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Anisomastia Como Trastorno De Asimetría En La Patología Mamaria

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Anisomastia Como Trastorno De Asimetría En La Patología Mamaria REV. SENOLOGIA Y PATOL. MAM., 5, 2 (83-91), 1992 L. C. Tejerizo López*, Anisomastia como J. L. Lanchares Pérez*, R. Morales Lugo**, A. García Iglesias*, trastorno de asimetría en J. A. González Pérez*, J. M. Jorge Mendoza**, la patología mamaria M.• J. Velasco Martín* M.a J. Doyague Sánchez* infantojuvenil SUMMARY Complejo Hospitalario. Hospital Clínico. Departamento de Anisomastia is to be considered today as a not infrequent possibility in Obstetricia y Ginecología the disorders of mammary pathology in infancy and adolescence. Three (J. L. Lanchares Pérez, cases of constitutional anisomastia in youths are studied in the present L. C. Tejerizo López). work without anisothelia and without any pathological process either Salamanca*. Hospital General de Lanzarote. concomitant or subjacent. Servicio de Obstetricia y Ginecología (R. Morales Lugo). Arrecife de Lanzarote**. Palabras clave Trastornos desarrollo mamario, Asimetría mamaria, Anisomastia. Correspondencia: Dr. L. C. Tejerizo López. Keywords Varillas, 16-18, 1.° C. 37001 Salamanca. Disorders in mammary development, Mammary asymetry, Anisomastia. INTRODUCCION desarrollo, los procesos inflamatorios, la displasia o mastopatía fibroquística y los tumores. Fernández-Cid, 1 al establecer la clasificación de la Señalan Capraro y Dewhurst 3 que es tal la varie­ patología mamaria infantojuvenil, incluye los trastor­ dad de padecimientos que afectan a la mama duran­ nos del desarrollo, los trastornos funcionales, los pro­ te la infancia y adolescencia, que sus lesiones no co­ cesos inflamatorios, las displasias mamarias (masto­ rresponden a una sola especialidad y algunas de patías), los traumatismos y dermatosis y los tumores. ellas, sobre todo las relacionadas con el desarrollo, Al considerar específicamente a los trastornos del de­ pueden incluirse entre las que suscitan el interés del sarrollo refiere 7 formas de presentarse los mismos ginecólogo. (tabla 1). En una clasificación anterior el mismo autor 2 Debe considerarse ·como alteración del desarrollo considera las asimetrías como alteraciones del tama­ toda desviación del desarrollo mamario nor­ ño, e incluye desarrollo precoz de la mama y las alte­ mal. 3· 6· 7 Como consecuencia de una alteración en raciones mixtas (tabla 11). los mecanismos que regulan el desarrollo mamario Capraro y Dewhurst 3 consideran, dentro de. las en­ pueden surgir diversas alteraciones del órgano que 7 fermedades de la mama en la infancia y adolescen­ afectan a su morfología o a su estructura. • 8 cia, las anomalías congénitas, las modificaciones de En opinión de Fernández-Cid, 7 no es tarea fácil es­ la respuesta fisiológica, el desarrollo sexual prematu­ tablecer una clasificación idónea de los trastornos del ro, las lesiones inflamatorias, los tumores, las faltas desarrollo mamario en función, sobre todo, de la sino­ de desarrollo, las lesiones del pezón y la aréola y las nimia de los procesos y de que algunos de estos tras­ lesiones traumáticas (tabla 111). Similar clasificación tornos pudieran ser considerados como funcionales. reflejan Huffman et al. 4 Da Cunha Bastos 5 incluye en La frecuencia de los trastornos del desarrollo ma­ la patología mamaria infantojuvenil las anomalías del mario es muy alta, 7 alcanzándose cifras de hasta el 83 . L. C. Tejerizo López y cols. TABLA 1 MATERIAL V METODOS PATOLOGIA MAMARIA INFANTOJUVENIL: TRASTORNOS DEL DESARROLLO Se analizan 3 casos de anisomastia, no acompaña­ (Fernández-Cid, 1989) 1 da de anisotelia, como trastorno de asimetría dentro 1 . Alteraciones de número de la patología del desarrollo mamario infantojuvenil. - Polimastias. Las pacientes, de edades respectivas de 14, 17 y - Politelias. 18 años de edad, acudieron a consulta refiriendo asi­ - Agenesia mamaria. metría mamaria sin aludir a otro tipo de anomalías. - Agenesia de pezón (atelia). - Agenesia de aréola. Antecedentes familiares y personales sin interés. Ningún antecedente de ingesta de hormonas ni de 2. Alteraciones de tamaño patología mamaria neonatal. Peso y talla al nacimi­ - Macromastia. mento normales. Menarquía a los 13, 11 y 12,S años, - Macrotelia. respectivamente. Reglas normales. - Macroaréola. - Micromastia. Inicio del desarrollo mamario entre los 1O años (la - Microtelia. paciente 1 ) y los 11 años (la paciente 2), con comien­ - Microaréola. zo casi simultáneo del desarrollo del vello pubiano. Notaron el desarrollo asimétrico entre 4 años antes 3. Alteraciones de forma de la consulta (la paciente 3) y 2 años (la paciente 1). - Mamas cónicas. - Mamas discoides. La paciente número 1 alcanzó el estadio actual a los - Mamas globulares. 13 años, la número 2 a los 1S años y la número 3 a - Mamas pediculadas. los 16 años. - Mamas péndulas. - Aréola prominente. La exploración general muestra fenotipo femenino - Aréola retraída. con pilificación femenina en las 3 pacientes. Aparato - Pezón prominente. genital normal, tanto por exploración como por eco­ - Pezón aplanado. - Pezón umbilículo. grafía. - Pezón pediculado. La exploración mamaria refleja consistencia normal - Pezón bipartito. y similar en ambas glándulas. 4. Alteraciones de la situación Medición de las mamas según la técnica de Capra­ ro y Gallego6 (mediciones en centímetros): - Mamas con distinta implantación. - Mamas con escudo. Paciente 1 (fig. 1 ). Mama derecha: 21 x 20 (420 - Mamas supraareolares. - Pezones exoareolares. unidades mamarias); mama izquierda: 16x 1S (240 - Teletelia. unidades mamarias). Mama izquierda normal para la edad. 3· 6 5. Alteraciones de peso y densidad Paciente 2 (fig. 2). Mama derecha: 22 x 20 (440 unidades mamarias); mama izquierda: 19 x 17 (323 6. Alteraciones de pigmentación unidades). Mama izquierda normal para la edad. 3, 6 7. Asimetrías (anisomastias y anisotelias) Paciente 3 (fig. 3). Mama derecha: 18 x 17 (306 unidades mamarias); mama izquierda: 17x 16 (272 - Por situación. - Por tamaño. unidades). Ambas mamas normales para la edad de - Por forma. la paciente, aun existiendo asimetría mamaria. - Por ausencia parcial. - Amastia (síndrome de Polland). Estadio mamario y pubiano de Marshall y Tanner: 10 Paciente 1: S4 y VPS. 2S% de las mujeres y siendo menores en los hom­ Paciente 2: SS y VPS. bres. Marshall 9 señala que, en términos generales, Paciente 3: SS y VP6. se ha prestado una relativa poca atención al estudio Edad ósea normal. Rx de silla turca normal. Carioti­ de las anomalías del desarrollo mamario, aunque ta­ po (técnica bandas G): morfología normal, dotación les defectos pueden producir graves crisis emociona­ 46XX. les en los adolescentes. Ecografía mamaria y, eventualmente, mamografía: 84 ANISOMASTIA COMO TRASTORNO DE ASIMETRIA EN LA PATOLOGIA MAMARIA INFANTOJUVENIL TABLA 11 CLASIFICACION DE LAS ANOMALIAS Y ALTERACIONES DEL DESARROLLO (Fernández-Cid et al., 1986) 2 A) Alteraciones de número C) Alteraciones de forma Afectación Exceso Localización Componentes Mama Cónicas y Mayor diámetro piriformes anteroposterior Por exceso Aplanadas Reducción del y discoides diámetro Mama Mamas Línea Completas anteroposterior hipermastias accesorias mamilar Mamas Vecindad de Mamilares Pezón Cilíndricas Diámetros ectópicas la línea Areolares o glandulares invariables mamilar Glandulares Pediculadas Menor diámetro en la Mamas Alejadas de base que en la aberrantes la línea superficie mamilar Prominente Pezón y Hipertelias En la aréola Completas Pediculado aréola Pezones Cerca de la Mamilares Aplanado (hipertelias) accesorios aréola Areolares Retraído Pezones Alejadas de Pilosas Aréola Prominente aberrantes la aréola Melánicas Retraída Por defecto O) Alteraciones de la situación Mama Agenesia Unilateral Completas Amastia Mama Asimetría. Desviación del área ocupacional normal. Pezón Atelia Bilateral Incompletas Pezón Supraaréolares. En la aréola. y aréola Exoaréolar. Fuera de la aréola. B) Alteraciones del tamaño E) Alteraciones del peso F) Alteraciones de la pigmentación Afectación Mama . Pezón y aréola - Exceso Hiperpigmentación Exceso Macromastia Macrotelia Defecto Hipopigmentación (hipertrofia) (hipertrofia) Vitíligo Ginecomastia Defecto Micromastia Microtelia G) Alteración de «momento» (hipoplasia) (hipoplasia) (Desarrollo precoz) Desigualdad Anisomastia Anisotelia H) Alteraciones mixtas Paciente 1: Ecografía: no imágenes patológicas. DISCUSION No se realizó mamografía. Paciente 2: Ecografía normal. No se practicó ma­ En opinión de Capraro y Dewhurst 3 y Huffman mografía. et al. 4 con frecuencia se observa asimetría de las Paciente 3: Ecografía y mamografías normales. mamas durante las etapas normales del desarrollo de Estudio hormonal: FSH y LH (en condiciones basa­ estas glándulas. La yema o brote mamario comienza les y tras estimulación con LH RH), prolactina (basal a menudo su desarrollo en un lado antes que el y después de estimulación con TRH), 17-beta-estra­ otro. 3, 11 Según Zeiguer, 12 es habitual el hecho de diol y progesterona, en las 3 pacientes normales. que el desarrollo mamario se produzca, en sus prime­ Conclusión diagnóstica: Anisomastia constitu­ ros estadías, en una mama antes que en la otra con cional. una diferencia de 6 a 12 meses. Se ha subrayado por 85 L. C. Tejerizo López y cols. TABLA 111 CLASIFICACION CLINICA DE LAS ANOMALIAS, LESIONES Y ENFERMEDADES DE LA MAMA EN LA INFANCIA Y ADOLESCENCIA (Capraro y Dewhurst, 1975)3 1 . Anomalías congénitas -Ausencia. - Multiplicidad. 2. Modificación de la respuesta fisiológica - Hipertrofia neonatal. - Ingurgitación o congestión dolorosa en la pu- bertad. - Asimetría. - Hipoplasia. - Hipertrofia virginal. - Atrofia. Fig.1. - Galactorrea. 3. Desarrollo sexual prematuro desarrollo,
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