Necrosis of abdominal fat tissue. Manifestation of fat necrosis. Leading specialists from clinics abroad
Fat necrosis of the mammary gland refers to benign changes in the mammary gland. The essence of the disease is the occurrence of necrosis (death) of adipose tissue in a certain area.
Why does fat necrosis occur?
How does fat necrosis manifest?
Why is fat necrosis dangerous?
TREATMENT OF FAT NECROSIS
Fat necrosis of the mammary gland refers to benign changes in the mammary gland. The essence of the disease is the occurrence of necrosis of adipose tissue in a certain area.
Reasons for the development of fat necrosis
Fat necrosis occurs most often due to injury. As a result of damage small vessels the area of adipose tissue may lose its blood supply, resulting in necrosis. Minor impacts (for example, an elbow in a vehicle, bruises on door frames, etc.) can act as a traumatic factor. Fat necrosis can also occur under the influence of radiation therapy(after organ-preserving operations, during radiation therapy before surgery, etc.).
MANIFESTATION OF FAT NECROSIS
The main manifestation is the presence of a tumor in the mammary gland, determined by palpation. The tumor is usually painless.
Danger of fat necrosis
Fat necrosis does not turn into a malignant tumor, but can simulate it. With mammography and ultrasound, fat necrosis can be determined as a malignant tumor, which requires active tactics - biopsy, and, if necessary, sectoral resection.
TREATMENT OF FAT NECROSIS
Consists of removing the lesion fat necrosis. Usually, we're talking about about sectoral resection of the mammary gland.
High-quality diagnostics and treatment can only be provided by a specialist who, in accordance with your indications and based on your situation, will select you individual scheme therapy and will give further recommendations.
FAT NECROSIS, more correctly, necrosis of adipose tissue (German: Fettgewebsnek-rosen), are focal necrosis of adipose tissue, most often found in the area of the pancreas and in its immediate vicinity, somewhat less often among the retroperitoneal adipose tissue of parts of the abdomen remote from the pancreas, among the fat of the omentum [cm. separate table (vv. 103-104), drawing 2], mesentery; rarely - in the fatty tissue of the mediastinum, the fatty layer of the epicardium, the fatty layer under parietal pleura, even less often in subcutaneous fatty tissue, in bone marrow. In most cases, we are dealing with multiple foci of glandular disease. small sizes, which are concentrated ch. arr. in the area of the pancreas and from it, as if from the center, spread to the sides to a certain distance. Foci of Zh. n. have sizes from a pinhead to a lentil, rarely larger, and appear against a light yellow, translucent background of normal adipose tissue in the form of matte spots of white or yellowish-white color (if jaundice is present, yellow), dense, reminiscent of stearin (French “taches de bougies"), less often of a liquid consistency. The Ben-da reaction, which consists of fixing the tissue for 24 hours at 37° in “Weigert’s copper-alum-acetic acid mordant for neuroglia” with the addition of 10% formalin, distinguishes J. n. green. Under a microscope in the lesions AND. n. a pattern of adipose tissue is visible, but there are no nuclei in it, and fat cells turn out to contain clumpy, lumpy masses that are insoluble in alcohol and stain on hematoxylin-eosin preparations, partly pink, partly purple; among these masses the presence of crystals is also noticeable fatty acids. As established microchemically (Langerhans et al.), this microscopy. the picture is explained by the breakdown of neutral fat from dead fat cells with the formation of fatty acids and fatty acid soaps; lumpy masses that give a violet color from hematoxylin consist primarily of fatty acid lime. In more later periods around the centers of Zh. n. an inflammatory reaction is detected, which first manifests itself in the appearance of one or another number of wandering cells here, phagocytosing the products of fatty breakdown (“steatoclasts” Reitmann "a), later in development granulation tissue, usually with giant cells, surrounding and permeating the dead lesion. As a result, at the site of the outbreak of Zh. There may be either a scar or a cyst surrounded by a connective tissue capsule, or encapsulated calcareous stones. In more in rare cases purulent melting of the focus of the gastrointestinal tract occurs, which most often occurs when Bact is introduced into the focus. with And comm.; a developing abscess usually ruptures into the abdominal cavity, resulting in local or general peritonitis. The basis of the pathogenesis of Zh. pancreatic area and in general abdominal cavity lies the effect on adipose tissue of steapsin, which is integral part pancreatic juice; as established by experiments and pathological anat. observations, in case of disturbances in the secretion of pancreatic juice of the most diverse origin, the latter can diffuse into the surrounding tissue, which acts in a necrotizing manner. The fact that in such cases, in the presence of fat breakdown, there is usually no manifestation of the action of another enzyme of pancreatic juice, trypsin, is explained by the fact that the fat proenzyme is activated much more easily and quickly than protrypsin. However, in some cases, along with Zh. necrosis and pictures of digestion of the glandular tissue of the pancreas and its connective tissue stroma are observed, which relates to the action of trypsin. Steap-syn of diffusing pancreatic juice breaks down the fat of fat cells and thereby kills them; all subsequent changes are associated with further stages of the process of fat breakdown and the reaction of the surrounding tissue (see above). - Whereas most foci of G. n. in the abdominal cavity, and also probably chest cavity(mediastinum, epicardium) can be explained by the above diffusion of pancreatic juice - to explain certain foci of pancreatic inflammation, especially those located more distantly, for example in subcutaneous adipose tissue, the assumption of embolism by cells of the pancreas, gland (if its tissue is damaged) is acceptable ).-AND. n. of the above pancreatic origin are observed very often with a wide variety of lesions of the pancreas, both severe and mild, with various injuries ah gland, its inflammation, neoplasms (both the gland and the papilla of Vater duodenum). Further, when the Wirsungian duct is compressed by tumors, their metastases, scars, inflammatory foci; when the duct is blocked not only by a stone, but also by mucus, for example. when moving to the Wirsungian duct, catarrhal, inflammation from the duodenum or from the bile duct; finally, when i-eelchi enters the (Wirsungian duct due to the resulting spasm of the duct and increased secretion mucus. G. n., observed near the pancreas, sometimes without any of the above-mentioned disorders of its condition, are explained by a perversion in the direction of its secretion during agony. Most often J. n. pancreas glands and abdominal cavity are found in obese subjects, alcoholics, and people suffering from gallstones. Usually presenting only a complication of this or that suffering, J. n. do not provide great influence for the course of the main b-no; only in cases of wide distribution of life sciences. the inflammatory reaction around their foci and the absorption of toxic products of the breakdown of adipose tissue can be affected by corresponding symptoms and worsening of the disease. - In addition to the above, Zh. of pancreatic origin, focal necrosis of fatty tissue is observed, which have nothing to do with the pancreas. This includes lobular necrosis of adipose tissue of embolic origin (for example, with sepsis lenta), necrosis of subcutaneous fatty tissue with various injuries and inflammations in it, with vasospasm from prolonged cooling, and finally the so-called. spontaneous gastritis, arising as a result of angioneurotic disorders, sometimes from intoxicating influences. With all fat necrosis of this kind, the fat of the fat cells, under the influence of the lipase enzyme contained in them, undergoes splitting in the same way, and an inflammatory reaction occurs around the foci of fat necrosis; this gives pictures generally similar to those indicated above in relation to pancreatic fat necrosis. Lit.: Abrikosov A., About the so-called “oleogranulomas”, Rus. Klin., vol. VII, No. 33, 1927; B e n d a C, Eine makro- und mikrochemische Re-aktion der Fettgewebsnekrose, Virchows Archiv, B. CLXI, 1900; Kauffmann E., Lehrbuch der speziellen patholog. Anatomie, B. I, p. 806, B.-Lpz., 1922; Slmmonds M., tlber disseminierte Fettge-websnekrose bel Cholelithiasis, Munch, med. Wochen-sehrift, 1902, No. 21.A. Abrikosov.Fat necrosis of the mammary gland (lipogranuloma) is benign education, resulting from the replacement of adipose tissue with connective tissue. Fat necrosis can form in any area of the breast and occurs at any age. The disease is more common in women with large breasts. Men can also experience fat necrosis, but this is very rare.
The mammary gland consists of lobules (which produce milk) and milk ducts, through which milk flows to the nipple. They are surrounded by glandular, fibrous and adipose tissue. Fat necrosis can form due to damage to the fatty tissue of the mammary glands, for example, after surgery or radiation therapy.
Damage to adipose tissue can occur due to sudden weight loss, severe bruise, breast biopsy, radiation therapy, or any breast surgery, including:
- Plastic surgery
- Breast reduction (reduction mammoplasty)
- Lipomodeling (injection into the breasts of fat taken from another part of the body for aesthetic purposes)
When damaged breast tissue is repaired, scar tissue usually forms. But not all fat cells have the same ability to regenerate, so some of them release their contents. During this process, an oil cyst may form.
Diagnostics
Oil cysts and fat necrosis are tumor-like or bumpy formations that are usually not accompanied by painful sensations. In some cases, the skin around the lesion may be red, tender, and sometimes dimpled. With fat necrosis, the nipple may be retracted.
If a formation is detected, the specialist will refer you for a mammogram or ultrasound of the mammary glands. When examining the breasts and performing a mammogram, fat necrosis can be similar to breast cancer. If mammography or ultrasound examination clearly show that this is fat necrosis, then there will be no reason for a biopsy. If there is doubt about the origin of the tumor, a biopsy will be performed.
Treatment
Fat necrosis is safe and does not require treatment. Light massage zones of formation may contribute to the resorption of the compaction. As a rule, necrosis resolves over time. Doctors usually try to avoid surgical intervention due to the fact that it can cause further fat necrosis. However, in some cases, surgery to remove fat necrosis may be recommended:
- In case the biopsy did not provide enough information to confirm the diagnosis;
- If fat necrosis causes discomfort;
- If the formation does not go away or becomes larger in size.
If surgery is necessary, the focus of fat necrosis will be removed using sectoral resection of the mammary gland. The surgery will leave a small scar that usually goes away with time.
An oil cyst can be removed by fine needle aspiration and drainage of its contents.
Risk of developing breast cancer
Fat necrosis is not a precancerous condition and does not increase the risk of developing breast cancer.
The body consists of numerous cells that work together, participating in many processes. Sometimes by various reasons cell death occurs. If this happens in the fatty tissue of the mammary gland, it is called necrosis. Fat necrosis of the breast is the formation of dead areas in the fat tissue and their transformation into scars or cysts.
More often aseptic necrosis occurs after bruises and injuries and is a benign formation. The disease has many names, one of which is steatonecrosis.
ICD-10 code – N64.1
The disease itself is not dangerous and often does not even require any treatment. All cases are considered individually and must be diagnosed in a timely manner. Only after studying the anamnesis, the doctor prescribes treatment.
The focal area is deprived of blood flow, but this does not mean that the blood supply to the mammary glands will be impaired. Damaged capillaries cease to function, and blood flow continues through the available channels. Due to lack of blood, dead areas are formed.
Do not hesitate, since fat necrosis can cause more complex pathologies, for example, breast cancer.
Most common reason– damage to the mammary glands. These could be bruises, cuts, compression, punctures. Women with large size breasts are most susceptible to necrosis because adipose tissue occupies a significant part of the organ. The disease can occur with sudden changes in weight. When a woman loses weight incorrectly, the fat becomes thinner, and some areas do not have time to recover, which leads to necrosis. Treatment of breast steatonecrosis depends on the nature of the changes in the structure of the organ.
The dead zone may vary in the nature of the disease, size and other characteristics. The disease can be called oleogranuloma or steatonecrosis and occurs:
- artificial
- post-traumatic nature
- peri-inflammatory nature
- of an incomprehensible nature
Causes
Often, fatty tissue necrosis appears after various operations for breast enhancement. Introduction foreign bodies may cause the formation of necrosis. After severe injury Dead areas often appear on the breasts. Sometimes the force of the bruise can be minimal, but regular - this will be enough for the occurrence of pathology. For example, an incorrectly performed massage can lead to necrosis. If any inflammation is detected in the mammary gland, tissue deformation will occur. In this case, blood circulation is disrupted, and individual areas of adipose tissue may die.
Steatonecrosis can occur due to:
- chest injuries
- surgical intervention
- hormonal imbalance
- infectious diseases
- weight loss
- radiation therapy
- injections and foreign bodies in the mammary gland
At first, the process is reversible if treatment is started on time. If treatment is not followed, nodules form at the site of cell death. They harden and grow connective tissue, which is trying to repair the damage. Thus, an increase in necrosis occurs. If the affected areas continue to grow, they must be removed. A more severe and dangerous course of the disease is liponecrosis.
Necrosis can also affect superficial areas. An infrequent manifestation of necrosis is necrosis of the areola. It can be complete or partial. The disease is characterized by impaired blood supply to the nipple and areola, which leads to necrosis of the areas. Sometimes the dead cells are rejected, and the areola is separated from the rest of the tissue. Most often, areolar necrosis occurs as a result of improperly performed breast surgery. When enhancing an organ, women often go under the knife to look better. An example is mammoplasty - changing the shape of the breast. However, the consequences can be corrected throughout your life. With complete necrosis, necrosis of the nipple is also present. After diagnosis, surgery is necessary.
Symptoms of necrosis
Symptoms of fat necrosis of the breast can vary. Depending on the type of disease, the symptom may manifest itself as pain. In this case, the patient may not suspect the presence of the disease. This course of the disease is characterized unspecified reason appearance.
If the manifestation of the disease appeared after a bruise, the affected area will be for a long time get sick. Deformation and asymmetrical breasts may be noticeable. First time painful area may increase in size. The skin is thickened and lumpiness can be felt to the touch. Another sign is that the affected area is often warmer than the surrounding tissue. Indentations may appear at the site of the lesion. If this happens at the site of the nipple areola, the nipple is often retracted inward. When adipose tissue dies, the area loses sensitivity, and skin covering takes on a reddish tint. Discharge from the nipple is noted.
Symptoms may not show obvious signs of illness. Lymph nodes may often be enlarged, but general state the body remains normal. Body temperature does not increase. Necrosis usually develops gradually and is characterized by slow dynamics. The affected area of skin fuses with nearby tissues. Peculiarity severe cases— the dead area is not destroyed. The rejection process begins and sepsis may occur. The entire cavity is filled with pus, and in protracted stages ulcers and cracks appear.
Diagnosis of the disease
If necrosis is suspected, it is necessary to identify the nature of the disease and the size of the affected area. For this purpose the following studies are prescribed:
- mammography
- x-ray
- tomography
A set of research results shows blurred contours, heterogeneous structure, calcifications or oncology. If it is necessary to study the tissues of the affected area, the collection is carried out using a biopsy. Histological examination is performed by trepanobiopsy or fine-needle puncture. A biopsy is necessary to rule out breast cancer.
Based on the results, the specialist prescribes the most optimal treatment. The duration of necrosis and its size play a major role.
Treatment and prevention
The main treatment for fat necrosis of the breast is surgery. In some cases, when it comes to minor injuries, surgery is not required - treatment can only be medicinal. It is prescribed when the affected area is minimal, does not increase in size, and the tissue can be restored.
In other cases, especially when difficulties arise in accurate diagnosis— perform sectoral resection of the mammary gland. The surgeon decides to operate only on the dead area, sparing the adjacent tissue. The sample taken is sent for repeated testing. histological examination to check for cancer.
If the affected area is very large, the only remedy is complete removal organ. After the operation, a course of rehabilitation is prescribed. It lies in drug treatment: anti-inflammatory, antibiotics, painkillers and other drugs. Good healing effect Physiotherapy will be provided.
No folk method will not be able to cure the disease. It is necessary to resort only to traditional medicine.
As a preventive measure, it is recommended to undergo examinations and treatment from a doctor more often. Self-examination can also become a good habit. Even minor worries thoracic region may indicate incipient problems that need to be treated promptly. What is hidden from view will be shown diagnostic studies. It is necessary to treat the sensitive organ with caution, to avoid injuries and bruises, which can lead to necrosis. If the mammary gland has already been operated on previously, the risk of necrosis increases significantly. To avoid this, you need to follow your doctor’s recommendations and not be careless about your health.
Timely contact with a specialist and quality treatment gives good result. If the disease has no complications, the prognosis for cure is positive.
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