Relationship between mastocytosis and breast cancer
Both mastocytosis and breast cancer are lump-based in clinical manifestations and have similarities in pathogenesis. Moreover, certain types of mastocytosis can develop into breast cancer, although mastocytosis and breast cancer are two different diseases in nature:
1. Pathogenesis: These two diseases may have similarities in pathogenesis, such as.
(1) Both are caused by endocrine imbalance, and both are related to high estrogen levels.
(2) In terms of epidemiology, both are associated with psychological factors, marriage and childbirth, and breastfeeding.
(3) The risk factors for the development of mastocytosis are also the risk factors for the development of breast cancer.
2.Pathological changes.
(1) Any cancer is the ultimate evil of cell proliferation, which is the process of qualitative change of cell proliferation on the basis of quantitative change, mild hyperplasia, atypical hyperplasia, cell mutation and cancerous hyperplasia, which can eventually develop into breast cancer.
(2) Most of the hyperplastic cells develop to a certain extent and then no longer continue to develop and stagnate at a certain stage, only some of the mammary hyperplasia can develop into breast cancer, which is precancerous hyperplasia.
(3) The cancer rate of breast hyperplasia is about 3 times higher than the chance of breast cancer in general women, while the chance of cancer in cystic hyperplasia is up to 30 times. Pathological biopsies have confirmed that many early stage breast cancers are transformed by cystic fibroplasia of the breast. Breast cancer is a qualitative change of hyperplasia on the basis of quantitative change. When hyperplasia develops to a high degree of ductal epithelial hyperplasia and atypical hyperplasia, it can easily develop into cancer; this is actually a transformation to malignancy.
(4) Mammary hyperplasia, as the early stage of breast tumor, has a rather high rate of malignant transformation. And breast hyperplasia, breast cysts and breast fibroids are the most common conditions. Although there are many causes of breast cancer, most of them are caused by the malignant transformation of breast hyperplasia. The disease occurs in adults and middle-aged and elderly people, and it is entirely possible to reduce or stop the occurrence of breast cancer with detailed diagnosis and treatment.
The process of mammary hyperplasia leading to breast cancer
1. Pre-cancerous lesion of breast: it is obviously impossible to change from normal cells to cancer cells at once, there is a gradual process from quantitative to qualitative change between them.
If there is only an increase in the number of cells without morphological changes, it is called simple hyperplasia; if there is an increase in the number of cells and abnormal changes in morphology and structure, it is called atypical hyperplasia, and only those with mid-stage atypical hyperplasia have the tendency to become cancerous.
When atypical hyperplasia develops to an advanced stage, there are very abnormal changes in cell morphology and structure, which is close to cancer, and this is precancerous lesion. Precancerous lesions can develop in three directions, one is to gradually become cancerous; or to reduce the lesion after active and effective treatment; or may be stagnant at this stage for life, the development of precancerous lesions to cancer is a rather long process.
2. Those who suffer from cystic breast hyperplasia, especially those with pathologically confirmed active papillomas in the milk ducts, are also prone to breast cancer. Mammary hyperplasia can be an independent disease or an early lesion of breast tumor. According to some statistics, its malignancy rate is relatively high in some patients. About 70% of young and middle-aged women over 25 years old in China are suffering from various breast diseases, with breast enlargement, breast cysts and breast fibroids being the most common. Although there are many causes of breast cancer, most of them are caused by the malignant transformation of breast hyperplasia.
The importance of atypical hyperplasia of breast developing into cancer
There is no significant relationship between general hyperplasia and breast cancer, while the relative risk of cancer increases with the severity of atypical hyperplasia. According to the basic pathological process of tumorigenesis (normal → hyperplasia → atypical hyperplasia → carcinoma in situ → invasive carcinoma), mammary hyperplasia is divided into two categories: simple hyperplasia and atypical hyperplasia, and atypical hyperplasia is divided into three levels according to histological patterns.
Grade I (mild) epithelial hyperplasia forms solid. Sieve-like papillary or glandular structures. The cell volume is larger than that of simple hyperplasia, the anisotropy is not obvious, the arrangement is polarized, and there is a clear bilayer structure.
Grade II (moderate) In addition to the formation of the above-mentioned heteromorphic structures, the hyperplastic ducts became thicker and larger in diameter, and the cell volume also increased significantly, with mild heteromorphism and disorganized cell arrangement, and the marginal layer remained polarized, and the bilayer structure was still visible.
In grade III (severe), any of the above-mentioned forms of hyperplasia, the diameter of the ducts is significantly enlarged and rounded. This results in a group of hyperplastic ducts in close proximity to each other, or in groups. There is also a marked increase in cell size, a certain degree of anisotropy, disorganized cell arrangement or only residual polarity, and the disappearance of bilayer structure or only residual polarity. The bilayer structure is absent or occasionally seen, and the cells are loosened without necrosis.
Cystic hyperplasia has its main lesions as follows:
(i) cysticercosis;
②Papillomatosis;
(iii) epithelial hyperplasia of the milk ducts;
④ adenopathy;
(5) sweat gland hyperplasia. Among them, ①②③ are closely related to breast cancer.
The smaller the diameter of the tumor, the more common and more severe the atypical hyperplasia is; the larger the diameter of the tumor, the less common and the less severe the atypical hyperplasia is, and even no atypical hyperplasia can be found.
Breast cancer and its multiple primary focal lesions all occur on the basis of extensive hyperplasia of the breast epithelium, indicating that breast cancer is not an isolated local lesion. Atypical hyperplasia is an important paraneoplastic lesion, and its existence and extent are closely related to the type of pathology and size of the tumor, and is a morphological reflection of precancerous lesions, which can develop into carcinoma in situ under certain conditions.
The relationship between pathological changes of cystic hyperplasia of the breast and breast cancer
Cystic hyperplasia of the breast is a late stage of mastoproliferative disease and is mainly characterized by the expansion of most small and medium-sized milk ducts to form a cystic shape. In a few patients, the epithelium of the milk ducts can be seen to change from hyperplasia to cancer, so the disease is also called pre-cancerous lesions. The cancerous changes are mostly in the range of 10% to 20%. The general pathological changes are
Visually: cysts of different sizes and softness in the focal gland. The cyst walls are of varying thickness and are grayish or blue in color. The cysts contain clear, transparent, yellowish, cloudy, thick green or brown bloody fluid. Granular or papillary masses can be seen on the inner wall of the cysts protruding into the cavity, which can fill the cavity when large. Large cysts may contain multiple small cysts that communicate with each other in a honeycomb pattern. More or less gray or grayish-pink granular elevated areas are commonly seen between cysts or in adjacent tissues.
Microscopic findings: the main ones are
(i) cysts.
②ductal epithelial hyperplasia.
(iii) ductal adenopathy.
(iv) sweat gland-like metaplasia.
⑤ papillomatosis. Small and medium-sized ducts and terminal duct epithelial hyperplasia in the form of papillary structures.
Typing: According to the degree of hyperplasia, it is divided into three degrees: mild, moderate and severe.
Mild degree shows mild ductal dilatation, epithelial hyperplasia forming low and sparse simple papillae with one to two layers of epithelial cells covering the surface, and myoepithelial cells are clearly visible.
In moderate cases, there are more papillae, often interconnected into a network, covered with 3-5 layers of glandular epithelial cells, and even occupying most of the duct lumen, but the cells are not heterogeneous and the myoepithelium is clearly visible.
In severe cases, the ducts are obviously dilated, with crowded papillae, few interstitial spaces, complex branching, covered with more than 6 layers of glandular epithelium, or even forming solid cell areas, with partially disordered polarity, and mild cellular heterotypes, and myoepithelial cells can still be seen.
These three degrees can coexist, and the more severe ones are closely related to breast cancer, which is an important biological characteristic of the disease.