Mammary duct ectasia

Last updated: November 21, 2022

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Mammary duct ectasia is a chronic inflammatory condition characterized by dilatation of the terminal (subareolar) lactiferous ducts, with a peak incidence in women between 40–50 years of age. Although often asymptomatic, mammary duct ectasia may manifest with unilateral or bilateral nipple discharge, nipple inversion, or a subareolar mass. The diagnostic workup is based on the age-appropriate evaluation for pathological nipple discharge and/or a palpable breast mass. A biopsy may be required if imaging is inconclusive or depicts features concerning for malignancy. The typical histopathological features of duct ectasia include periductal inflammation, luminal secretions with/without inflammatory infiltrate, and foamy histiocytes. As most cases resolve spontaneously, expectant management is usually appropriate. Surgical excision of the affected duct may be considered for symptomatic control.

Epidemiological data refers to the US, unless otherwise specified.

Inspissated luminal secretion → stasis → periductal inflammation → fibrous obliteration

Mammary duct ectasia is the most common cause of greenish nipple discharge.

Approach [1][2]

Imaging [3]

Biopsy [3][4]

  • Periductal inflammation and/or fibrosis
  • The ductal lumens may be obliterated or filled with inspissated secretions and inflammatory cells.
  • Foamy histiocytes are characteristically present within the inflammatory infiltrate.

  • Expectant management is usually sufficient as most cases resolve spontaneously. [1][5]
  • Consider surgical duct excision for patients with: [2]
  1. ACOG. Practice Bulletin No. 164 Diagnosis and management of benign breast disorders. Obstetrics & Gynecology. 2016; 127 (6): p.e141-e156. doi: 10.1097/aog.0000000000001482 . | Open in Read by QxMD
  2. Salzman B, Collins E, Hersh L. Common Breast Problems. Am Fam Physician. 2019; 99 (8): p.505-514.
  3. Ferris-James DM et al.. Imaging Approaches to Diagnosis and Management of Common Ductal Abnormalities. RadioGraphics. 2012; 32 (4): p.1009-1030. doi: 10.1148/rg.324115150 . | Open in Read by QxMD
  4. D’Alfonso TM, Ginter PS, Shin SJ. A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples. Journal of Pathology and Translational Medicine. 2015; 49 (4): p.279-287. doi: 10.4132/jptm.2015.06.11 . | Open in Read by QxMD
  5. Warren R, Degnim A. Uncommon Benign Breast Abnormalities in Adolescents. Semin Plast Surg. 2013; 27 (01): p.026-028. doi: 10.1055/s-0033-1343993 . | Open in Read by QxMD

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