Duct Ectasia

Dilation and shortening of the major lactiferous ducts

Aetiology

  • Common presentation in peri-menopausal women, with 40% of women having significant duct dilatation by 70 yrs
  • Associated with smoking

Pathophysiology

  • Sub-areolar duct dilation
  • Periductal inflammation and fibrosis
  • Scarring and distortion

Clinical presentation

Acute episodic inflammatory changes:
  • Pain
  • Bloody and/or purulent nipple discharge
  • Fistulation
  • Nipple retraction and distortion

Investigations

  • Duct ectasia can be identified by mammography by dilated calcified ducts without any other features of malignancy
  • If biopsied, the mass typically contains multiple plasma cells on histology

Management

  • Can be managed conservatively, unless radiological findings cannot exclude malignancy
  • Unremitting nipple discharge can be treated with duct excision

Complications

  • Acute mastitis/abscess