Gorins A, Tournant B, Perret F, Degrelle H, Nahoul K, Kottler M L
Centre des Maladies du Sein, Hôpital Saint-Louis, Paris.
Verh K Acad Geneeskd Belg. 1991;53(2):101-18; discussion 118-20.
The mammary cyst is part of the fibro-cystic disease. Only cysts with a diameter of more than 3 mm would have a pathological significance. Its clinical symptomatology is well known. The clearing puncture is the essential diagnostic and therapeutic act. Mammography, sustained by cystography, furnishes highly worthy information. Thermography and ultra-sonography may also be useful. Its pathogeny is still being very much discussed. Hormonal factors are incriminated: hyperestrogenemia, luteal deficiency, dysprolactinemia are inconstant. They are neither necessary nor sufficient to induce the cystic disease. The titration of TeBG may perhaps open an interesting path for research. The study of intracystic steroids (among which DHEAS) furnishes instructive results. Intracystic glycoproteins, proteins and electrolytes are also the objects of promising research. Recently, the interest lying in the study of EGF, its possible relation to DHEAS and the intracystic Na/K ratio were emphasized. It is also important to notice the presence of cysts with a flat wall or with a hyperplastic wall, of the apocrine type. The psychogenic factors seem to be determining in the cystic flare-ups. The relations with breast cancer remain the fundamental problem. Although the cyst itself only exceptionally degenerates into cancer (cyst-epithelioma), the very presence of a macrocytic disease multiplies by 3 or 4 the risk of cancer. The treatment is composed of psychotherapy, tranquillizers and a clearing puncture of the strained cysts. The administration of phlebotonics, anti-prostaglandins, colostrum extracts, can give substantial results. The author gives details about the part of hormonal treatment as a function of the titrations and the severity of the case. If it appears necessary to block the gonadotropic function, Danazol is a very effective agent. Surgery has but a small place. Indication of subcutaneous mastectomy will rest upon a very severe case-selection.
乳腺囊肿是纤维囊性疾病的一部分。只有直径超过3毫米的囊肿才具有病理学意义。其临床症状众所周知。穿刺抽液是重要的诊断和治疗手段。乳腺X线摄影在囊肿造影的辅助下,能提供非常有价值的信息。热成像和超声检查也可能有用。其病因仍备受争议。激素因素被认为有影响:高雌激素血症、黄体功能不足、催乳素血症不稳定。它们既不是诱发囊性疾病的必要条件也不是充分条件。甲状腺素结合球蛋白(TeBG)的测定可能为研究开辟一条有趣的途径。对囊内类固醇(其中包括硫酸脱氢表雄酮,DHEAS)的研究提供了有启发性的结果。囊内糖蛋白、蛋白质和电解质也是有前景的研究对象。最近,对表皮生长因子(EGF)的研究兴趣增加,强调了其与DHEAS以及囊内钠/钾比值的可能关系。还需注意存在壁扁平或壁增生的顶泌汗腺型囊肿。心理因素似乎在囊肿发作中起决定性作用。与乳腺癌的关系仍然是根本问题。虽然囊肿本身极少恶变为癌症(囊肿 - 上皮瘤),但这种大囊性疾病的存在会使患癌风险增加3至4倍。治疗包括心理治疗、使用镇静剂以及对紧张的囊肿进行穿刺抽液。使用静脉活性药物、抗前列腺素、初乳提取物可能会取得显著效果。作者详细介绍了根据测定结果和病情严重程度进行激素治疗的情况。如果有必要阻断促性腺功能,达那唑是一种非常有效的药物。手术的作用很小。皮下乳房切除术的指征将基于非常严格的病例选择。