What is adipose tissue necrosis after a bruise. Steatonecrosis or fat necrosis of the mammary glands and nipple-areolar complex

Everyone knows that female breast is a very delicate gland, the tissues of which should not yield physical influences(injuries, bruises). Girls should be aware that they need to protect their breasts from being squeezed by a bra, cover their breasts with their hands when there is a massive crowd of people, and avoid even the most minimal breast injuries in every possible way. This is because the mammary gland consists of extremely sensitive tissues that, when the slightest influence can change their structure. The mammary glands are very susceptible to such pathological processes, such as mastopathy, fibroadenoma, mastitis, papillomas. There may also be fat necrosis of the breast.

Fat necrosis of the mammary gland. Causes of lipogranuloma

Fat necrosis of the mammary gland is an aseptic focal necrosis of fatty tissue. Wherein adipose tissue replaced by scar tissue. Fat necrosis is also called oleogranuloma, lipogranuloma and steatogranuloma. Fat necrosis refers to non-enzymatic necrosis. The main cause of oleogranuloma is chest trauma. Patients with large breasts are more susceptible to fat necrosis of the mammary glands than those with small ones.

Traumatic factors that can provoke fatty necrosis of the mammary glands: accidental blows and bruises, for example in transport, sports training, medical manipulations. Sometimes the cause of oleonecrosis is quick loss weights or holding radiation therapy. Sometimes necrosis occurs after breast surgery or mastectomy.

What happens in breast tissue during fat necrosis?

When breast tissue is injured, small capillaries in the area of fatty tissue are damaged. Next, the breast tissue reacts to this process with the appearance of an inflammatory reaction. A demarcation zone is formed that limits the dead tissue. After completion of the inflammatory reaction, the process of fibrosis begins, in which necrotic masses are replaced by cells connective tissue. This is how scar tissue forms. Subsequently, calcium salts are deposited in such areas of necrosis of the adipose tissue of the mammary gland, and petrification of the foci occurs. IN in rare cases processes of ossification are observed.

Symptoms of fat necrosis of the breast

After a chest injury, a painful swelling appears, which is fused to the skin. It has a dense consistency and round shape. Later, the affected area of adipose tissue begins to lose sensitivity. Externally, the gland may change in color - the skin of the gland may acquire a bluish or red tint, the nipple may be somewhat retracted. This picture often resembles mastitis and misleads women, but it is very simple to distinguish fat necrosis from mastitis - with mastitis there will be an increase in body temperature to febrile levels.

With all this, fat necrosis can be clinically similar to breast cancer. Deformation of the mammary gland, density of the infiltrate, the appearance of retracted areas on the skin of the gland and an increase in regional lymph nodes may resemble breast cancer. In advanced conditions, fat necrosis can occur in the form of sequestration and melting of tissue.

Diagnosis of fat necrosis of the mammary gland

In diagnostics fat necrosis great importance The patient has a history of a chest injury that occurred recently. Upon palpation, the mammologist determines a painful lump that does not have clear contours and can fluctuate.

When performing an ultrasound of the mammary glands, CT or MRI, a heterogeneous formation of a nodular nature is revealed, which has heavy, uneven contours. With these tests, the results are often very similar to breast cancer. But, after some time, when the focus of necrosis begins to calcify, on mammography the focus of fat necrosis looks like a spherical calcification like “ eggshells" This allows us to exclude the malignancy of the process.

For differential diagnosis It is advisable to perform a biopsy of gland tissue followed by histological examination. Breast biopsy is performed under ultrasound guidance.

Treatment and prevention of fat necrosis of the breast

In the presence of fat necrosis, only surgical treatment is indicated - organ-preserving sectoral resection of the mammary gland. After this, the material is checked histologically. Microscopically, this material is represented by nodular growths of granulation tissue from epithelioid cells, large lipophages, and xanthoma cells around fatty inclusions. The main components of lipogranulomas are: fatty cysts- cavities with thin walls that are filled with serous and oily liquid.

If the gland is injured, it is necessary to elevate it with a bandage and immediately consult a doctor.

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 breasts are most susceptible to necrosis, since 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 become overgrown with connective tissue, which tries 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 we're talking about for minor injuries, surgery is not required - treatment can only be with medication. 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.

Mastitis is characterized by the following symptoms: fever; enlarged axillary lymph nodes; sharp chest pain; formation of suppuration. This disease can be eliminated conservatively only with initial stage. Without proper treatment, it can cause an abscess, which can only be removed through surgery. Another disease of the mammary glands that occurs very often in women is mastopathy. This is a benign inflammatory change, usually developing as a result of hormonal disorders. Its signs are lumps in the chest, pain, and discharge from the nipples. Breast diseasesNodular mastopathy is considered more dangerous than diffuse mastopathy; it quite often requires surgical treatment. Mammologists advise being as attentive as possible to the prevention of hormonal disorders, especially if mastopathy has already been identified before. There is a hypothesis according to which oncological diseases mammary glands, as a rule, appear with mastopathy. A form of breast disease called a mammary cyst is also quite common. This disease also usually occurs due to hormonal imbalance; a strong risk factor, in particular, is misuse oral contraceptives. As a result, fluid-filled cavities form in the chest. Treatment consists of removing fluid from the affected area using a special needle, but it does not exclude recurrence of the disease. It is not surprising that the most feared disease of the mammary glands is cancer. The situation is complicated by the fact that in the first stages the disease may either not manifest itself at all, or produce symptoms reminiscent of signs of the development of mastopathy. That is why, at the slightest suspicion of the presence of cancer cells, it is necessary to undergo additional research: blood test, mammography, ultrasound biopsy. This will help correct positioning diagnosis.

Tumor disintegration is a fairly common phenomenon and can be observed in most patients with malignant neoplasms. This process leads to an even greater deterioration in the well-being of patients and poisoning of the body harmful products exchange and even the emergence of life-threatening conditions.

Tumor decay means the death of cancer cells, which are destroyed and release toxic metabolic products. Is it good or bad? It’s difficult to answer unequivocally.

On the one hand, against the background of decay, severe intoxication occurs, on the other hand, this is most often the result of treatment, which is designed to destroy cancer cells Therefore, this process can be considered a natural manifestation of antitumor therapy.

However, it must be borne in mind that during this period patients may need emergency help Therefore, constant monitoring in a hospital setting is necessary.

Decay malignant tumor may occur spontaneously or under the influence specific therapy, as mentioned above. Spontaneously, that is, by itself, the tumor often disintegrates large sizes, since the vessels may simply not be able to keep up with the increase in cell mass, and then a disruption of the blood supply, hypoxia and necrosis is inevitable. Neoplasms located on the skin or in the mucous membrane of the stomach and intestines can be injured mechanically by the action of hydrochloric acid and enzymes, so the risk of their destruction is especially high. Some tumors, in particular Burkitt's lymphoma and leukemia, are themselves prone to tumor decay, and this must be taken into account when treating such patients.

Necrosis of cancer cells provokes the development of the so-called rapid tumor decay syndrome (tumor lysis syndrome), manifested by severe intoxication. Death large number cells leads to the release uric acid and its salts, potassium, phosphates, lactic acid derivatives, which enter the bloodstream, spread throughout the body, significantly disrupt the acid-base balance and damage internal organs. A state of acidosis is created in the blood - acidification (lactic acidosis), which, coupled with dehydration, can cause serious blow on kidney function.

Metabolic changes during breakdown cancerous tumor include:

Increased levels of uric acid and its salts in the blood;
Increased phosphate concentration and decreased calcium;
Hyperkalemia – increased potassium concentration;
Acidosis (acidification) internal environment body.

Typically, the described changes accompany treatment and may persist for several days after the end of chemotherapy.

Significant amounts of uric acid circulate in the blood and its salts can lead to their closing of the lumens renal tubules, collecting ducts, which is fraught with the development of acute renal failure(OPN). The risk of such changes is especially high in patients who had any kidney disorders before the disease or the start of antitumor therapy. In addition, acidosis and dehydration both promote and aggravate the manifestations of acute renal failure.

Phosphate yield from destroyed cancer cells provokes a decrease in calcium in the blood serum, which is accompanied by convulsions, drowsiness, and an increase in potassium coming from the site of tumor growth can lead to cardiac arrhythmias, sometimes fatal.

In addition to these metabolites, cancer cells are capable of secreting enzymes and other aggressive waste products, so the process of tumor tissue breakdown can be complicated by inflammation, infection with suppuration or damage large vessel with bleeding. These complications complicate treatment, worsen the well-being of patients and can cause sepsis and severe blood loss.

Symptoms of the collapse of a malignant tumor

Symptoms of tumor tissue breakdown vary, but are very similar in most patients. This:

Severe weakness, increasing day by day;
Fatigue;
Fever;
Dyspeptic disorders - nausea, vomiting, abdominal pain, decreased or lack of appetite, stool disorders;
In case of defeat nervous system possible disturbance of consciousness up to coma, convulsions, changes in sensitivity;
Arrhythmias, against the background of acute renal failure - often ventricular, cardiac arrest is possible;
Progressive weight loss extreme degree which - cancer cachexia(exhaustion);
Changes in the skin and mucous membranes - pallor, yellowness, cyanosis with impaired liver function and microcirculation.

At different types cancer other than those described common symptoms, there may be other signs characteristic of a specific tumor location.

Thus, decay often serves as a reason for classifying the disease as the fourth stage. Massive cell necrosis, skin involvement, infection lead to the formation of large and long-lasting non-healing ulcers, which in most cases prevent the oncologist from starting antitumor therapy as quickly as possible, since the latter can further aggravate cancerous decay. While the patient is undergoing antibacterial and detoxification therapy, the tumor continues to grow and progress, often leaving no chance for surgical treatment. The issue of treating disintegrating breast tumors is very acute, especially considering the high frequency of late visits and running forms diseases among women.

Prone to disintegration large sizes, then there is a high probability of perforation of the organ wall and release of contents into abdominal cavity– peritonitis. Such peritonitis is accompanied by severe inflammation, infection of the peritoneum with digestive products and can lead to death, if the patient is not provided urgent Care. Another manifestation of the disintegration of a stomach tumor can be massive bleeding, which is manifested by vomiting with blood like “ coffee grounds", weakness, tachycardia, fall blood pressure and etc.

Disintegration is dangerous due to damage to the vessels of the intestinal wall and bleeding, and in the rectum it is possible not only to join severe inflammation, infection and suppuration, but also formation fistula tracts to other pelvic organs ( bladder, uterus in women).

Decay may allow air to enter pleural cavity(pneumothorax), massive bleeding, and discharge is added to the usual symptoms of cough, shortness of breath, pain large quantity fetid sputum of a putrid nature. and

They are prone to decay when the tumor is large in size. When cancer cells are destroyed, severe inflammation and infiltration of surrounding tissues occurs, and fistulas are formed in the bladder and rectum, through which the neoplastic process will spread to these organs. The disintegration of cancer of this localization is accompanied by severe intoxication, fever, and widespread inflammation in the pelvis.

Signs of the beginning disintegration of a malignant tumor are always an alarming “bell” that should not be ignored, so any deterioration in the patient’s well-being should be a reason to exclude this dangerous condition. It is especially important to monitor the condition of patients undergoing antitumor treatment.

Methods for correcting disorders in tumor decay syndrome

Treatment of tumor collapse syndrome should be carried out only under the supervision of a specialist and in a hospital setting. It includes:

Antiemetic drugs, sorbents, laxatives for constipation, if ineffective - enemas, which not only remove feces, but also help reduce intoxication by metabolic products.
Infusion therapy for correction acid-base balance- administration of calcium preparations, glucose solution with insulin, aluminum hydroxide with an increase in phosphates in the blood serum, sodium bicarbonate. Perhaps acidosis during tumor disintegration - the only one a justified case for the (so notoriously popular) use, but such treatment should only be carried out by a specialist and under strict control of the acid-base state of the blood.
Hemodialysis when signs of acute renal failure appear.
Antiarrhythmic therapy for cardiac arrhythmias.
In case of anemia, the administration of iron supplements is indicated.
Painkillers and anti-inflammatory drugs, which, in addition to relief pain syndrome, help reduce fever.
Good nutrition and adequate drinking regimen.

Before starting, in order to prevent complications, it is necessary drinking plenty of fluids and rehydration therapy for 24-48 hours.

With adequate prevention of tumor tissue decay syndrome, the prognosis is generally favorable, and hemodialysis in cases of developed acute renal failure practically contributes to full restoration kidney function. The key to successfully combating this dangerous phenomenon– patient vigilance and constant control from the doctor.

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment in this moment, unfortunately, they do not turn out to be.

– focal aseptic necrosis of fatty tissue of the breast with its subsequent replacement by scar tissue. Fat necrosis is characterized by the appearance of dense painful formation, deforming the mammary gland; retraction of the skin and a change in its color, which first of all makes one think about tumor processes. Diagnosis includes palpation of the mammary gland, ultrasound, mammography, and fine-needle biopsy. Treatment of fat necrosis requires sectoral resection of the breast.

ICD-10

N64.1

General information

Fat necrosis of the mammary gland (oleogranuloma, lipogranuloma, steatogranuloma) refers to non-enzymatic necrosis, most often caused by various injuries breasts According to clinical observations According to modern mammology, fat necrosis accounts for 0.6% of cases of all nodular formations of the mammary glands. Fat necrosis of the mammary glands is more common in patients with macromastia than in women with small breasts.

Traumatic factors can include accidental bruises and blows in everyday life or transport, medical procedures, and sports training. Less commonly, fat necrosis of the breast is caused by rapid weight loss or radiation therapy. IN in some cases formation of fat necrosis is noted in patients who have undergone reconstructive mammoplasty own tissues after mastectomy.

Damage to capillaries can lead to loss of blood supply local area fatty tissue. Further changes are characterized by the development of reactive inflammation in the damaged area with the formation of a demarcation zone delimiting dead tissue. After inflammation subsides, the process of fibrosis begins - the replacement of necrotic masses with connective tissue cells. In these cases, scar tissue forms at the site of necrosis. Subsequently, calcium salts may be deposited in the area of fatty necrosis of the mammary gland, causing calcification (petrification) of the necrosis focus; in some cases, processes of ossification are noted.

Symptoms of fat necrosis of the breast

The development of fat necrosis in most cases is preceded by a traumatic effect on the mammary gland. At the site of injury, a painful tumor appears, adherent to the skin, having a round shape and a dense consistency. In the future, the area of fat necrosis of the mammary gland may lose sensitivity.

The skin over the breast tumor may be cyanotic or red in color. With the formation of fatty necrosis of the mammary gland in the area of the areola, nipple retraction is possible. Unlike mastitis, with fat necrosis of the mammary gland, body temperature, as a rule, remains normal.

Dense infiltration, deformation of the mammary gland, the appearance of “dimples” on the skin, enlarged lymph nodes gives fat necrosis an external similarity to clinical picture breast cancer. In unfavorable cases, the development of fatty necrosis of the mammary gland can occur with septic melting of the lesion and sequestration.

Diagnosis of fat necrosis of the mammary gland

When diagnosing fat necrosis of the mammary gland important has the patient's indication of a recent chest injury. During palpation of the mammary gland, the mammologist easily identifies a painful lump with unclear contours, sometimes a fluctuation. Ultrasound of the breast does not reveal characteristic features fat necrosis.

A survey mammography, CT or MRI of the mammary glands reveals a nodular formation with a heterogeneous structure and heavy, uneven contours. The X-ray, tomographic and echographic picture of fat necrosis often resembles that of breast cancer. Later, when calcification occurs, the focus of fat necrosis of the mammary gland appears on mammograms in the form of spherical calcification of the “eggshell” type, which makes it possible to exclude the malignancy of the process.

For differential diagnosis, a breast biopsy (fine needle puncture or trepanobiopsy) is indicated, followed by cytological and histological examination of the obtained samples. Breast biopsy is recommended to be performed under ultrasound or x-ray guidance.

Treatment and prevention of fat necrosis of the mammary gland

Considering the irreversible focal changes in fatty tissue, as well as the difficulties of differential diagnosis in case of fat necrosis, organ-preserving sectoral resection is indicated - removal of a part (sector) of the mammary gland.

Only postoperative histological examination of the macroscopic specimen can exclude an oncological process. Microscopically, fat necrosis of the mammary gland is represented by nodular growths of granulation tissue from epithelioid cells, multinucleated giant lipophages and xanthoma cells around fat inclusions. One of the components of lipogranulomas are fatty cysts - thin-walled cavities filled with oily and serous fluid.

To prevent fat necrosis, it is necessary to avoid injuries to the mammary glands, and also promptly contact a mammologist if damage does occur. In case of injury to the mammary gland, it is necessary to give it an elevated position using a bandage.

ICD-10 code