Thursday, 16 May 2019

Breast- A small unilateral lump is often termed as duct ectasia let us know hat exactly it is ?


 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
 What is duct ectasia?
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
Lobules diagram
 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.
  What are the symptoms of duct ectasia?
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
How is duct ectasia diagnosed?
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.

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 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.
5. Does duct ectasia increase my risk of breast cancer?
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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