Mammary-duct ectasia. A clinical study

Duct Ectasia and Periductal Mastitis in Indian Women

There is very little awareness of the general physicians and surgeons about the benign breast conditions such as duct ectasia (DE) and periductal mastitis (PDM) causing nipple discharge. Not only that these benign breast diseases ring a false alarm of cancer, they are also the second most common cause of benign breast diseases. The objective was to study the clinical and microbiological profiles of duct ectasia and periductal mastitis in Indian women for better understanding of the disease process, in order to be able to treat them well. Forty-one consecutive patients presenting to the Surgical Out-Patient Department with non-bloody nipple discharge with clinical and radiological features suggestive of DE or PDM were included. Microbial culture and cytopathological study of the nipple discharge were done. Histopathological studies and culture of the ductal tissue taken intraoperatively were carried out. There is no significant difference in the age distribution among women with DE and PDM. Smoking is not associated with DE and PDM of Indian patients in contrast to the Western literature evidence. Infective etiology was present in nearly 46 % of the patients in the study population more so in the periductal mastitis cases. The most common isolated pathogens were Staphylococcus aureus and Staphylococcus epidermidis, unlike in Western population where nearly 50 % were anaerobes. Since the isolated organisms were resistant to the routinely used antibiotics in high proportion of cases, culture and sensitivity should be done in all possible cases for appropriately treating the subareolar sepsis before proceeding with the definitive treatment in the form of duct excision.

Periductal mastitis/duct ectasia

Periductal mastitis/duct ectasia affects major breast ducts and is poorly understood. A variety of different terms have been used for this condition and these probably reflect different stages in one disease process. It appears to be responsible for 1-2% of all symptomatic breast conditions. Although the incidence is higher in postmortem studies, much of what is included as so-called "periductal mastitis" or "duct ectasia" in these studies is duct dilatation, which occurs as part of normal breast involution. Periductal mastitis appears to be the primary condition with duct ectasia being the outcome. The cause of this periductal mastitis is uncertain, although bacteria, particularly anaerobic organisms, appear to play some role. Clinically, this condition can present with noncyclical mastalgia, nipple discharge, nipple retraction, a subareolar breast mass with or without overlying breast inflammation, a periareolar abscess, or a mammillary fistula. Antibiotics effective against the organisms isolated from this condition are effective in resolving periareolar inflammation and are useful when combined with surgery in mammillary fistula.

Periareolar pilonidal abscesses in a hairdresser

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Post-menopausal breast abscess

Thirty post-menopausal women with breast abscess were treated at Port of Spain General Hospital, Trinidad, between 1976 and 1980. In this age group, breast abscess can be confused with cancer due to a lack of inflammatory features. History and physical examination are often not helpful in differentiating an abscess from carcinoma. Although the usual treatment of an abscess is incision and drainage, in post-menopausal women, excision of the lesion is helpful for accurate histological diagnosis.

Are the lesions of duct ectasia sterile?

A prospective study was established to determine whether, using suitable transport media, bacteria could be isolated from the lesions of mammary duct ectasia. The results indicate that both aerobic and anaerobic organisms are present in a high proportion of patients with nipple discharge associated with this condition and in all patients who develop peri-areolar sepsis (abscess and mammillary fistulae) as part of the syndrome. The lesions of duct ectasia are therefore not sterile and the possibility exists that bacteria have a role in the aetiology and pathogenesis of this condition.

Duct ectasia in the male breast

Mammary duct ectasia in the male is a distinct rarity. A patient is described who presented with a tender subareolar mass and with nipple retraction. The clinical features and pathology are described, followed by a brief review of the literature.

Duct ectasia in the male

Three cases of inflammatory duct ectasia occurring in the male breast are described. The clinical presentation of the disease in the male closely resembles that in the female. Nipple retraction, nipple discharge, periareolar inflammation and bilateral involvement are all seen. Conservation measures produced unsatisfactory results similar to those in women. A similar operative approach to that used in women is advocated.

Mammary duct ectasia, mammillary fistula and subareolar sinuses

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