Benign Ductal Disease (Duct Ectasia and Papilloma) Flashcards
Define duct ectasia
Benign dilation of ducts behind nipple
Periductal mastitis – occurs in younger women (20-30) and is also associated with
smoking; abscess in ducts around nipple; tender, red, hot, discharge, inverted nipple
What are the causes/risk factors of duct ectasia?
Secretory stasis and periductal fibrosis -> secretions collect in ducts -> irritation and pain Fibrosis -> hardening behind nipple Shortening of ducts can invert nipple • Age (normally >35 – perimenopausal) • Smoking
What are the signs and symptoms of duct ectasia?
- Recurrent cheesy discharge – may be green/bloodstained
- Palpable mass behind areola
- Pain/tenderness
- Slit-like nipple/nipple inversion
What investigations are carried out for duct ectasia?
Triple assessment:
• Mamography
- Dilated linear branching densities in subareolar region
- Calcifications are rod like or cigar or broken needle like which are pointing towards the nipple
• USS
- Dilated, fluid filled subareolar ducts with moving debris on real time sonography without mass
- These findings often mimic an intraductal tumour (papilloma)
• Biopsy
Define papilloma
Benign lesion that consists of branching fibrovascular cores with overlying layers of
epithelial and myoepithelial cells
Large/central subtype: IDP arising from a large duct; gross, solitary, central
Small/peripheral subtype: originates at the terminal duct lobular unit; small, multiple
and peripheral; may be associated with increased risk of breast cancer
What are the signs and symptoms of papilloma?
• Asymptomatic (small subtype) • Unilateral serous or bloody nipple discharge • Palpable breast mass • Breast pain
What investigations are carried out for papilloma?
Triple assessment • History and examination • Imaging - USS <35 years - Mammography >35 years • Biopsy - FNA (fluid-filled) - Core biopsy (solid)
