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Djalalova Feruza Mahammatjanovna, Assistant of the Department of Oncology and Medical Radiology Mamadaliyeva Yashnar Mamasolievna, Doctor of Medical Sciences, Associate Professor Head of oncology and USD Urmanbaeva Dilbaroy Abdulkosimovna, Assistant of the Department of Oncology and Medical Radiology Akbarova Maftuna Adxamovna, Assistant of the Department of Oncology and Medical Radiology Mamarasulova Dilfuzaxon Zakirjanovna, Doctor of Medical Sciences, Associate Professor, Head of the Department of Oncology and Medical Radiology Uzbekistan, Andijan, Andijan State Medical Institute Uzbekistan, Tashkent, Tashkent Medical Academy
E-mail: [email protected]
NON-PALPABLE BREAST TUMORS AND FEATURES IN MORPHOLOGICAL APPROACHES TO DIAGNOSIS
Abstract. This review article presents the types of non-palpable breast tumors. All types of diagnostic studies of the mammary gland, and features in the morphological approaches to the diagnosis of intraductal formations of the mammary gland are given.
Keywords: Breast, tumor, diagnosis.
Breast cancer occupies the first place in the structure of cancer belongs to the nodular form. Metastasis to regional
the cancer incidence of the female population, its frequency lymph nodes, according to domestic and foreign literature,
continues to grow, especially in old age. Mortality from breast is observed in 6.2-26% [6]. These features characteristic of
cancer remains high, despite advances in treatment and im- intracystic cancer can affect the choice of surgical treatment
proving the quality of diagnosis of this pathology [3; 5; 10]. in the direction of organ-preserving operations.
Early diagnosis of breast cancer improves the quality of Traditionally, intraductal proliferation is divided into sim-
treatment and improves the prognosis of the disease. In this re- ple ductal hyperplasia, atypical ductal hyperplasia and cancer
gard, intracystic breast cancer is of undoubted interest [4; 8]. in situ. Population mammology screening requires the iden-
On the morphological basis, it is papillary, and belongs to rare tification of pathological conditions that are extremely high
forms of cancer. For the first time, papillary cancer was isolated as risk of developing invasive breast cancer. The results of further
"independent" in 1959. Its frequency, according to a number of clinical studies have shown that various intraductal prolifera-
authors [2; 6; 7] ranges from 0.3-2.2% of all breast cancer cases. tions with different frequencies pass into cancer in situ and in-
Diagnosis of intracystic breast cancer is difficult, a reli- vasive cancer. Thus, the risk of developing vasic breast cancer
able diagnosis in a clinical examination is impossible. Differ- from simple ductal hyperplasia is 1.5%, from atypical ductal
ential diagnosis of intracystic cancer with intracystic papillary hyperplasia 4-5% and cancer in situ 8-10% [1]. growths is difficult and often impossible without a combina- Simple (ordinary) ductal hyperplasia often occurs against
tion of several diagnostic methods. According to various au- the background of mastopathy and looks like the proliferation
thors, the age of patients with papillary cancer ranges from 55 of the epithelium with signs of some polymorphism inside the
years to patients older than 60 years. ducts. The ducts are unevenly sized. Characterized by a change
Intra cystic cancer is characterized by a slow rate of tumor in the normal structure of the ducts, the formation of dilated,
growth [7], which affects the degree of aggressiveness of the regular shape of the ducts around the lobules of normal struc-
disease. According to the type of tumor growth, intracystic ture. Ducts branch in the form of streams from the center of
NON-PALPABLE BREAST TUMORS AND FEATURES IN MORPHOLOGICAL APPROACHES TO DIAGNOSIS
the site of hyperplasia to the periphery. Cell proliferates can form solid areas, cribrosa structures, bridges [1; 5].
Cellular composition of proliferates polymorphic. Moreover, it should be noted that cell polymorphism is tumor. The epithelium of the ducts, despite the different size of the nuclei and different expressions of the cytoplasm, has a mature appearance. Cell polymorphism is formed by the presence of the epithelium, which is in a functional of a different state. In one duct, cells with marked signs of secretion (often the cells are located in the center of the duct), as well as signs of proliferation (usually near the basement membrane) can be marked. Epithelial cells can form 2-4 layers. The presence of microcalcifications and necrosis is not excluded. In cases where there is no true atypia of the cells, these signs should not bend the pathologist towards the diagnosis for "atypical hyperplasia" or "cancer in situ". It should be noted that necrosis and microcalcinates often imitate cancer in situ [2; 6].
Criteria for simple ductal hyperplasia. Cytological. Variability of nucleus forms with hyperchromic round and oval nucleoli, asymmetric nucleoli.
Histological. Epithelial cells tend to be irregularly located in the ducts, the variability of the distance between the nuclei is noted, the orientation of the cells is disturbed, their cytoplasm is not clearly delineated, and secretion is often detected [3]. Intercellular distances differ in size and shape, often gap-like structures are noted. An immunohistochemical study confirms the mosaic pattern of various cell patterns. Some cells express high molecular weight cytokeratin (HMW SC), such as CK 5/10/14. There is a high expression of E-cadherin. The number of cells with an estrogen receptor is higher than in normal breast tissue. Cyclin D1 was detected in 11-19% of cases of simple ductal hyperplasia [1; 4; 6].
The risk of developing invasive cancer from simple ductal hyperplasia is 2.6% over the observation period of about 14 years. It should be noted that this percentage of invasive cancer on the background of atypical ductal hyperplasia is formed in 8.3 years [7; 8]. Ordinary ductal hyperplasia is one of the morphological manifestations of hormonal changes in a woman's body.
Morphological and functional changes that occur during different periods of the menstrual cycle and pregnancy can simulate normal ductal hyperplasia, so the pathologist must have information about the condition of the woman, her age, the presence of endocrine and gynecological diseases. Be sure to meet the timing of taking a biopsy or an operation in accordance with the menstrual cycle [3; 9].
Ductal neoplasia with mild atypia. In this variant of ductal neoplasia, proliferation of the epithelium is more pronounced compared to the previous one, the cells form in the
duct from 1 to 3-5 rows, more significantly the manifestation of cell atypia. Papillary, cribrous, solid proliferates are absent.
The morphological picture in this pathology corresponds to Grade 1A ductal intraepithelial neoplasia. The risk of developing invasive cancer against the background of simple ductal atypia is higher than against the background of simple ductal hyperplasia [3].
Atypical ductal hyperplasia. This disease is characterized by a more pronounced proliferation of the epithelium, increased sign of accurate polymorphism and the appearance of atypia of varying severity. The disease is characterized by a moderate risk of developing invasive breast cancer.
The morphological picture corresponds to Grade 1B ductal intraepithelial neoplasia, in some places the ducts resemble cancer in situ G1. For atypical ductal hyperplasia, areas of simple ductal hyperplasia are required. The most important feature of any form of ductal intraepithelial neoplasia is the presence of a continuous basement membrane and a layer of myoepithelial cells. Depending on the degree of the duct of intraepithelial neoplasia, the number of epithelial cells is different [3; 9].
Intraductal papilloma. These formations are possible anywhere within the duct system from the nipple to the terminal lobular ductal unit. There are benign variants (intraductal papilloma), atypical (atypical papilloma) and malignant (intraductal papillary cancer) [2; 5; 7].
Central and peripheral variants are distinguished from intraductal papillomas, depending on localization. Central intraductal papilloma is a solitary formation, which is located, as a rule, in the subareolar zone, often in the cystic extended duct. Peripheral intraductal papillomas often multiple. Most researchers believe that single intraductal papillomas do not have a tendency to malignancy. Multiple papillomas, especially in the peripheral parts of the lobular duct system, are prone to malignancy. Great difficulties arise in the diagnosis of central intraductal papillomas, since they can be clinically accompanied by bloody nipple discharge [1; 5].
Diagnosis of papillomas includes necessarily mammography, ultrasound (US), as well as cytological examination of nipple discharge [10]. All intraductal papillomas have a common morphological code in the International Classification of Oncological Diseases - 8503/0.
Central intraductal papilloma. It is 10% of all benign lesions of the breast. More often detected in women of middle age (40-50 years). Palpable lesions are rounded formations with well-defined contours; there is a connection with the dilated large duct. Puncture biopsy allows to obtain serous contents. The size is usually large, from 3-4 mm to several centimeters.
The histological structure of the central and peripheral in-traductal papilloma is the same. However, given the large size of the central papilloma in it can be noted areas of two types:
ductal and papillary. Papillary formations are represented by a fibrovascular pedicle covered with two epithelium. The ductal component has the structure of the ductal hyperplasia described above. Tumors dominated by ductal component and sclerosis are commonly referred to as "sclerosing papilloma" [2; 5].
Peripheral intraductal papilloma. Unlike the central intraductal papilloma, this tumor develops in younger women. The clinical course often proceeds hidden. Large papilloma sizes can be palpated. Mammography often reveals multiple nodules with clear contours, and microcalcifications are possible [5].
Atypical intraductal papilloma. This form of intraductal papilloma is highlighted by its important prognostic value, because, however, against the background of atypical intraductal papi, invasive carcinomas are more common [5; 6].
Intraductal papillary carcinoma is deprived (almost all over) of the myoepithelial cell layer and is characterized by the proliferation of atypical epithelium. Often there is a multicenter growth [2; 3].
This tumor has its own morphological code in the International Classification of Oncological Diseases -8503/2.
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