaging, limited glandular thickening, suspicious nodules found by color ultrasonography, microcalcifications found by mammography, etc.
Hyperplastic disease of the breast is the most common form of breast disease and accounts for the highest incidence of breast disease. Hyperplastic disease of the breast can occur in women of any age after puberty, but is most common in young and middle-aged women between the ages of 30 and 50. Its main clinical features are breast lumps and breast pain, which usually worsen in the premenstrual period and decrease after menstruation. Mastalgia is also characterized by non-cyclical pain that is not associated with the menstrual cycle and is asymmetric, often unilateral and mostly localized.
Mastocytosis is neither a tumor nor an inflammatory disease, but rather an overgrowth or undergrowth of the gland. As for the naming of mastoproliferative disease, many scholars at home and abroad have adopted different names according to the lesion characteristics and pathological changes of the disease, so its naming is quite confusing, such as chronic fibrocystic mastopathy, benign epithelial hyperplasia of the breast, lobular hyperplasia of the breast, breast pain, mastopathy, mammary gland structural dysplasia, etc.
The etiology of mastocytosis has not been determined. It is generally believed that the factors associated with mastocytosis are.
1. endocrine factors. Most scholars believe that it is related to ovarian endocrine imbalance. Elevated estrogen levels and decreased progesterone levels or an imbalance in the ratio of estrogen to progesterone, which leads to excessive hyperplasia or incomplete replenishment of the mammary glands and fibrosis triggering mastalgia, tissue structure disorders, varying degrees of hyperplasia of the ductal epithelium and fibrous tissue of the breast and the formation of cysts in the terminal ducts or alveoli; clinical observation of anti-estrogen therapy for mastoproliferative disorders effectively supports this view. However, no abnormalities in plasma hormone levels were found in patients with mastocytosis; therefore, it has been proposed that mastocytosis is related to increased sensitivity of breast tissue to sex hormones.
2. Essential fatty acids. Women with mastalgia have abnormal fatty acids, as well as low plasma essential fatty acid levels. An increased ratio of saturated to unsaturated fatty acids in women may cause abnormal sensitivity of estrogen and progesterone receptors. Mastalgia is effective with the use of evening primrose oil, which is rich in essential fatty acids, suggesting that essential fatty acids have a role in relieving mastalgia.
3. Social and psychological factors. In modern society, life and work are stressful and the spirit is often in a high state of tension, which is also one of the causes of mastalgia. In addition, living habits such as high-fat and high-protein diet may also play a part.
The clinical diagnosis of mastocytosis includes a complete history taking, physical examination, imaging and pathological examination when necessary. History taking includes mainly the type of pain, relationship to menstruation, duration, location, and associated problems. A thorough breast examination is important, and any swelling or nodule needs to be carefully examined, as well as an in-depth examination of the area of pain. Placing the patient in a lateral position with the breast tissue descending from the chest wall often identifies whether the pain is from the breast or from the deeper side of the rib cage.
Color ultrasonography is recommended as the first choice for imaging patients with breast hyperplasia because the disease is gland rich and most patients are younger than 40 years of age, and ultrasonography has a much better resolution than mammography for nodules and cystic and solid masses in dense glands. Mammography is preferred in older patients who do not have an abundance of glands, and when necessary, a combination of the two is feasible. Of course, in some cases, because of mass or nodule formation, it is not easy to differentiate from fibroadenoma and breast cancer, and the diagnosis should be confirmed with the necessary pathological histological examination (hollow-core needle aspiration biopsy, fine-needle aspiration cytology or surgical biopsy).
The diagnosis of mastocytosis is not difficult to make, but the diagnosis of mastocytosis should never be made blindly. The main reason for patients to visit the clinic is the fear of breast cancer. Appropriate imaging and pathological histological examination of suspicious lesions to exclude subclinical cancer is the key to the problem.
Clinically, it is often divided into different types according to different periods and the manifestations are also different.
1.Breast pain syndrome: It is mostly seen in 21~25 years old with a history of several weeks or months, with an average of 3 months. The prominent manifestation is breast pain. The pathology is characterized by mild or severe hyperplasia of the ductal vesicles and lobular interstitium, and mild dilatation of the small ducts.
2. Lobular hyperplasia type: Most commonly seen in 26-30 years old. The hypertrophic glands with poorly defined boundaries can be palpated, with tenderness, mostly accompanied by premenstrual distension and menstrual disorders. The pathology is characterized by increased enlargement of lobular hyperplasia with clear boundaries, and the degree of lesion changes with the menstrual cycle.
3.Fibroadenopathy type: Mostly seen in 31~40 years old. The prominent manifestation is breast lumps, which can be found as lamellar lumps with poorly defined borders, or round nodules with unsmooth surface, hard texture and varying sizes. The pathology is hyperplasia of both the main stroma and interstitium, with dilated ducts and may be accompanied by verrucous nodules.
4.Fibrosis type: Most commonly seen in 41~45 years old. A small number of patients have premenstrual breast pain. On examination, irregular, ill-defined, unsmooth and tough masses without tenderness can be found. The pathology is seen as interstitial fibrosis, lobular atrophy or disappearance, and deformation of the glandular ducts.
5, cystic disease type: mostly seen in 46~55 years old. It often presents as a single or several scattered cysts, 1-2 cm or even 3-4 cm in diameter, with little or no premenstrual breast distension. Pathology is seen as ducts and alveoli that are dilated to varying degrees, forming cyst-like changes of varying sizes.
Generally speaking, although breast pain is a physiological change, it is also an early lesion of breast enlargement, while the cystic type is a more advanced lesion with the possibility of cancer.
Disease classification.
1. Light: Breast pain is vague and intermittent. Unilateral or bilateral breast lumps; a single small lump, or granular but small in extent, or a cord-like object but soft, confined to one quadrant.
2.Medium-sized: breast pain is dull pain and tenderness, swelling and pain are obvious, the lump is large, or in the shape of a sheet or disk, involving both breasts, but the range is in two quadrants.
3.Heavy: breast pain is cramping or stabbing pain, obvious tenderness, large lumps, multiple cystic nodules, involving both breasts, and the range is more than two quadrants.
The relationship between mastocytosis and breast cancer is the most important concern of patients. Mastocytosis cannot be collectively referred to as precancerous lesions. The risk of breast cancer does not increase significantly in most cases of mastocytosis, and the risk of breast cancer in patients with breast pain does not differ from that of the normal population, but increases significantly only when the risk of breast cancer is confirmed by biopsy to be atypical hyperplasia, i.e. a true precancerous lesion.