Home   Chapter Home   Jobs   Conferences   Fellowships   Books

 

 

Advertisement 

 

Breast-nonmalignant

Inflammatory / infectious

Duct ectasia of breast

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 26 September 2012, last major update March 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

=========================================================================

● Dilated large ducts with fibrous thickening of wall, elastic fibers in wall and foamy macrophages in lumen; often calcifications

 

Terminology

=========================================================================

● Also called periductal mastitis, although some believe they are different entities (Br J Surg 1996;83:820)

● Late stage is ductitis obliterans or mastitis obliterans with total occlusion of ducts (Breast J 2007;13:599)

 

Epidemiology

=========================================================================

● Usually women in reproductive years

● Dilated ducts also occur in some neonates (see neonatal breast)

 

Sites

=========================================================================

● Major ducts, may be bilateral

 

Etiology

=========================================================================

● May be a response to stagnant colostrum

 

Clinical features

=========================================================================

● Painful, erythematous, subareolar mass, may have fistulous tract

● Often nipple discharge

● Associated with smoking (Int J Clin Pract 2005;59:1045), possibly pituitary adenomas and increased prolactin levels (Am J Surg Pathol 1988;12:130)

● Recurrences may cause nipple inversion or discharge, resembling carcinoma

 

Prognostic factors

=========================================================================

 

Case reports

=========================================================================

● 2 year old boy with bloody nipple discharge (Turk J Pediatr 2005;47:379)

● 13 year old girl with bloody nipple discharge (J Natl Med Assoc 2004;96:543)

● Associated with Bechet’s disease (Saudi Med J 2001;22:1030)

● Duct ectasia in both normally located and accessory breast tissue (J Coll Physicians Surg Pak 2009;19:57)

 

Treatment

=========================================================================

● Excise duct and fistulous tract in continuity

 

Clinical images

=========================================================================

 

Gross description (Macroscopy)

=========================================================================

● Dilated large ducts with fatty (cheesy) material in lumen

 

Micro description (Histopathology)

=========================================================================

● Dilated large ducts with fibrous thickening of wall, elastic fibers in wall and foamy macrophages in lumen; often calcifications

● Additional inflammatory infiltrate that varies from acute (early) to lymphoplasmacytic (late), then is replaced by fibrosis

● Keratin goes deep within ductal system causing dilation and rupture of duct with intense chronic and granulomatous inflammation

● May have associated epithelial hyperplasia or apocrine metaplasia

 

Micro images

=========================================================================

 

                                                                       

Ducts are dilated with sparse secretions,                  Dilated duct has amorphous stasis

lower duct is partially disrupted releasing                  material and lymphoid nodules at

material into stroma and causing                                  at sites of secondary duct branching

periductal fibrosis and elastosis

 

 

                                                               

Periductal lymphocytes, thickened basement           Narrowed duct lumen due to

membrane and lack of cells in duct contents            periductal collagen and elastic tissue

 

 

                                                               

Dilated ducts with foamy macrophages                      Late stage with hemosiderin-laden

and periductal inflammatory infiltrate                          macrophages

 

 

Foamy macrophages below luminal epithelium

 

 

         

Other images

 

 

  

Periductal scarring (late)

 

Virtual Slides

=========================================================================

 

Videos

=========================================================================

 

Cytology description

=========================================================================

● Paucicellular, with few scattered cohesive clusters of ductal epithelial cells with mild atypia and peripheral myoepithelial cells

● Also CD68+ macrophages with finely vacuolated cytoplasm (Acta Cytol 2001;45:1027)

 

Cytology images

=========================================================================

 

Positive stains

=========================================================================

 

Negative stains

=========================================================================

 

Electron microscopy descriptions

=========================================================================

 

Electron microscopy images

=========================================================================

 

Molecular / cytogenetics description

=========================================================================

 

Molecular / cytogenetics images

=========================================================================

 

 

Differential Diagnosis

=========================================================================

● (link to topic)

 

Additional references

=========================================================================

Stanford University

 

End of Breast-nonmalignant > Inflammatory / infectious > Duct ectasia of breast

 

 

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment.  This website should not be used as a substitute for the advice of a licensed physician.

 

All information on this website is protected by copyright of PathologyOutlines.com, Inc.  Information from third parties may also be protected by copyright.  Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).