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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
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● Dilated large ducts with fibrous thickening of wall, elastic fibers in wall and foamy macrophages in lumen; often calcifications
Terminology
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● 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
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● Usually women in reproductive years
● Dilated ducts also occur in some neonates (see neonatal breast)
Sites
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● Major ducts, may be bilateral
Etiology
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● May be a response to stagnant colostrum
Clinical features
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● 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
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Case reports
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● 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
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● Excise duct and fistulous tract in continuity
Clinical images
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Gross description (Macroscopy)
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● Dilated large ducts with fatty (cheesy) material in lumen
Micro description (Histopathology)
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● 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
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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
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Videos
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Cytology description
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● 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
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Positive stains
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Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● (link to topic)
Additional references
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End of Breast-nonmalignant > Inflammatory / infectious > Duct ectasia of breast
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