In my daily practice, many patients and colleagues ask me this question: How to treat mastocytosis? Can it be cured? Is it cancerous? Now let me talk about this relatively common disease in breast disease. There is a group of very common non-inflammatory, non-tumorigenic lesions in the breast with varying degrees of hyperplasia in the main and interstitial mammary glands, some of which are referred to as “mammary dysplasia” and some as “cystic disease”. It is now generally referred to as “mastocytosis”.
Mammary hyperplasia is a common and frequent disease in women of childbearing age, and its pathogenesis: mammary hyperplasia is a disorder of the breast tissue structure caused by physiological hyperplasia and incomplete regeneration.
Its pathogenesis has the following causes.
1, ovarian endocrine imbalance.
2, unreasonable pregnancy history, breastfeeding history.
3, mental factors.
4, lifestyle habits.
The main pathological manifestations of mastocytosis are as follows: lobular hyperplasia; ductal hyperplasia; cystic cavity formation; fibrous tissue hyperplasia; sweat gland hyperplasia; inflammatory cell infiltration; fibroadenoma-like changes; adenopathy; ductal epithelial atypical hyperplasia: (severe atypical ductal epithelial hyperplasia is regarded as precancerous lesions); papillomatosis (divided into mild, moderate and severe levels, of which severe papillomatosis is regarded as precancerous lesions and has clinical practical significance.
Clinical manifestations of mastocytosis.
1. Periodic breast pain and breast lumps are the main features.
2. About 10% of patients have a history of nipple discharge, which is mostly plasma and a few are bloody.
3. Periodic breast swelling and pain starts about 1 week before menstruation.
Its pain characteristics: breast (unilateral or bilateral) swelling, tingling, tenderness, etc. The pain can be aggravated by emotion and exertion, and relieved after menstruation. However, in some cases, this regularity may not be obvious. Breast lumps: They appear as single or multiple nodular or granular sensations in the breast. They are indistinct, hard and tough, mostly in the upper outer quadrant of the breast; they may also show partial or full breast lump thickening without obvious boundaries, and the size of these breast lumps may vary with the menstrual cycle. The size and hardness of these breast lumps can change with the menstrual cycle. In severe cases, the pattern of lump changes with the menstrual cycle is not obvious.
Diagnosis of mastocytosis: Generally speaking, a specialist physician can make a clinical diagnosis by physical examination + clinical symptoms. However, “mastocytosis” should be distinguished from physiological hyperplasia and development of the breast in adolescent women. It should also be distinguished from frozen shoulder, costochondritis, herpes zoster, etc. Necessary ancillary tests: mammography, ultrasonography, and cytology of nipple secretions. If the patient has severe symptoms, obvious nodules or masses, and clinical differentiation between benign and malignant is difficult, puncture cytology or histological examination of pathological sections of mass excision can be used. Pathological examination is the most reliable method to differentiate and confirm the diagnosis of mastocytosis from other breast diseases.
Treatment of mammary hyperplasia: A small number of patients with mammary hyperplasia (mid-to-late ductal papillomatosis and ductal epithelial atypical hyperplasia in cystic hyperplasia of the breast) will develop cancer, so they should be treated actively. The patient should be seen at a hospital with a breast specialist. Treatment should be provided only after the diagnosis is clear. The disease is a chronic disease, the main treatment is symptomatic treatment with Chinese herbal medicine to activate blood circulation and remove blood stasis, move qi and relieve pain, the best time to use the medicine is 1 week of treatment before menstruation, stop using it during menstruation; the use period is usually 1-2 weeks, stop taking it after pain relief. Supplemented with the necessary psychotherapy. Combination therapy with other drugs (estrogen receptor antagonists, etc.) is used when necessary. It should be recognized that this disease cannot be eradicated in premenopausal women of childbearing age and has the potential for cancer, and should be reviewed regularly (once every six months or so), which is more important than the use of medication! Most patients with breast enlargement do not need surgery.
However, surgery may be considered in the following cases.
1, nodules or lumps as the main symptom, by the system of medication, symptomatic treatment is not effective, the lump gradually increased.
2. Breast lumps with hard texture, suspected to be breast cancer.
3.Family history of breast cancer.
4.Patients with breast lumps that are overburdened with thoughts and affect their work and life. Surgical treatment is based on local excision of the lump and routine pathological examination should be performed after surgery.