Benign ductal disease (duct ectasia & papilloma) Flashcards
Define duct ectasia.
Dilatation and shortening of the terminal breast ducts within 3cm of the nipple.
The duct walls also thicken, and can fills with fluid.
What is the pathophysiology of duct ectasia?
Subareolar ducts become dilated and blocked with desquamating secretory epithelium, necrotic debris, and chronic inflammatory cells.
Usually peri-menopausal or post-menopausal.
What is the epidemiolgy of duct ectasia?
Common.
Incidence increases with age.
Mostly affects middle-aged to elderly parous women but can affect children.
Smoking is a risk factor
What are the signs and symptoms of duct ectasia?
It typically presents with nipple retraction and occasionally creamy nipple discharge.
- Nipple discharge - green/yellow/brown discharge in periductal mastitis arising from duct ectasia. May be sticky
- Subareolar mass
- Nipple inversion or retraction may be present - usually slit-like compared to carcinoma where the whole nipple is pulled in
- May or may not be tender
- Single or multiductal, unilateral or bilateral nipple discharge provoked on physical examination
- Non-cyclical in nature
What investigations would you do for duct ectasia?
- US +/- mammography - may show microcalcification
- FNA
- Core biopsy
Other:
- Ductography - contrast injected into milk duct and mammogram performed
- Ductal lavage/cytology - p_lasma cells_ are a characteristic feature on histology
What is ANDI?
Aberrations of Normal Development and Involution
These aberrations include:
- fibroadenoma
- benign cystic change (fibroadenosis)
- intraductal papillomas
- duct ectasia
- cysts
What are the signs and symptoms of intra-ductal papilloma?
Discharge - often serous or serosanguinous discharge in intra-ductal papilloma (bloody discharge is suggestive of carcinoma);
Define (intra-ductal) papilloma.
Benign tumours of the subareolar ducts (with atypical but non-cancerous cells) that produce nipple discharge.
What is the pathophysiology of papilloma?
- Epithelial hyperplasia produces a wartlike tumor in a lactiferous duct.
- 2–3 cm in diameter
- May occur singly or in multiples
- They are NOT pre-malignant
What are the signs and symptoms of papilloma?
- Spontaneous/provoked nipple discharge - serous or bloody
- Usually unilateral
- Mass behind nipple may or may not be present
- May need excisional biopsy to rule out malignancy
What investigations would you do for duct papilloma?
Same as usual: US/mammography, cytology/biopsy, clinical examination.
Best seen on US, diagnosis confirmed by biopsy (shows a localised form of epitheliosis. A carcinoma would lack the well defined stromal cores.)
What is the management and prognosis with duct ectasia?
Patients with troublesome nipple discharge may be treated by microdochectomy (if young) or total duct excision (if older).
- Usually self limiting so surgery not indicated
- Paracetamol for pain
- Try not to squeeze nipple as this may encourage more discharge
What is the difference between duct ectasia and duct papilloma?
Duct ectasia is a benign condition that occurs when a breast duct widens and its walls thicken
Intraductal papillomas are benign, epithelial, wart-like tumours that grow within the milk ducts of the breast.
What is the management of duct papilloma?
Microdochectomy
Excision biopsy*
Vacuum-assisted excision biopsy*
Total duct excision
*local or general anaesthetic can be used.
What is duct ectasia often confused with?
Periductal mastitis - this presents in younger women, the vast majority of whom are smokers. It causes periareolar or subareolar infections and may be recurrent.
