Benign Ductal Disease

Question 1

Define Duct Ectasia

Answer 1

Dilatation and shortening of the terminal mammary breast ducts within 3cm of the nipple

If leakage occurs into periductal tissue → inflammatory reaction (= Periductal mastitis)

Question 2

Define papilloma

Answer 2

solitary or multiple benign lesions that arise from the epithelium of the lactiferous breast ducts (growth of a papilloma in a single duct)

Question 3

Aetiology of Benign ductal disease

Answer 3

Benign breast disorders are minor aberrations in normal development process, hormonal response & involution of the breast

Disorders of development: Polymastia | Polythelia | Accessory axillary breast tissue | Congenital nipple retraction | Macromastia | Fibroadenoma | Phyllodes tumour | Adolesecent hypertrophy
Disorders of cyclical change: Mastalgia | Nodularity
Disorders of involution: Fibrocystic change (cyst, fibrosis, sclerosing adenosis) | Periductal mastitis

Question 4

Aetiology of duct ectase

Answer 4

inspissated luminal secretion stasis leading to periductal inflammation and fibrous obliteration

Question 5

Risk factors for benign ductal disease

Answer 5

Less common in those on the OCP
Smoking (periductal mastitis)
Peri-menopasual and menopausal women (mammary duct ectasia)
Younger patient (papilloma)

Question 6

Symptoms of duct ectasia

Answer 6

usually present age >50 years

Nipple discharge (May be from single or multiple ducts 
 | discharge is often creamy/cheese-like or thick and green)
Nipple retraction

Firm, stable, painful mass under the nipple

Question 7

Symptoms and signs of papilloma

Answer 7

Usually asymptomatic

Clear or blood stained discharge originating from a single duct
May have a palpable mass close to or behind the nipple
May be multiple lesions (peripheral papilloma)

Unusual to have a palpable lump, unless large

Question 8

Investigations for duct ectasia

Answer 8

Clinical diagnosis

USS/mammogram: determine the mammary duct diameter

Biopsy: MAY show:

• Central cavity filled with neutrophils and secretion
• Pericentral inflammation and/or fibrotic breast parenchyma
• Obliteration of the ducts

Question 9

Investigations for papilloma

Answer 9

Core needle biopsy: Fibroepithelial tumour (Shows papillary cells with fibrovascular core covered by both epithelial and myoepithelial cells)

Ductogram (Mammogram with contrast to visualise the breast milk ducts)