Mammary duct ectasia with bloody nipple discharge in a child

Comparative study of ultrasound-guided microwave ablation and traditional surgery in the treatment of plasma cell mastitis: a multicenter study

Background

Plasma cell mastitis (PCM) is a benign breast disease that is refractory and difficult to cure. We integrated microwave ablation into the treatment of PCM to compare the clinical value of ultrasound-guided microwave ablation and traditional surgery in the treatment of PCM.

Methods

A total of 68 patients with PCM who were admitted to 3 centers (Zhejiang Cancer Hospital, Hebei Province Hospital of Traditional Chinese Medicine, and Yantai Affiliated Hospital of Binzhou Medical university) from January 2017 to June 2019 were selected. All patients were diagnosed with PCM after pathological and clinical manifestations. Among these, 38 cases were treated with ultrasound-guided microwave ablation, and 30 cases were treated with traditional surgery. The operation time, hospitalization time, incision healing, intraoperative blood loss, postoperative pain degree, evaluation of breast shape effect, time taken for postoperative lesion disappearance, effective rate, and recurrence were recorded in the follow-up, and the clinical efficacy was compared and observed.

Results

The effective rate of the ablation group was 86.8% (33/38), that of the operation group was 46.7% (14/30), and the difference was statistically significant (95% CI: 2.311-24.618; P<0.05). The average time of the lesion completely disappearing was 75.55±43.59 days in the ablation group and 103.87±45.98 days in the operation group, and the difference was statistically significant (P<0.05). The hospital stays, operation time, and intraoperative blood loss of patients in the ablation group were less than those of the operation group, and the difference was statistically significant (95% CI: -10.69 to -6.27, 95% CI: -77.06 to -51.26, and 95% CI: -21.54 to -13.64; P<0.05). The postoperative pain scoring, operative incision healing at 14 days after the operation, and breast appearance evaluation after treatment in the ablation group were better than those of the operation group, and the difference was statistically significant (P<0.05).

Conclusions

Compared with traditional surgery, ultrasound-guided microwave ablation is a more effective treatment option for PCM.

Ultrasound Findings of Mammary Duct Ectasia Causing Bloody Nipple Discharge in Infancy and Childhood

Bloody nipple discharge in infancy and childhood is extremely rare, and mammary duct ectasia is the most common etiology. Ultrasound (US) findings of mammary duct ectasia include dilated ducts and tubular anechoic lesions that may contain echogenic debris in the subareolar region. However, mammary duct ectasia may show variable US findings, which are not well described in the literature. We report 3 cases of mammary duct ectasia in infancy and childhood with variable imaging findings, including complex cystic and solid lesions. Detailed initial clinical and US findings and serial follow-up US images are described.

Bloody nipple discharge as a benign, self-limiting disorder in young children: A systematic review including two related case reports

BACKGROUND/PURPOSE

Bloody nipple discharge (BND) is rare, distressing for parents, and presents a challenge for physicians.

METHODS

We used PubMed to search for cases of BND that were diagnosed before adolescence and added data from two of our cases.

RESULTS

The analyzed cohort comprised 46 patients (28 boys and 18 girls; mean [SD] age, 12.5±13.3months; range, 20days to 4years). The mean time for spontaneous resolution was 2.8±2.4months (range, 1week to 8months) after onset of BND without any intervention. The diagnosis was mammary ductal ectasia (MDE) in 15 patients, gynecomastia with MDE in two patients, hemorrhagic cysts in two patients, and gynecomastia alone in one patient. The majority (89.3%) of patients <1year old were managed conservatively, but half of them aged >1year (50.0%) underwent surgery. Surgery was performed more often in patients in whom a mass had been identified.

CONCLUSIONS

Age and findings at physical examination affect selection of treatment, but not sex. We found no reported cases of malignancy. Symptoms in children who are managed conservatively resolve within 10months. Children with BND should be conservatively managed to avoid the risk of developing breast deformities before adolescence.

[Mammary duct ectasia in children: A case report]

INTRODUCTION

Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation.

OBJECTIVE

Report of a case of MDE in order to improve physicians' diagnosis accuracy and avoid aggressive studies and treatments.

CASE REPORT

Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up.

CONCLUSIONS

The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.