What are Bartholin glands and where are they located. How do Bartholin glands contribute to female reproductive health. What are common pathologies associated with Bartholin glands. How are Bartholin gland cysts and abscesses diagnosed and treated. What surgical considerations are important for Bartholin gland procedures. How does Bartholin gland embryology influence its structure and function. What is the blood supply and innervation of Bartholin glands.

Anatomy and Location of Bartholin Glands

Bartholin glands, also known as greater vestibular glands, are essential components of the female reproductive system. These paired glands are located in the vulvar vestibule, flanking the external vaginal orifice. Each gland is typically oval-shaped and measures approximately 0.5 cm in size. A key anatomical feature is the 2-cm long efferent duct that connects each gland to the posterolateral aspect of the vaginal opening, specifically between the hymen and labia minora.

Are Bartholin glands palpable under normal circumstances? In healthy women, these glands are non-palpable and only become active after menarche. Their discreet nature makes them undetectable during routine physical examinations unless pathological changes occur.

Function and Physiological Importance

The primary function of Bartholin glands is to produce a mucoid secretion that plays a crucial role in vaginal and vulvar lubrication. This lubrication is particularly important during sexual intercourse, as it reduces friction and enhances comfort. The secretion from these glands contributes to maintaining the delicate balance of the vaginal ecosystem.

How does the secretion from Bartholin glands differ from other vaginal secretions? While other glands in the reproductive tract produce different types of secretions, the mucoid nature of Bartholin gland secretions is specifically tailored for lubrication during sexual activity. This unique composition sets it apart from cervical mucus or general vaginal discharge.

Embryology and Development

Understanding the embryological origin of Bartholin glands provides insight into their structure and function. These glands develop from the sinus urogenitalis, which also gives rise to the lower portion of the vagina and most of its epithelium. This common origin explains the seamless integration of the glands with the surrounding reproductive structures.

What is the cellular composition of Bartholin glands? The body of each gland consists of mucinous acini lined by simple columnar epithelium. This cellular arrangement is optimized for mucus production. The efferent ducts of the glands are lined with transitional epithelium, which gradually changes to squamous epithelium as it approaches the vaginal opening. This epithelial transition facilitates the smooth release of secretions into the vaginal environment.

Blood Supply, Lymphatics, and Innervation

The vascular and nervous supply of Bartholin glands is crucial for their proper functioning and has important clinical implications. The external pudendal artery provides the primary blood supply to these glands, ensuring adequate nutrition and oxygenation for secretory function.

Where do Bartholin glands drain lymphatically? The lymphatic drainage of these glands is directed towards the superficial inguinal and pelvic lymph nodes. This drainage pattern is significant in the context of potential infections or malignancies, as it dictates the likely path of spread for pathological processes.

Regarding innervation, the pudendal nerve is responsible for supplying the Bartholin glands. This neural connection is essential for regulating glandular activity and maintaining sensitivity in the surrounding tissues.

Common Pathologies and Clinical Presentations

Bartholin gland pathologies can manifest in various ways, ranging from asymptomatic to severely symptomatic conditions. One of the most common presentations is the formation of cysts or abscesses, which typically occur in women of reproductive age.

• Asymptomatic masses: These may cause vulvar asymmetry without other symptoms.
• Symptomatic masses: Can present with severe tenderness, surrounding erythema, and edema.
• Cysts: Fluid-filled sacs that may develop due to duct blockage.
• Abscesses: Infected cysts that can cause significant pain and discomfort.

How can healthcare providers differentiate between a Bartholin gland cyst and abscess? Cysts are typically painless or mildly uncomfortable, while abscesses are often associated with severe pain, redness, and swelling. Additionally, patients with abscesses may experience fever and general malaise due to the infectious process.

Diagnostic Approaches and Treatment Options

Diagnosing Bartholin gland pathologies often involves a combination of clinical examination and, in some cases, imaging studies. Treatment options vary depending on the severity and nature of the condition.

Diagnostic Methods:

• Physical examination
• Ultrasonography (in some cases)
• Biopsy (if malignancy is suspected)

Treatment Options:

1. Conservative management for asymptomatic cysts
2. Incision and drainage with Word catheter placement
3. Marsupialization
4. Surgical excision
5. Carbon dioxide laser therapy
6. Silver nitrate ablation

When is surgical intervention necessary for Bartholin gland pathologies? Surgical procedures are typically reserved for cases where conservative treatments have failed, or when there’s a suspicion of malignancy. The choice of surgical approach depends on factors such as the size of the cyst or abscess, recurrence, and patient preferences.

Surgical Considerations and Techniques

Surgical interventions for Bartholin gland pathologies require careful consideration and precise techniques to ensure optimal outcomes. Here are some key surgical approaches:

1. Incision and Drainage with Word Catheter Placement:

This procedure involves making a small incision in the cyst or abscess after applying local anesthesia. A Word catheter (a thin rubber tube with an inflatable balloon tip) is then inserted to allow continuous drainage and promote the formation of a new outflow tract. The catheter can remain in place for up to four weeks.

2. Marsupialization:

In this technique, an elliptical incision is made in the vulvar mucosa and the underlying cyst wall. After draining the contents, the edges of the cyst cavity are sutured to the surrounding skin, creating a permanent open pocket. This new outflow tract gradually shrinks as it heals.

3. Surgical Excision:

This more invasive procedure involves completely removing the Bartholin gland. It’s typically performed when other treatments have failed or if there’s a suspicion of malignancy. The procedure requires careful dissection to separate the cyst or abscess from surrounding structures, followed by ligation of the blood supply and multi-layer closure of the surgical site.

What precautions should surgeons take during Bartholin gland procedures? It’s crucial to avoid incising on the outer margin of the labium majus due to the risk of fistula formation. Additionally, care must be taken to preserve surrounding structures and minimize bleeding during dissection.

Emerging Treatment Modalities

As medical technology advances, new treatment options for Bartholin gland pathologies are emerging. These novel approaches aim to provide effective treatment with minimal invasiveness and reduced recovery time.

Carbon Dioxide Laser Therapy:

This outpatient procedure uses laser energy to vaporize the cyst. Research by Fambrini M et al. has shown that CO2 laser vaporization is a safe and effective method for treating Bartholin cysts completely. The precision of laser therapy allows for targeted treatment with minimal damage to surrounding tissues.

Silver Nitrate Ablation:

Following cyst drainage, silver nitrate can be applied to the cyst cavity. A prospective randomized trial demonstrated that this method was as effective as marsupialization and resulted in less scar formation. This approach offers a balance between efficacy and cosmetic outcomes.

Experimental Techniques:

Other procedures, such as cyst fenestration and needle aspiration with or without alcohol sclerotherapy, are being explored. While these methods show promise, they require further clinical research to establish their long-term efficacy and safety profiles.

How do these emerging treatments compare to traditional surgical approaches? Emerging treatments often offer the advantages of being less invasive, having shorter recovery times, and potentially causing less scarring. However, their long-term effectiveness, especially for recurrent cases, is still being evaluated compared to established surgical techniques.

Impact on Sexual Function and Quality of Life

Bartholin gland pathologies and their treatments can have significant implications for a woman’s sexual function and overall quality of life. Understanding these impacts is crucial for comprehensive patient care.

Does surgical removal of Bartholin glands affect sexual function? Interestingly, studies have shown that the surgical removal of Bartholin glands does not typically interfere with sexual function. This is likely due to the presence of other lubrication mechanisms in the female reproductive system. However, the psychological impact of surgery and recovery can temporarily affect sexual well-being.

Cysts and abscesses can cause discomfort during sexual activity, leading to decreased libido and sexual satisfaction. Prompt and effective treatment is essential to minimize these impacts. Additionally, recurrent infections or persistent symptoms can lead to anxiety and reduced confidence in intimate situations.

It’s important for healthcare providers to address these psychosocial aspects when managing Bartholin gland conditions. Open communication about sexual health concerns and providing reassurance about the expected outcomes of treatment can greatly improve patient satisfaction and overall quality of life.

Future Research Directions and Unanswered Questions

While our understanding of Bartholin glands and their pathologies has advanced significantly since their first description by Caspar Bartholin Secundus in 1677, there remain several areas that warrant further investigation.

• Long-term outcomes of different treatment modalities
• Genetic factors influencing susceptibility to Bartholin gland disorders
• Role of microbiome in recurrent infections
• Development of targeted, minimally invasive therapies
• Potential applications of regenerative medicine in gland restoration

What are the most pressing research questions regarding Bartholin glands? One key area is understanding the factors that predispose certain women to recurrent cysts or abscesses. Another important focus is developing more effective preventive strategies to reduce the incidence of these conditions.

Advancements in imaging technologies may also lead to improved diagnostic accuracy, particularly in differentiating benign cysts from rare malignancies. Furthermore, exploring the potential role of Bartholin glands in overall vaginal health beyond lubrication could open new avenues for women’s health research.

As our knowledge expands, it’s likely that more personalized treatment approaches will emerge, taking into account individual patient factors such as age, reproductive status, and specific pathology characteristics. This tailored approach could significantly improve outcomes and patient satisfaction in the management of Bartholin gland disorders.

Anatomy, Abdomen and Pelvis: Bartholin Gland – StatPearls

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Last Update: January 16, 2023.

Introduction

The Bartholin’s glands (or greater vestibular glands) are important organs of the female reproductive system. Danish anatomist Caspar Bartholin Secundus first described them in 1677.[1] Their primary function is the production of a mucoid secretion that aids in vaginal and vulvar lubrication. The glands are located in the vulvar vestibule, at either side of the external orifice of the vagina. They are homologous to the bulbourethral (Cowper’s) glands in males.

Bartholin gland pathology may present as an asymptomatic mass, causing only vulvar asymmetry. Symptomatic masses may exhibit severe tenderness, surrounding erythema, and edema. Cysts and abscesses often form in women of reproductive age and do not require treatment. Rarely, mass biopsy and excision may be necessary if malignancy is suspected.

Structure and Function

The primary function of the Bartholin glands is the production of a mucoid secretion that lubricates the distal end of the vagina during intercourse. The glands become active after menarche and are non-palpable. Each gland is oval-shaped and measures, on average, 0.5 cm. A two-centimeter-long efferent duct connects each gland to the posterolateral aspect of the vaginal orifice (between the hymen and the labia minora).[2]

Embryology

During embryogenesis, the sinus urogenitalis gives rise to the Bartholin glands, the inferior part of the vagina, and the majority of its epithelium. The body of each Bartholin gland is composed of mucinous acini lined by simple columnar epithelium. Their efferent ducts are composed of transitional epithelium, which merges into squamous epithelium as the orifices open into the vagina. [3]

Blood Supply and Lymphatics

The external pudendal artery provides the blood supply to the Bartholin glands. Both glands drain into the superficial inguinal and pelvic lymph nodes.[2]

Nerves

The pudendal nerve innervates the Bartholin glands.[2]

Surgical Considerations

Incision and Drainage plus Word Catheter Placement

A scalpel is used to perform a medial incision into the cyst/abscess after the application of a local anesthetic. The incision should not be performed on the outside of the labium majus due to the risk of fistula formation.[4] A Word catheter (a small, thin rubber tube with an inflatable balloon tip) is placed inside the cyst after removing its contents. The catheter can remain in place for up to four weeks for continuous drainage and re-epithelization of the new outflow tract.

Marsupialization

A scalpel is used to perform an elliptical incision in the mucosa of the vulva and the underlying cyst wall. Care should be taken not to incise on the outer margin of the labium majus due to the risk of fistula formation. After draining the contents of the open cavity, the edges of the cyst cavity are sewn to the surrounding skin. This procedure forms a permanent open pocket, and the new outflow tract will shrink over time as it heals. 

Surgical Excision

Excision of a Bartholin cyst or abscess may be required when office-based treatments fail. Possible complications include an increased risk of bleeding, post-surgical infection, pain secondary to scar tissue, and complications from general anesthesia. The surgical removal of Bartholin glands has not been shown to interfere with sexual function.[5] A specialist should perform this procedure.

The surgeon uses a scalpel to perform an elliptical incision in the mucosa of the vulvar. Care is necessary not to incise into the cyst/abscess. Dissection using sharp and blunt methods separates the cyst/abscess from the surrounding structures. At the base of the cyst of the Bartholin gland is identified. The blood supply can be ligated using either cautery or suture. Then the cyst/abscess can be removed entirely. Utilizing a multi-layer closure, the space where the Bartholin cyst/abscess was is closed with interrupted sutures. The mucosal layer is closed with a simple running suture.

Other Treatment Methods

Carbon dioxide laser therapy can provide cyst vaporization in the outpatient setting. A study by Fambrini M et al. has concluded that CO2 laser vaporization is a safe and effective way to treat a Bartholin cyst completely.[6] Silver nitrate ablation following cyst drainage was as effective as marsupialization and caused less scar formation in a prospective randomized trial.[7] Procedures such as cyst/abscess fenestration and needle aspiration with or without alcohol sclerotherapy require further clinical research.

Clinical Significance

Bartholin gland cysts, abscesses, and masses may significantly affect a woman’s life. Pain and swelling can prevent sitting, walking, and intercourse. The diagnosis of Bartholin cysts and abscesses is often clinical. Atypical masses may require further imaging (such as magnetic resonance), tissue biopsy, or complete excision.

Bartholin Gland Cyst

Bartholin gland cysts account for approximately 2% of all gynecological visits every year.[8] A cyst may form as a result of efferent duct obstruction, leading to the accumulation of mucous and distension of the gland. Cysts are frequently sterile and unilateral. They present as painless masses usually detected during a routine pelvic examination. Rarely, larger cysts may cause sexual discomfort or vulvar disfiguration.

Asymptomatic cysts in healthy patients may receive conservative treatment.[9] A cyst that ruptures and drains spontaneously may only require hot sitz baths. In some cases, cysts may become enlarged and painful or infected. Treatment options are available for symptom relief as well as cosmetic concerns. Antibiotics may be necessary in the event of secondary infection. Postmenopausal patients may need further investigations to rule out the possibility of cancer.

Bartholin Gland Abscess

Bartholin gland abscesses may result from either an infected cyst or a primary gland infection. They typically present with severe pain and swelling, making sitting, walking, and sexual intercourse difficult. Other presenting signs and symptoms may include:

• An acute, painful, unilateral vulvar swelling

• Erythema and edema surrounding a fluctuating vulvar mass

• Sudden symptom relief following spontaneous mass discharge/rupture

• Pyrexia is not a common feature in healthy patients

A study by Kessous et al. has described the most common microbial pathogens associated with Bartholin abscesses. Escherichia Coli was the most commonly found pathogen (43.6%), followed by Staphylococcus aureus (6.4%), group B Streptococci (4. 8%), and Enterococcus spp (4.8%). Less than 10% of cases were polymicrobial in origin. E. Coli-positive cultures were more common in recurrent infections (56.8%) than in primary infections (37%).[10] Sexually transmitted infections were seldom causative, but testing for chlamydial and gonococcal infection remains important in susceptible patients. Broad-spectrum antibiotic coverage is advisable in the absence of microbial sensitivities.[4]

There are numerous options available for the treatment of symptomatic Bartholin cysts or abscesses. The most common interventions include incision, drainage with Word catheter placement, and abscess marsupialization. A systematic review by BJG Illingworth et al. found that current randomized trial evidence does not support the use of any single surgical method.[11] The outcomes of other interventions, such as rubber ring catheter insertion, cavity closure, and alcohol sclerotherapy, have yet to be sufficiently studied.

Bartholin cysts and abscesses can very rarely lead to complex and poorly understood complications such as a rectovaginal fistula or a recto-Bartholin’s duct fistula. [12]

Bartholin Gland Benign Tumor

Benign solid lesions of the Bartholin gland rarely appear in the literature. Histopathology of excised glands includes nodular hyperplasia and adenomas.[13][14]

Bartholin Gland Carcinoma

Primary carcinoma of the Bartholin gland is rare, accounting for 1 to 5 percent of all vulvar malignancies.[15][16] Its incidence is highest in women in their 60’s.[2] Atypical presentations should raise suspicion of a possible carcinoma, and it merits consideration in the differential diagnosis of any enlarging asymptomatic vulvar mass in a postmenopausal woman. Malignant masses may also be fixed to the underlying tissues.

A retrospective cohort study concluded that Bartholin mass excision in postmenopausal women is not justified as a first-line treatment since the incidence of cancer is so low (0.114 per 100,000 woman-years). These patients may benefit from mass drainage and selective biopsy.[17]

Adenocarcinomas and squamous cell carcinomas are the two most common histological types of primary Bartholin gland carcinoma. Other more rare types are transitional, adenoid-cystic, and undifferentiated carcinomas. Human papillomavirus (HPV) type 16 has previously been detected via polymerase chain reaction in squamous cell carcinomas.[18]

Other Issues

A retrospective cohort study found the incidence of Bartholin gland abscesses to be low (0.13%) during pregnancy. There was no significant difference in pathogens found in culture-positive samples of pregnant and non-pregnant women.[19]

Review Questions

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Figure

Bartholin’s Gland. Illustration by Emma Gregory

References

1.

Bora SA, Condous G. Bartholin’s, vulval and perineal abscesses. Best Pract Res Clin Obstet Gynaecol. 2009 Oct;23(5):661-6. [PubMed: 19647493]

2.

Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A. Clinical Pathology of Bartholin’s Glands: A Review of the Literature. Curr Urol. 2015 May;8(1):22-5. [PMC free article: PMC4483306] [PubMed: 26195958]

3.

Heller DS, Bean S. Lesions of the Bartholin gland: a review. J Low Genit Tract Dis. 2014 Oct;18(4):351-7. [PubMed: 24914884]

4.

Hill DA, Lense JJ. Office management of Bartholin gland cysts and abscesses. Am Fam Physician. 1998 Apr 01;57(7):1611-6, 1619-20. [PubMed: 9556648]

5.

Aydogan Mathyk B, Aslan Cetin B, Cetin H. Sexual function after Bartholin gland abscess treatment: A randomized trial of the marsupialization and excision methods. Eur J Obstet Gynecol Reprod Biol. 2018 Nov;230:188-191. [PubMed: 30308402]

6.

Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, Scarselli G, Marchionni M. Carbon-dioxide laser vaporization of the Bartholin gland cyst: a retrospective analysis on 200 cases. J Minim Invasive Gynecol. 2008 May-Jun;15(3):327-31. [PubMed: 18439506]

7.

Ozdegirmenci O, Kayikcioglu F, Haberal A. Prospective Randomized Study of Marsupialization versus Silver Nitrate Application in the Management of Bartholin Gland Cysts and Abscesses. J Minim Invasive Gynecol. 2009 Mar-Apr;16(2):149-52. [PubMed: 19598336]

8.

Marzano DA, Haefner HK. The bartholin gland cyst: past, present, and future. J Low Genit Tract Dis. 2004 Jul;8(3):195-204. [PubMed: 15874863]

9.

Lee WA, Wittler M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 30, 2023. Bartholin Gland Cyst. [PubMed: 30335304]

10.

Kessous R, Aricha-Tamir B, Sheizaf B, Shteiner N, Moran-Gilad J, Weintraub AY. Clinical and microbiological characteristics of Bartholin gland abscesses. Obstet Gynecol. 2013 Oct;122(4):794-799. [PubMed: 24084536]

11.

Illingworth B, Stocking K, Showell M, Kirk E, Duffy J. Evaluation of treatments for Bartholin’s cyst or abscess: a systematic review. BJOG. 2020 May;127(6):671-678. [PubMed: 31876985]

12.

Kim YS, Han HS, Seo MW, Kim WS, Lee JH, Park NK, Sang JH. Recto-Bartholin’s duct fistula: a case report. Gynecol Obstet Invest. 2015;79(2):136-8. [PubMed: 25633604]

13.

Hjortø SP, Pehrson C, Gernow A. [Nodular hyperplasia of the Bartholin gland]. Ugeskr Laeger. 2010 Mar 22;172(12):969-70. [PubMed: 20334800]

14.

Tseng YA, Lawrence WD, Slater SE. Nodular Hyperplasia of the Bartholin Gland, A Benign Mimicker of Aggressive Angiomyxoma: A Case Series and Literature Review. Int J Gynecol Pathol. 2018 Nov;37(6):554-558. [PubMed: 28914673]

15.

Wu JC, Xi ML, Wang YQ, Tang WB, Zhang YQ. Primary small cell neuroendocrine carcinoma of the Bartholin’s gland: A case report. Oncol Lett. 2018 Oct;16(4):4434-4438. [PMC free article: PMC6126345] [PubMed: 30197672]

16.

Heine O, Vahrson H. [Primary cancer of Bartholin’s gland]. Geburtshilfe Frauenheilkd. 1987 Jan;47(1):35-40. [PubMed: 3569825]

17.

Visco AG, Del Priore G. Postmenopausal bartholin gland enlargement: a hospital-based cancer risk assessment. Obstet Gynecol. 1996 Feb;87(2):286-90. [PubMed: 8559540]

18.

Felix JC, Cote RJ, Kramer EE, Saigo P, Goldman GH. Carcinomas of Bartholin’s gland. Histogenesis and the etiological role of human papillomavirus. Am J Pathol. 1993 Mar;142(3):925-33. [PMC free article: PMC1886794] [PubMed: 8384409]

19.

Boujenah J, Le SNV, Benbara A, Bricou A, Murtada R, Carbillon L. Bartholin gland abscess during pregnancy: Report on 40 patients. Eur J Obstet Gynecol Reprod Biol. 2017 May;212:65-68. [PubMed: 28342391]

Disclosure: Catarina Quaresma declares no relevant financial relationships with ineligible companies.

Disclosure: Paul Sparzak declares no relevant financial relationships with ineligible companies.

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Structure of glands – Exocrine – Endocrine – Histology

• 1 Exocrine Glands
• 2 Clinical Relevance – Cystic fibrosis
• 3 Endocrine Glands
  • 3.1 Pituitary Gland
  • 3.2 Pancreas

Glands are collections of secretory epithelial cells. This article discusses the structure of the two main types of glands (exocrine and endocrine).

Exocrine Glands

Exocrine glands secrete onto a surface and possess ‘ducts’ lined with epithelium; they can either be simple or compound.

• Simple glands – these have a single, unbranched duct. Examples include sebaceous glands, intestinal crypts and uterine glands.
• Compound glands – these have multiple, branched ducts. Examples include the salivary glands and the pancreas.

Exocrine glands are classified by the shape of their secretory unit:

• Tubular glands – these have secretory units that resemble a tube-like shape and are found in the uterus, alimentary tract and sweat glands.
• Acinar  (alveolar) glands – these have a more rounded secretory unit and are found in the breast.

Secretory units of both shapes, are referred to as a tubuloacinar or tubuloalveolar gland. They are found in the pancreas and salivary glands.

Exocrine glands can have mucous, serous or mixed secretions; mucous glands secrete a glycoprotein mixture (mucus), serous glands produce a watery fluid containing a variety of enzymes and finally, mixed glands secrete a mixture of both mucous and serous secretions.

By CNX OpenStax, [Creative Commons 3.0] via Wikimedia Commons

Figure 1 – Diagram to show the different types of exocrine gland

Clinical Relevance – Cystic fibrosis

Cystic Fibrosis is an autosomal recessive genetic disorder, where a mutation in the CFTR gene leads to defective chloride channels in the exocrine glands of the body.

Secretions become hyperviscous and causes signs and symptoms such as salty-tasting skin, poor growth, accumulation of thick mucus, coughing and shortness of breath. There is no known cure for Cystic Fibrosis and so treatment is mainly symptomatic management.

Endocrine Glands

Endocrine glands are ductless and release their secretions (hormones) directly into the bloodstream. These form the basis of the endocrine system, which relies heavily on the right level of hormones secreted throughout the body.

Examples of endocrine glands include the pituitary gland, pancreas, adrenal glands, the thyroid gland and parathyroid glands.

Pituitary Gland

The pituitary gland is an important gland of the endocrine system that secretes a number of hormones which target different organs to regulate vital body functions and general wellbeing. It sits below the hypothalamus and consists of the anterior (adenohypophysis) and posterior (neurohypophysis) pituitary.

The anterior pituitary secretes the following hormones:

• Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH)
• Growth Hormone
• Prolactin
• Thyroid Stimulating Hormone (TSH)
• Adrenocorticotrophic Hormone (ACTH)

The posterior pituitary secretes the following hormones:

• Oxytocin
• Antidiuretic Hormone (ADH)

Pancreas

The pancreas has both endocrine and exocrine functions:

• The endocrine pancreas regulates glucose levels in the body by secreting the hormones glucagon, insulin, somatostatin, gastrin and pancreatic polypeptide.
• The exocrine pancreas secretes an alkaline fluid, containing enzymes (such as trypsinogen and lipase) and bicarbonate ions, into the duodenum through the pancreatic duct.

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glands. Great Russian Encyclopedia

Organs

Glands, animal and human structures that produce and secrete (secreting) specific substances that play an important role in the life of organisms. Glands can be represented by: individual cells (for example, goblet cells in the composition of the epithelium), independent anatomically separate organs (for example, the thyroid gland), part of an organ (for example, the glands of the stomach). There are exocrine glands, or glands of external secretion, which secrete their products (secrets) through the excretory ducts to the surface of the body or mucous membranes, and endocrine glands, or endocrine glands, which secrete their products (hormones) directly into the blood or lymph. Diagram of the structure of the exocrine gland.
BDT. T. 10. Scheme of the structure of the exocrine gland.
BDT. T. 10. Some glands selectively absorb certain substances from the blood (for example, end products of metabolism), concentrate them and remove them from the body, thereby preventing its poisoning (liver, kidneys, sweat glands, partly lacrimal glands).

Exocrine glands and most of the endocrine glands develop as derivatives of the epithelium, some endocrine glands from other tissues. For example, the interstitial cells of the sex glands involved in the production of sex hormones develop from the mesenchyme, the chromaffin cells of the adrenal medulla, which produce catecholamines, are modified nerve cells; neuroglia participate in the formation of some endocrine glands (pineal gland, posterior pituitary gland).

The secretions of most glands (eg, parotid, pancreas) are chemically proteins and are secreted as serous fluids (protein or serous glands). Mucous glands (eg, glands in the esophagus or uterus) produce glycoproteins (mucins and mucoids). The secrets of some glands (including sebaceous) contain lipids. Some, so-called. heterocrine glands produce simultaneously both protein and mucous secretions.

In the course of evolution of organisms there was a concentration of glandular cells with the formation of glandular fields and more complex structures. With an increase in the number of glandular cells in certain areas of the epithelial layer, they penetrate into the underlying connective tissue and form a glandular fossa, which, in the course of further development, takes the form of a separate tube. In the depths of this tubule, the terminal secretory section, or adenomere, of the developing gland differentiates, and the part of the glandular tube that goes to the surface of the epithelium becomes the excretory duct. In simple glands, each adenomere passes into an unbranched excretory duct, in complex glands, the excretory duct branches and each branch ends with its own adenomere, which can also branch. Both simple and compound glands are tubular (eg, sublingual gland) or alveolar (eg, pancreas and parotid glands). Sometimes in the same complex gland, some adenomeres are tubular, while others are alveolar (for example, the submandibular gland). In rare cases, tubular adenomeres, branching, are interconnected into a loose network, and the gland becomes a complex mesh structure (for example, the liver, the anterior pituitary gland).

In simple glands with branched adenomeres and in complex glands with a large number of adenomeres, the gaps between them are filled with connective tissue, in which blood vessels and nerves pass. Thus, in large multicellular glands, a parenchyma is distinguished, which is of epithelial origin and forms the terminal sections and excretory ducts, and a connective tissue stroma, which nourishes and supports the parenchyma. A prolonged weakening of the functional activity of the glands leads to atrophy of the parenchyma cells, and the stroma begins to replace it (sclerosis of the gland).

According to the nature of secretion, apocrine glands are distinguished (the secretion occurs with the separation of the terminal part of the secretory cell), holocrine glands (the formation of a secret is associated with the complete destruction of cells) and merocrine glands (the secret is released without destruction of the glandular cells).

Iordansky Nikolai Nikolaevich. First publication: Great Russian Encyclopedia, 2008. Publication date: July 5, 2022 at 11:22 am (GMT+3)

Breast cancer – symptoms, signs.

Have you been diagnosed with breast cancer?
Surely you are wondering: what to do now?

Such a diagnosis always divides life into “before” and “after”. All the emotional resources of the patient and his family are thrown into experiences and fear. But it is at this moment that it is necessary to change the vector “for what” to the vector “what can be done”.

Very often, patients feel overwhelmingly alone at the beginning of the journey. But you must understand that you are not alone. We will help you cope with the disease and will go hand in hand with you through all stages of your treatment.

Here is a brief but very detailed overview of breast cancer.

It was prepared by highly qualified specialists of the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin and the Department of Oncoplastic Surgery of the Herzen Moscow Research Institute of Oncology, the Department of New Medical Technologies with a Group for the Treatment of Breast Cancer – branches of the National Medical Research Center for Radiology of the Ministry of Health of Russia, edited by the heads of departments Aziz Zikiryakhodzhaeva, Evgeny Troshenkov and Mrina Kiseleva.

This booklet provides information about the diagnosis and treatment of breast cancer. Here are collected the main methods of treating this disease, including the latest developments of domestic and foreign oncologists.

More than 70,000 new cases of breast cancer are diagnosed in Russia every year. Even more depressing are the death rates from this cancer. Every year the Russian Federation loses more than 22,000 of its women, many of whom were of reproductive age.

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Overview of breast cancer

Malignant neoplasms are one of the main causes of death and disability in the population of developed, and in recent years, developing countries. Economic losses are associated with significant costs for social security and insurance due to the high cost of treatment, preventive and rehabilitation measures, long-term, often irreversible disability. In the structure of the incidence of malignant neoplasms of the female population of Russia in 2017, breast cancer was 21. 1%. The cumulative risk of developing breast cancer increased from 4.81 to 6.02 from 2007 to 2017. Among women of the most socially active category (aged 20 to 59years) breast cancer was diagnosed in 30,818 cases in 2017, which accounted for 43.7% of the total number of newly diagnosed cases (70,569). In 2017, the number of patients diagnosed with stages I-II of the disease was 69.9%. . However, does breast cancer always mean a sentence? Of course not, because modern medicine has developed many effective ways to treat this disease. However, much depends on the woman herself. After all, the ability to recognize the symptoms of the disease in time will facilitate the process of healing the patient for doctors.

Prevalence of breast cancer

Breast cancer has been known since ancient civilizations. For example, a disease that has a typical set of signs of breast cancer is described in ancient Egyptian papyri. In that era, the disease was considered incurable and leading to quick death. However, in earlier times this ailment was most likely a rarity. Currently, there is a rapid increase in the number of cases. Statistics say that in developed countries, approximately one in ten women is faced with breast cancer. Every year, only in Russia, malignant tumors in this organ are found in 50,000 women. And worldwide this number exceeds one million. And the statistics on survival are also disappointing so far. Almost half of the cases in women are fatal.

Description of breast cancer

The mammary gland is a paired organ that is a hallmark of the mammalian class, to which humans also belong. The ability to feed their offspring with milk containing easily digestible nutrients has given mammals a huge competitive advantage over other branches of the animal kingdom. However, you have to pay for everything. The mammary glands are also complex organs, whose work depends on the effects of sex hormones. The slightest deviations in the biochemical processes occurring in the body affect the mammary gland.

This organ is made up of many lobes of alveoli that produce milk. Through special ducts, milk enters the nipple, where it is secreted during lactation. Also in the chest there is a lot of adipose and connective tissue, there are blood and lymphatic vessels.

Women are well aware that their breasts are subject to various diseases – mastitis and mastopathy. Not uncommon and benign tumors of the mammary glands, for example, adenomas. Under certain circumstances, they can degenerate into malignant ones. However, breast cancer can also appear on its own, without being associated with other diseases. The tumor, in fact, is a conglomerate of overgrown glandular cells, constantly growing and spreading its pathogenic influence on other organs.

It should be noted that the mammary glands are by no means a female privilege, unlike other female reproductive organs. Under the nipples of a man, glands are hidden in the same physiological sense as in women, although many men are not aware of this. However, unlike women, the glands in men are in a “sleeping” state and are not active, since female hormones are needed to activate the glands. However, the similarity of male breasts to female breasts means that men can also suffer from breast tumors. Cancer of this organ, however, is observed in the stronger sex about 100 times less often than in women.

In terms of nosology, malignant tumors of the breast are represented by two main varieties – ductal carcinoma and lobular carcinoma. In total, there are more than 20 types of tumors that form in the tissues of the mammary glands. Tumors can be invasive, that is, spread very quickly to other tissues and non-invasive. Also, cancerous tumors are divided into those that are susceptible to female hormones and actively respond to them, and those that are not susceptible to hormones. The last category of breast tumors is considered the most difficult to treat.

Causes of breast cancer

As with many other cancers, the exact causes of breast cancer are still unknown. However, there is an assumption that cancer of this organ is largely associated with a violation of the hormonal balance in the body, primarily with an increase in estrogen levels above normal. According to this theory, the following women fall into the risk group:

• who have never given birth to children,0077
• who had multiple abortions,
• who took estrogens for a long time,
• who started menstruating early,
• who had a late menopause (at 50 and older).

The significance of these factors is easily explained – the more a woman had menstrual cycles, the more her body is exposed to estrogens during her life. Estrogens stimulate the regeneration of tissues in many organs, including the mammary glands, which means that the likelihood of mutations in these tissues increases.

Also, in some cases, breast cancer is a genetic disease. Genes have been found, damage to which with a 50% probability causes disease in their carriers. However, genetically determined cancer accounts for only a small proportion of all cases of the disease.

The following women are also likely to be at risk:

• older women who have entered menopause;
• suffering from oncological diseases of other organs;
• who had benign breast tumors;
• obese, diabetic, arterial hypertension, atherosclerosis;
• having bad habits – using nicotine and alcohol;
• having been in contact with carcinogens or frequently exposed to radiation;
• eating large amounts of animal fats.

There is also a theory linking many cases of breast tumors with the negative effects of certain viruses.

Sometimes there is an opinion that mechanical injuries of the breast can lead to malignant tumors of the mammary glands. However, in fact, there is no substantiated evidence of such a relationship.

Most breast cancers occur in older women. The peak of the disease falls on 60-65 years. The proportion of women under 30 who have been diagnosed with the disease is small. And in most cases, their tumor is not particularly aggressive. And in adolescent girls, the disease occurs only in isolated cases.

Diagnosis of breast cancer

Breast cancer is one of the few cancers where self-diagnosis is extremely effective. This means that a woman can often detect a tumor herself when examining her mammary glands. In this case, it is necessary to know only a set of symptoms that accompany this disease. Indeed, in about 70% of cases of breast tumors, suspicious masses were initially discovered by the patients themselves, and not detected during a medical examination.

Therefore, every woman should make a habit of self-examination of her breasts. This procedure is simple and should be carried out every month after the end of menstruation.

When examining, priority attention should be paid to the following parameters:

• symmetry of the breasts,
• their size,
• skin color,
• skin condition.

If a suspicious symptom or formation of an incomprehensible nature is detected, then you should consult a mammologist. He will perform a manual breast examination and may prescribe additional procedures such as ultrasound, mammography (x-ray of the breast area), ductography (mammography with a contrast agent). If suspicions of the malignancy of the formation still remain, then a biopsy is performed followed by a study of the cellular material. A blood test for tumor markers is also performed.

Symptoms of breast cancer

As mentioned above, a woman can often determine whether everything is okay with her breasts during a self-examination. However, for this it is necessary to know the set of symptoms that accompanies cancer.

It should be borne in mind that pain is not the defining symptom in this case. Breast tumors in most cases develop in the early stages almost painlessly. If a woman, during self-examination, finds a painful induration, then in most cases it is a benign formation.

However, there are exceptions to this rule. Symptoms of erysipelatous, shell and inflammatory diffuse tumors usually include severe chest pain. These forms of the disease are also often characterized by a set of symptoms such as high fever and inflammation, which can be confused with some kind of infectious disease. A sign of such tumors is the absence of clear boundaries and rapid spread over a large area. In the shell-like form of cancer, the tumor can compress the surface of the breast, due to which it decreases in size.

The main signs of breast cancer are a hard surface and uneven contours of the tumor. Smooth and round tumors, as a rule, are benign formations. Usually, a malignant tumor is immobile and only slightly shifts when pressed. Another symptom of a tumor is a change in the appearance of the skin located above it. The skin may retract and wrinkles and folds may form.

As the disease progresses, cancer cells can enter the lymph nodes, which can cause them to grow in size. These signs – an increase in lymph nodes, their uneven surface, should also be alarming. In most cases, lymph nodes affected by cancer cells remain painless.

In addition, a common symptom of gland tumors is discharge from the nipples, not associated with lactation. These secretions are usually pathological and contain blood or pus.

TNM breast cancer staging system

Also, breast cancer stages are often indicated according to the TNM system, in which the T index determines the size of the tumor, N – the degree of lymph node damage, M – the presence of distant metastases.

Index T can take values ​​from 1 to 4:

• Stage T1 – tumor size up to 2 cm,
• Stage T2 – tumor size from 2-5 cm,
• Stage T3 – tumor size more than 5 cm,
• Stage T4 – tumor spreads to the chest wall and skin.

Index M takes values ​​from 0 to 3:

• N0 – no metastases in the lymph nodes;
• Stage N1 – metastases in the axillary lymph nodes of the 1st and 2nd level, not soldered together;
• Stage N2 – metastases in the axillary lymph nodes of the 1st and 2nd level, soldered together, or damage to the internal mammary lymph node;
• Stage N3 – metastases in the subclavian lymph nodes 3 level or metastases in the internal mammary and axillary lymph nodes, metastases in the supraclavicular lymph nodes.

Index M can take only two values ​​- 0 and 1 M0 – no distant metastases were found, M1 – distant metastases were found.

Treatment of breast cancer

The priority of modern clinical oncology is functionally sparing and organ-preserving treatment. The bulk of the contingent of cancer patients is formed from patients with malignant tumors of the breast.

Advances in clinical oncology have led to the cure of many thousands of cancer patients, however, the difficult problem of adaptation and rehabilitation of patients who have undergone anticancer treatment has arisen. Disability of cancer patients is a consequence of functional, anatomical, aesthetic and psychological disorders. It is the elimination or reduction of the effects of anticancer treatment that can radically improve the rehabilitation of cancer patients.

The possibility of rehabilitation of a particular patient is considered individually, taking into account a complex of prognostic factors: localization and stage of the tumor, its morphological structure, the nature of the treatment performed, the degree of anatomical and functional disorders, as well as general biological and social characteristics – age, gender, profession, position in society, family, etc.

One of the main principles of functionally sparing treatment is the combination of the stages of surgical removal of the tumor and surgical rehabilitation. This principle is currently applicable for patients with stages I-II and most of stage III due to the introduction of a reconstructive-plastic component of the restoration of the affected organ into oncology. The reconstructive-plastic component of the surgical rehabilitation of patients with breast cancer includes a set of reconstructive-plastic surgery measures that allow to restore the appearance of the organ and its aesthetic parameters in the shortest possible time and with maximum efficiency. This component can be represented by the use of both autografts and artificial materials.

Surgical rehabilitation of patients with breast cancer is closely related to improving the quality of life.

The Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin presents all areas of surgical rehabilitation of patients with breast cancer.

I DIRECTION

Organ-preserving treatment

The Department of Breast and Skin ORPH has developed new methods of organ-preserving treatment of breast cancer in the form of oncoplastic resections based on the author’s methods of reduction mammoplasty, which allow obtaining not only good oncological, but also aesthetic results. Received patents for the invention. 90% of women were satisfied with postoperative aesthetic results.

The sentinel lymph node detection technique, which is used in most cases in organ-preserving surgeries, makes it possible to avoid unnecessary lymphadenectomy and reduce the risk of postoperative complication in the form of post-mastectomy edema of the upper limb. Surgeries involving detection of the sentinel lymph node are less traumatic, meet the standards of oncological care, and contribute to earlier rehabilitation of patients with breast cancer.

Breast-conserving surgery options that can be performed in patients with early stage breast cancer or in patients after effective neoadjuvant drug treatment in accordance with the requirements for breast-conserving treatment of breast cancer.

Variants of organ-preserving operations:

1) Resection of the mammary gland with determination of the “sentinel lymph node”

2) Radical resection of the mammary gland with simultaneous reconstruction of the latissimus dorsi muscle

3) Radical resection of the mammary gland with simultaneous reconstruction with a fragment of the pectoralis major muscle

4) Oncoplastic resection of the mammary gland

Scheme of one of the options for oncoplastic resections mammary gland. We are interested in that our patients by the day of discharge from the hospital were not only healthy, but also beautiful and were ready to return to a socially active life, to the family, to society.

Therefore, one of the options for organ-preserving surgical treatment and simultaneous surgical rehabilitation are:

5) Oncoplastic resection of the mammary gland with a symmetrizing operation on the contralateral mammary gland

Scheme of reduction mammoplasty

6) Symmetrizing (corrective) operation on the contralateral mammary gland

90 002 The patient may apply for a symmetrizing operation on the contralateral mammary gland also after completion of antitumor treatment.