Breast small
unilateral lump:- often termed as duct ectasia As soon as a woman is diagnosed
as having such a diag at a specialized center the following Q. come in her mind. Some
spend sleepless night unless duly counseled .The following are the questions
that creep in the minds of a woman or a care giver whenever a tender
discharging small lump is felt in one beast . Fibroadenoma
1. What is duct ectasia?
2. What are the symptoms of duct ectasia?
3. How is duct ectasia diagnosed?
4. How is duct ectasia treated?
5. Does duct ectasia increase my risk of breast cancer?
2. What are the symptoms of duct ectasia?
3. How is duct ectasia diagnosed?
4. How is duct ectasia treated?
5. Does duct ectasia increase my risk of breast cancer?
Duct ectasia
is a benign (not cancer) breast condition in which there is blockage or clog
formation in one or few Lactiferous duct with greenish discharge.
It’s caused by normal breast changes that happen with age. This is not at all
abnormal but warrants long term follow up .However duct ectasia of the breast or mammary
duct ectasia ( sometimes pathologists call it plasma cell mastitis )
is a condition in which the lactiferous duct becomes blocked or clogged. This is
the most common cause of greenish discharge. Mammary duct ectasia can mimic
breast cancer. AS such long term follow up under specialist care at least 6 monthly
follow up nibs suggested.. It is a disorder mainly of peri- or post-menopausal
age. Duct ectasia syndrome is a synonym for nonpuerperal mastitis but the term
has also been occasionally used to describe special cases
of fibrocystic diseases, mastalgia

Anatomy of Breast:-Breasts are made up of
lobules (milk-producing glands) and ducts (tubes that carry milk to the
nipple). These are surrounded by glandular, fibrous and fatty tissue.
As
a woman gets nearer to the menopause and the breasts age (from 35 years
onwards) the ducts behind the nipple shorten and widen. This is called duct
ectasia. Sometimes a fluid is produced that can collect in the widened ducts.
Evidence
suggests that duct ectasia is more common in smokers, although the exact reason
for this is unknown.
Men
can also get duct ectasia, but this is very rare.
Often,
duct ectasia doesn’t cause any symptoms but people may notice the following:
discharge
from the nipple – usually thick but sometimes watery and may be bloodstained
breast
pain, although this is not common
a
lump felt behind the nipple – this could mean the tissue behind the nipple has
become infected or scarred
an
inverted nipple (where the nipple is pulled inwards) – this could be because
the ducts have shortened
Incase
if a lump is noticed in any of the breast or if there is some abnormal
discharge from one or both breast then those who are residing at metro cities
they should ideally consult a doctor who is attached to a dedicated breast
clinic .Otherwise a general surgeon must be consultant without any dally. That
is I mean m, after a breast examination one should if possible consult a breast
surgeon or report a spl breast clinic, where one will be examined by specialist
doctors or nurses. Breast examination means local examination ( by the woman-
SBE- self breast examination or by nurse of breast or by doctor. Some cases may
warrant following laboratory test
What are the Lab tests for
Breast disease : 1) an ultrasound –initial / primary non invasive tests 2)FNAC:: fine needle aspiration (FNAC) 3) a
core biopsy (using a hollow needle to take a sample of breast tissue to be
looked at under a microscope – several tissue samples may be taken at the same
time 4) a mammogram (breast
x-ray) What about
mammography?? Detail of a mammography showing liponecrosis (round/oval
calcifications) and plasma cell mastitis with typical rod-like calcifications Duct
ectasia syndrome has been associated with histopathological findings that are
distinct from a simple duct widening. In addition to nonspecific duct widening
the myoepithelial cell layer is atrophic, missing or replaced by fibrous
tissue. The original cuboidal epithelial layer may be also severely impaired or
missing. Characteristic calcifications are often visible on mammographic
images.
Periductal
mastitis, comedo mastitis, secretory disease of the breast, plasma cell
mastitis and mastitis obliterans are sometimes considered special cases or
synonyms of duct ectasia syndrome.
Tr
:-Noninvasive
methods to determine duct diameter in live patients are available only recently
and it is not clear how the results should be compared with older results from
biopsies. Histologically, dilation of the large duct is prominent. Duct
widening with associated periductal fibrosis is frequently included in the
wastebasket definition of fibrocystic disease.In plasma cell rich lesions
diagnosed on core biopsies, steroid-responsive IgG4-related mastitis can be identified by
IgG/IgG4 immunostaining.
How is duct ectasia treated?
Most
cases of duct ectasia don’t need any treatment or follow-up as it’s a normal
part of ageing, and any symptoms will usually clear up by themselves. Try not
to squeeze the nipple as this may encourage further discharge. In the meantime,
if one is having pain or discomfort then prescribes pain killers such as
paracetamol.
Role of Surgery
If
one continue to have discharge from the nipple (without squeezing), she may be offered an operation to remove the
affected duct or ducts. This might be removal of just the affected duct or
ducts (a micro dochectomy), or removal
of all the major ducts (a total duct excision).The operation is usually done
under a general anaesthetic. Usual she is discharged on the same day like Diag
Lap but one might have to stay overnight. There will be a
small wound near the areola (the darker area of skin around the nipple) with a
stitch or stitches in it. Breast specialist team will tell explain the pt how
to care for it afterwards.
Paracetamol
is necessary for couple of days. Due to sore and bruised. The operation will leave a
small scar but this will fade in time.
After
the operation her nipple may be less sensitive than before. For a few people it
may become inverted.
This
operation is usually successful. However, sometimes finding all the ducts can
be difficult, and in such cases symptoms may return. If this happens she may
need further surgery to remove more ducts. It’s important to go be on follow up
if any new symptoms.
Having
duct ectasia doesn’t increase the risk of developing breast cancer in the
future. However, it’s still important to be breast
aware and be on regular follow u at Breast clinic which has
come up in Metro cities –all tets under one roof .(FNAC, Core biopsy, USG rarely mammography- a dying
procedure) go back to her doctor or breast clinic with all previous document
and if doctor at clinic notice any changes in her breasts, regardless of how
soon these occur after her primary or initial diagnosis of duct ectasia.
n our Conclusion:-
The
term has several meanings on histological and symptomatic levels and on both
levels usage overlaps
with mastalgia, fibrocystic disease and specific sub- or superclasses of
nonpuerperal mastitis. While this is not ideal for a definition it results from
actual usage in international literature. Because research literature regarding
duct ectasia is anything but abundant it is probably easiest to determine the
exact meaning(s) intended by the respective authors on a case by case basis and
this section can offer only a few hints.
Typical
usage in North America is a synonym of nonpuerperal mastitis, including the
special cases of granulomatous mastitis, comedo mastitis, subareolar abscess
with or without squamous metaplasia of lactiferous ducts and fistulation.[6]
Simple
duct widening should be carefully distinguished from more complex histological
changes.
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