Non malignant breast disease

Question 1

Duct ectasia

Answer 1

Dilation of major ducts in subareaolar region - eosinic granular secretions and foamy histiocytes
Up to 25% of normal breasts
Middle-aged to elderly parous women, smoking is RF
Nipple discharge, often thick and green, microcalcifications on routine mammogram
US, ductography, ductal lavage and cytology
Focused surgical excision

Question 2

Periductal Mastitis

Answer 2

Sometimes used interchangeably with duct ectasia but not the same thing
Younger age than duct ectasia
Smoking is strong RF
Pain, periaroalar mass, pus discharge from nipple, inflammation, abscess
Mammary duct fistula is potential complication
Broad spectrum antibiotics, surgical drainage of abscess/excision of residual mass

Question 3

Intraductal papilloma

Answer 3

Warty lesion in single duct usually behind areola
Clear or blood stained discharge
>40 - solitary lesion; <40 - multiple lesions
Triple assessment
No increased risk of malignancy

Question 4

Lactational mastitis/abscess

Answer 4

Breast ducts blocked by milk (non-infectious), bacteria enters through cracks in nipple (most commonly staph aureus)
Most common in first few weeks after birth, but can occur as long as breast feeding
Hot, tender, swollen, red breast, sore/cracked nipples +/- systemic symptoms
Abscess may occur
RF: problems feeding (technique anatomical abnormalities of baby), reduced feeding, pain, pressure on breast, cracked nipples
Reassurance, continued feeding (express if too painful), warm compresses, simple analgesia
Fluclox if no response to first line

Question 5

Non-lactational breast abscess

Answer 5

Associated with DM and immunocompromise
Smoking and nipple ring are RF
Staph aureus
Tender fluctuant mass
Abx and drainage
Overlying skin necrosis: surgical debridement
Complication is mammary duct fistula