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 is easy for those with typical symptoms of nipples and localized lumps with swelling and pain. For those without nipples but with localized lumps, careful medical history should be taken and the diagnosis is not difficult if there are symptoms of localized swelling and pain during menstruation and lactation. For patients without nipples and lumps, the diagnosis is more difficult and can be easily confused with normal menstrual swelling and pain in the ipsilateral breast. For such patients, we should ask about the location of the swelling and pain, examine the ipsilateral breast and exclude its pathology, carefully examine the anterior axilla or axilla, and supplement it with ultrasound and other examinations, and basically confirm the diagnosis after the above examinations.
Ultrasound diagnosis of glandular parametrial breast
There are obvious differences in the sonograms of parametrium during the general examination period, premenstrual period, lactation period and pregnancy period.
The sonogram of the parametrial breast during the general examination period is similar to that of normal breast tissue, but the echogenicity varies depending on the internal components.
2. The sonogram of the parametrium during the premenstrual period is characterized by interphase low to no echogenic areas in the echogenicity of the breast tissue, with more blurred borders.
3. During pregnancy, the image is characterized by lumpy echogenicity in the hypoechoic breast tissue with poorly defined borders, mostly irregular in shape and partially oval in shape.
The image during lactation is characterized by a single shuttle-shaped or grape-shaped echogenic area with clear borders and no envelope.
It is better to observe in the premenstrual period than in the menstrual period.
The latter has no peripheral echogenicity of breast tissue except for cystic echogenicity, and if infected, there are local inflammatory manifestations such as redness, swelling, heat and pain.
For hypoechoic parametrium, it should be distinguished from lipoma, lymph node, fibroma, neuroma and other subcutaneous nodules.
3. For premenstrual, pregnancy and lactation cases with typical clinical symptoms, ultrasound diagnosis is not difficult, but for cases with atypical clinical symptoms and sonograms, the sonograms of the masses should be compared before and after menstruation at this time, and confirmed by puncture biopsy or surgical pathology if necessary.
Ultrasound diagnostic details of parametrial breast
1. Abnormal location, mostly in the axillary area.
2, superficial location, located in the subcutaneous fat layer, but there is no hypoechoic fatty tissue between the skin tissue and most of them, and they are closely related and not clearly demarcated.
3. The parametrial tissues have no envelope and are not clearly delineated from the surrounding tissues.
4. The parenchymal echogenicity of the parametrium in the normal stage is generally slightly lower than that of the normal breast tissue or is of varying intensity, higher than that of the fatty tissue, with thickened light spots, uneven distribution and glandular duct-like structures visible inside.
5. In the nursing stage, the gland is thickened, the ducts are dilated, and there is milk flow.
Differential diagnosis
Differentiate atypical parammary glands from fatty accumulation, lipoma and enlarged lymph nodes in the axilla.
1. Fatty accumulation is characterized by echogenic thickening of the fatty layer, echogenic enhancement, and indistinct borders.
2. Lipoma: The echogenicity is very variable, mostly hypoechoic, with fibrous strong echogenicity, while angiolipoma and fibrolipoma are mostly slightly strong echogenicity. The boundary is mostly clear, and the envelope is present or absent.
3. Axillary enlarged lymph nodes: round or oval with clear borders and smooth envelope, hypoechoic cortex and hyperechoic medulla, with lymphatic portal structures mostly visible.
All the above lesions sonograms are not affected by endocrine cyclic changes. Therefore, it is not difficult to diagnose the parametrial gland with typical clinical symptoms by ultrasound, but for cases with atypical clinical symptoms and parametrial gland sonograms, two-dimensional image control observation of the menstrual cycle can be performed to improve the correct diagnosis rate by ultrasound.