Benign Ductal Disease

Question 1

What are the types of benign ductal disease?

Answer 1

Ductal ectasia
•Nonspecific dilatation of one or more ducts (>2mm)
•Typically filled with fluids/thick secretions/cellular debris
•When located peripherally, favours a malignant process

Periductal mastitis
•Pre-menopausal women
•Ducts beneath the nipple become inflamed and infected
•Nipple rings are a risk factor

Papillomas
•Epithelial proliferation on a fibrovascular stalk in major ducts
•Usually within a few centimeters of the nipple
•Increased risk of breast cancer

Papillomastosis
•Multiple papillomas
•Tend to occur in distal ducts

Question 2

What is the aetiology of benign ductal disease?

Answer 2

Ductal ectasia - Breast changes due to aging (glandular to fatty = involution)

Papilloma - Genetic mutations in lobular cells causing uncontrolled overgrowth of abnormal cells

Question 3

What are the risk factors of benign ductal disease?

Answer 3

Ductal ectasia - Smoking, Nipple inversion

Papilloma - Genetics, Oestrogen exposure

Question 4

What are the symptoms of benign ductal disease?

Answer 4

Ductal ectasia
•	Nipple discharge – green/brown/blood
•	Pain
•	Nipple retraction
•	Breast lump (not always)

Intraductal papillomas
• Bloody nipple discharge
• Pain between breast and nipple

Question 5

What are the signs of benign ductal disease

Answer 5

Ductal ectasia
•	Nipple discharge – green/brown/blood
•	Tenderness
•	Nipple retraction
•	Breast lump (not always)

Intraductal papillomas
• Small breast mass

Question 6

What are appropriate investigations for benign ductal disease

Answer 6

To diagnose all breast lumps = triple assessment

1. Clinical breast examination
2. Imaging (mammography, US)
3. Biopsy (pathology)

Ductal ectasia
• US
• Mammography

Intraductal papilloma
•	Breast US
Dilated duct with oval mass
•	Mammogram
May be negative
•	Ductogram = galactography
Filling defect of duct
•	Breast biopsy