Duct Ectasia / Papilloma

Question 1

Define

Answer 1

Duct ectasia is when ducts become blocked and secretions stagnate, causing nipple discharge +/- nipple retraction +/- lump.

Intraductal papilloma is a non-cancerous growth which occurs within the milk ducts – can be solitary or multiple growths.

Question 2

Causes of benign ductal disease

Answer 2

In duct ectasia, the central ducts become dilated with ductal secretion due to a blockage of the lactiferous ducts

Question 3

Epidemiology

Answer 3

Both occur near menopause age.

Question 4

Symptoms

Answer 4

Duct ectasia: green/brown/bloody nipple discharge

Swelling or lump

History of breast discomfort/pain

Intraductal papilloma: small lump near nipple, discharge.

Multiple papillomas are smaller and occur further away from nipple.

Question 5

Signs

Answer 5

1. Focal or diffuse nodularity of breast
2. Discharge
3. Features of malignancy absent, e.g. dimpling, peau d’orange, enlarged axillary lymph nodes

Question 6

Investigations

Answer 6

Triple assessment

1. Clinical Examination
2. Imaging
   
   • Mammography (two-view)
     
     • NOTE: benign lumps are less likely to be calcified
   • Ultrasound - in younger patients (< 35 yrs)
3. Cytology/Histology
   
   • Fine Needle Aspiration - sent for cytological analysis
   • Excision Biopsy - sent for histological analysis