Mammary duct ectasia

Last updated: June 13, 2023

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Summarytoggle arrow icon

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.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Pathophysiologytoggle arrow icon

Inspissated luminal secretion → stasis → periductal inflammation → fibrous obliteration

Clinical featurestoggle arrow icon

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

Diagnosticstoggle arrow icon

Approach [2][3]

Imaging [4]

Biopsy [4][5]

  • 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.

Managementtoggle arrow icon

  • Expectant management is usually sufficient as most cases resolve spontaneously. [2][6]
  • Consider surgical duct excision for patients with: [3]

Referencestoggle arrow icon

  1. $Contributor Disclosures - Mammary duct ectasia. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  2. 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
  3. Salzman B, Collins E, Hersh L. Common Breast Problems. Am Fam Physician. 2019; 99 (8): p.505-514.
  4. 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
  5. 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
  6. 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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