Fat necrosis of the breast
Fat necrosis of the mammary gland is a focal necrosis of adipose tissue that occurs after various injuries. This pathology is benign changes in the tissues of the mammary gland. With various damaging factors, as a result of a violation of the integrity of small vessels, the blood supply to the tissue site stops, after which necrosis develops. Injuries can be very different, for example, an elbow strike during sports training or a bruise on a doorframe.
Often, necrosis can be observed as a result of radiation therapy and with a sharp decrease in weight. Usually, painful symptoms of fat necrosis are either absent, and changes in adipose tissue are detected only during a physical examination by traditional palpation, or are manifested by painful sensations, and upon visual examination of the breast, enlarged lymph nodes and irregularities in the form of dimples on the skin are visible.
Fat necrosis does not degenerate into a malignant tumor, but can only simulate it. On mammography or ultrasound, fat necrosis is defined as a malignant tumor, which requires the use of a biopsy, and in some cases, sectoral resection. Fatty necrosis of the mammary gland, also called oleogranuloma, lipogranuloma and steatogranuloma, refers to non-enzymatic necrosis.
Changes in tissue structure are characterized by the development of reactive inflammation with the formation of a demarcation zone that separates dead tissue. The abatement of inflammation is accompanied by the process of fibrosis, that is, the replacement of necrotic masses with connective tissue. In places of necrosis, scar tissue is formed. Possible deposits on the site of fatty necrosis of calcium salts, calcification of the focus of necrosis.
Symptoms and diagnosis of fatty necrosis of the breast
The development of fatty necrosis is preceded by a traumatic effect on any part of the breast. If the blow is strong, then a painful tumor, cyanotic or red in color, round in shape and dense consistency, quickly forms at the site of the injury. It is soldered to the skin, sensitivity is lost.
Fatty necrosis entails retraction of the nipple, proceeds without an increase in body temperature. With an unfavorable development of the disease, septic fusion of the focus and the process of rejection of the necrotic site (sequestration) from the surrounding living tissues may take place. Diagnosis of fatty necrosis of the mammary gland necessarily begins with a survey of the patient, the doctor must know the nature of the traumatic effect, the timing of the development of necrosis.
In the process of contact determination, the doctor-mammologist reveals the degree of density, the clarity of the contours of fat necrosis, the symptoms of the presence of fluid (pus, blood). Plain mammography and MRI of the mammary glands help to detect structure heterogeneity, heavy uneven contours.
X-ray, tomographic and echographic studies of fat necrosis often show symptoms of breast cancer. After calcification occurs, the focus of fatty necrosis of the mammary gland resembles a spherical calcinate of the "eggshell" type, this circumstance completely excludes the presence of a malignant tumor. Differential diagnosis implies a breast biopsy, i.e., a fine-needle puncture or trepanobiopsy, which makes it possible for subsequent cytological and histological examination of the fragments obtained.
The biopsy is always done under ultrasound or X-ray guidance. Treatment and prevention of fatty necrosis of the mammary gland has its own specifics and some difficulties. It is good when patients go to the doctor at the beginning of detecting discomfort. Since focal changes in adipose tissue are irreversible, and there are also difficulties in differential diagnosis, an organ-preserving operation with the removal of a part of the mammary gland is indicated.
Repeated histological studies after surgery can completely exclude or confirm the process of cancer. Under the microscope, adipose necrosis consists of nodules of granulation tissue from epithelioid cells, multinucleated giant phagocytic fats and lipoids, and cholesterol ester-laden macrophages around fat inclusions.
Lipogranulomas contain fatty cysts in the form of thin-walled cavities filled with oily and serous fluid. The best prevention of breast necrosis is to be careful and respectful of your body parts. If, nevertheless, it was not possible to avoid injury, it is recommended to take measures of independent first aid, namely to raise the injured chest with a bandage and urgently consult a specialist.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
