Page 418 - Medicine and Surgery

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414 Chapter 10: Breast disorders

Duct ectasia younger women multiple smaller peripheral ducts may
be involved, termed peripheral papillomatosis. This is
Definition
associated with an increased risk of developing breast
Abenign breast disorder with dilation (ectasia) of the
cancer.
subareolar ducts as part of breast involution with accu-
mulation of cellular debris and inflammation.
Clinical features
Most patients present with a bloody or serous nipple
Age
discharge. It is often possible to identify the discharge
Most common in women approaching the menopause.
as arising from a single point on the nipple, where a di-
lated slit-like orifice may be visible. There may be a small
Aetiology/Pathophysiology
swelling at the areolar margin (30%), which if pressed
The dilated ducts are filled with inspissated secretions
may produce discharge.
with a chronic inflammatory response in the surround-
ing breast tissue. The cause is unknown.
Macroscopy/microscopy
One to two centimetres sized papilloma within a di-
Clinical features
lated duct with secretions collected behind it. The le-
Duct ectasia may be asymptomatic or may cause nipple
sion usually consists of fronds of vascular tissue covered
discharge (often green) and localised tenderness around
byadouble layer of cells resembling ductal epithelium.
the areola. Duct fibrosis and shortening can cause nipple
Malignant change is rare.
retraction without a lump.
Investigations
Macroscopy/microsopy
Mammography and/or ductography show the dilated
The ducts may be dilated as much as 1 cm in diam-
duct and filling defect.
eter and are filled with proteinaceous secretions, lipid-
laden macrophages and epithelial cells. There is periduc-
Management
tal chronic inflammation and fibrosis.
Awire is often passed into the responsible duct, which is
excised as a microdochectomy with the breast segment
Investigations
that drains into it.
Anylump should be investigated using the triple as-
sessment (see page 409). Although ductography or duc-
toscopy are possible, they are not routine investigations. Fat necrosis
Definition
Management
An uncommon condition in which there is death of fat
Once the diagnosis is confirmed surgery may be required
cellswithin the breast.
to exclude malignancy, if the discharge causes distress or
to evert the nipple. Treatment is by subareolar excision
Aetiology/pathophysiology
of the affected ducts.
The aetiology is unclear, it is suggested that the death
of fat cells may result from trauma. There is an acute
inflammatory response, which in some cases progresses
Duct papilloma
to chronic inflammation and organisation with fibrous
Definition tissue. The result may be a hard, irregular mass, which
Abenign proliferation of the epithelium within large can mimic carcinoma.
mammary or lactiferous ducts.
Clinical features
Aetiology pathophysiology Patients present with a hard mass, which may also have
Papillomas usually arise less than 1 cm from the nipple skin tethering; often in an obese patient with large
and obstruct the natural secretions from the gland. In breasts. Although the patient may recall trauma, this is