Fibroadenoma mamario con cambios fibrosos

The Breast Fibroadenoma can be seen in women of any age,they grow very slowly to reach from 2 to 3 centimeters in size. Its growth stops in the climacteric tending to involute in the menopause.

The characteristic of the nodule is well-defined, mobile and painless, It does not adhere to skin, or to deep planes.

Fibroadenoma Mamario con cambios quisticos y fibrosos

Black women develop Breast Fibroadenoma more often than caucasians ones and they do it in an earlier stage of their lives, 5 percent of fibroadenomas developed in adolescents may be youth-type fibroadenomas, and giant fibroadenomas that are characterized by a rapid growth reaching large size about  22 centimeters which produces stretching of the skin, superficial venous dilation and nipple displacement.

This tends to be more common in adolescents patients younger than 20 years but it may also be seen in adult women and elderly people. The fibroadenoma breast histologically is a tumor that originates in the breast lobules which have a mixed or biphasic, epithelial / stromal component devoid of a capsule, but that is well delimited, such proliferation starts in several adjacent lobules, which will then converge because of a possible Hormonal Alteration (hiperestrogenic State).

It may suffers haemorrhagic stroke, hyalinization, calcification, and/or ossification, areas of epithelial hyperplasia, areas of lobular carcinoma or ductal in situ or invasive, observed in less than 5 percent of the cases, 50 per cent of these, are lobular.

Fibroadenoma mamario con cambios fibrosos

The diagnosis is achieved:

a) clinic: reveals a hard, mobile and well-delineated tumor.

b) Mammography: circumscribed radioopaco low density tumor, and may have large and rude calcifications .

c) ultrasound: evidence eco dense very homogeneous.

d) Cytology (extended to puncture – pathologist): extended that reveal typical ductal cells mammary grouped in plates, in a fibromixoide fund. Treatment: Tumorectomia or removal of the injury or nodular tumor with margin of healthy tissue.

The etiology is unknown, It is  spoken of probable causal factors such as atrophy and involution breast of the postmenopausal, periductales inflammatory processes (periductal mastitis) nicotine addiction, long-term treatments with Phenothiazine and symptoms of hyperprolactinemia, which were associated with duct ectasia .

Ectasia Ductal de Conductos Galactoforos

The first symptoms are Nipple discharge (a spontaneous and intermittent liquid) that may be clear, turbidity, yellowish, grayish or bloody. It affects approximately 20 percent of the cases, Usually at this stage abnormalities do not occur in the subareolar Palpation,in the most advanced cases are noted a progressive subareolar induration in the shape of tumor masses “in the Shape of worms”.

Ectasia ductal

These ectatic ducts may suffer Cystic dilatation, which are occupied by fat secretions, cytodetritus and retained blood, sometimes with bacterial colonization staphylococcus aureus, bacteroids, enterococci, streptococcus anaerobic (approximately 50 per cent of the cases).

Later in some cases ,when the cyst wall breaks, and eliminate its contents into the surrounding tissue, generates significant inflammatory reactions (mastitis periductal) sometimes granulomatous, often recurrence, generating pain and inflammation at the level of the involved area, which is, generally , congestive and swollen at the areolar level, and It could evolve to an abscess, fistulas, granulomas and fibrous changes with nipple retraction or inversion.

Between 23 and 40 per cent of the patients with duct ectasia remain asymptomatic.

Ectasia Ductal Lobulillar

The ectasic secretion is alkaline with cellular debris and haematic retained material, can generate calcifications which are observed in the mammography, in different appearances, from linear and branching calcifications, speculated microcalcifications mass, thick and annular formations, etc.

The diagnosis is obtained by ultrasound, mammography, galoctografía and cytologic studies of the fluid that seeps out of the nipple.

The treatment is usually surgical, with reseccion of the affected area (reseccion of milk ducts or pipes central).

The duct ectasia may be associated with:

1) papilloma

2) ductal carcinoma insitu

Adenocarcinoma Prostatico

The mortality rates have remained almost unchanged in the recent decades with an increase of prostate cancer in recent years, done probably related to a greater efficiency and concern about the diagnosis in stages early and the increase in the half-life of the population.

The cause of prostate cancer is unknown, in the same possibly several factors, such as age, racial – genetic, hormonal and environmental concerns.

The age is without doubt the factor of greater influence in the emergence of prostate cancer, the incidence increases proportionally with age, most of the cases are diagnosed after 50 years, being exceptional before 40 years, increasing its frequency from the 60 years, coming to be present in the 30 % of individuals between 70 and 80 years and in up to 70 % in the age of 80.

The hormonal factors seem to play a role in the development of prostate cancer, was that the same does not occur in individuals castrated by any circumstance before puberty, with low incidence in patients with hiperestrogenismo by liver cirrhosis and in response to the medical treatment of estrógenoterapia.

Adenocarcinoma Infiltrante

It was not shown on a direct with the diet (excess consumption of fat and red meat), venereal diseases, sexual habits, smoking or occupational exposures. There is no convincing evidence of predisposition to prostate cancer by benign prostatic hyperplasia, although both coexist frequently.

It was not shown on a direct with the diet (excess consumption of fat and red meat), venereal diseases, sexual habits, smoking or occupational exposures. The prostate cancer tends to be located predominantly peripheral level glándular (adjacent to straight), region and subsequent posterior-side in a 75 % of the cases, 15 % central area and 10 % 15 % in transitional area.

The localized prostate cancer at peripheral level may be palpable through digital rectal examination as nodule firm or induration woody.

Histologically 95 % of the cancerous prostate adenocarcinomas are derived from acinar cells and tend to be multifocal in a 85 % of the cases.

Patients with prostate cancer to be diagnosed in most of the times develop a clinic obstructive, similar to that produce the prostatitis or prostate hyperplasia benign, the symptoms miccionales are essentially polaquiuria (emission abnormally frequent urine) day and night, decrease of force and caliber of voiding jet, chronic retention incomplete of urine and hematuria (voiding bleeding, more rare). 

Screening – Early Detection or Secondary Prevention of Prostate Cancer

The american association of cancer and the american association of urology believe that the evidence of early diagnosis of prostate cancer can save lives because:

(1) The prostate cancer is a problem of important public health.

2) Is the tumor more frequent.

3) Is the second cause of death.

4) Mortality has remained unchanged in recent decades.

5) 50 % of tumors are extended beyond the prostate when they are diagnosed.

6) The tumors spread (spread) cannot be cured by the ineffectiveness of the treatments in advanced disease.

7) The most tumors diagnosed by evidence of screening are usually located in the body (prostate).

The American Cancer Society suggests:

The men of high risk of prostate cancer as the individual African-Americans and men with relatives of first degree with prostate cancer (father, brother, uncle) at early ages, should initiate the screening from the 45 years.

Procedures for Early Detection of Prostate Cancer Include:

• Rectal

• transrectal ultrasound

• Determination of the antigen prostate specific (PSA) in blood (in several of its forms)

Digital rectal examination

Being the prostate a body part accessible to the exploration digital by their neighborhood anatomical rectum, rectal is one of the methods of choice in the early diagnosis of prostate cancer, carefully made a series of useful parameters to establish the clinical suspicion, sensitivity, size, consistency (nodule or area indurated), glandular limits and mobility.

The sensitivity diagnosed of rectal examination for prostate cancer varies between 50 and 75 %. To be a rectal examination a method practico, efficient and economical diagnostic early prostate cancer, should be carried out on a systematic and regular (annual) to every male that exceeds 50 years. A rectal examination should not be abandoned because it can detect some cancers of the prostate associated with a PSA serica normal.

It is of choice on the abdominal, not eliminating this last. The images ultrasonic transrectales with transducer of high-frequency to obtain the measures glandular, volume, ecoestructura internal, evaluating injuries iso, hiccups and hiperecogenicas, litiasis, cysts, etc, delimitation capsular prostate (Continuity, symmetry, lack of delimitation, broken, tumor permeation capsular) and commitment of seminal vesicle, serving also as a guide for obtaining prostate biopsies transrectales, in patients with PSA serica high or rectal abnormal or both.

The correlation ecografica and pathological studies suggest that approximately 70 – 75 % of the cancerous prostate are hypoechogenic and 25 to 30 % are isoecogenicos.

Determination of the Antigen Prostate specific (PSA) in Blood

The PSA is a protein substance (protease) produced by cells are prostate (acino-ductal) normal and neoplastic. Its function is the dissolution of seminal clot and its production depends on the presence of androgens and the size glandular, is practically a protein synthesis of exclusive prostate, a tiny fraction of the same passes blood circulation, which is dosada for diagnosis, prediction and monitoring of prostate cancer.

Infarto Prostatico

The lifting of the PSA is proportional to the tumor mass this far more advanced than the process tumor will be more frequent find values above the normalcy and these tend to be higher.

Using jointly by the PSA and rectal can discover more than 60 % of the cancerous prostate that still are located within the gland.

Infarto Prostatico

When developing a prostate cancer PSA levels increase above 4 ng/ml, if PSA levels are among 4 and 10 ng/ml the likelihood of having prostate cancer (positive predictive value) is a 20 to 30 %, if PSA levels are older than 10 ng/ml is 42 – 71 % and increases PSA levels increase as well.

If the PSA level this high is recommended biopsies of prostate a prostate cancer.

The PSA can help predict whether the cancer was confined to the gland or outside it, if the PSA level is very high cancer probably exceeded the levels of the gland. The PSA serves to monitor whether the treatment was effective after surgery or radiation, a rise later in the PSA can mean that there are remaining cancer or has recurred. The PSA can indicate the effectiveness or failure of a hormonal treatment.

They know that the PSA this usually higher in older men in the young people, even in the absence of cancer, so that the cutoff point of normal levels are on the increase with age. The reference values normal PSA serico vary according to the various laboratories.

Ranges of Reference According to Age:

30 – 40 Years     ——————    0 to 1.5 ng/ml

40 – 50 Years     ——————    0-2 ng/ml

50 – 60 Years    ——————-   0 to 3 ng/ml

60 – 70 years    ——————-   0 to 4.1 ng/ml

More than 70 years  ————   0 to 4.4 ng/ml

PSA levels range at random in the order of 15 % in an individual.

PSA levels can increase by many factors such as: benign prostatic hypertrophy.

Prostatitis

Infarction prostate

prostate biopsies

urinary tract infections

recent urinary catheterization

Operation recent urinary tract.

A rectal examination does not alter significantly PSA levels.

Carcinoma Papilar Mamario Infiltrante Ulcerovegetante

The main risk factor is the personal history of breast cancer or background of the same in one or more direct relatives of first degree, especially if happened at early ages and bilateral, which makes the risk increase 3 to 10 times the normal population, with a risk of incidence of 13.1 % for white women in the USA and a 9.6 % for women afro-american.

The more early is the diagnosis, the greater the likelihood of healing, with opportunity for therapeutic procedures conservatives are not mutilantes, to lower costs for the patient and medical institutions involved.

METHODS OF DETECTING EARLY

1- SELF-EXAMINATION OR BREAST SELF.

It is very important in the early diagnosis of breast cancer, it is estimated that 65 percent of all the breast nodules are discovered by the breast self.

It is essential educate prior to the patients on its importance, objective basis and technique of self, so that the same becomes effective, taking into account that the mode of presentation more frequent breast cancer, is like a painless nodule, located mainly in the quadrant superexterno in a 50 percent of the cases, 20% to level the central area and in smaller proportion in the remaining quadrants breast.

Carcinoma Mamario Ductal Infiltrante y Ectasia de Conductos Galactoforos

It should do monthly in any woman who starts menstruating (menarche), about 10 days later in the same and in the women women once a month. The technique of breast self includes:

A: inspection bilateral mammary what makes the patient stop foot, compared to a mirror, looking asymmetries, eritemas, retractions or ulceraciones of mammary skin, areola or nipple. B: palpation bilateral mammary is performed by hand fills, which must be done in three positions, standing, sitting and lying (with a small pillow under the shoulder).

It must examine all of the breast in a systematic way, in different directions, transverse vertical, radio and circular, including armpit in search of areas induladas or nodules. C: compression of nipples to rule out presence of secretions.

The breast self should not be abandoned, although beyond availability of mammography, because some cancers not breast are detected by mammography, but if the palpation, patients who regularly as technical, manage generally a stadium early from his illness.

2- REVIEW CLINICO OF THE BREAST

The makes the doctor and includes:

a- interrogation (background hereditary, personal, clinical data on the current illness if any).

b- inspection of skin and complex areola – nipple.

c- palpation breast to assess in case of injury, location, size, characteristic of the tumor, including in addition the consideration of armpit, supraclavicular region, cervical and for-external, looking for possible adenopathy (nodes).

The American Cancer Society” recommends a clinical examination annual breast to all women over age 40 and every 3 years women under 40 years from the menarche (1era menstruation).

3-MAMMOGRAPHY

The fundamental importance of the mammography is in the early detection of breast cancer, the screening mamografico, achieves a reduction in mortality close to 30 per cent, proving to be significantly more accurate, that the clinical examination, in the detection of cancers small or minimal.

When the method is implemented in the form optima, sensitivity and specificity may exceed 90 per cent is reproducible and effective cost, associating with a quotient irrigation/reduced profit.

The review mamografico is simple and does not represent major drawback for the patient must be made in the first half of the menstrual cycle, bilaterally and in different projections (skull flow, mediolateral, oblique, etc.).

The mammography to detect minor injuries to 5 mm in diameter, in many cases carcinomas in situ, clinically hidden no palpable, which currently represent about 20 percent of all cases of breast cancer.

Carcinoma Mamario Apocrino Infiltrante

This early detection, amending the natural history of the disease, significantly improving survival and the quality of life of the patients. The reduction in mortality from breast cancer depends on the detection of injuries minimum, before that takes place the spread systematically.

The mammogram detected about 85 percent of the cancers of the breast, most of them can be viewed on mammography, before be palpable, identifies malignancies clinically hidden, as evidenced, with microcalcifications grouped, asymmetries in the breast density, architectural distortion or clinical lesions palpable, in the form of tumor masses densely espiculadas.

The risks of radiation associated to the study mamografico is generally considered insignificant. THE AMERICAN CANCER SOCIETY, recommends the study mamografico and clinical examination annual breast in any woman from the 40 years, in patients with high-risk family, it could initiate the detection mamografíca, at earlier ages, with a mammogram basis from the 35 years.