Duct Ectasia or comedo mastitis
Duct Ectasia is a chronic inflammatory condition effecting the subareolar periductal (beneath the nipple and beside the ducts) region on the breast. Left untreated it can eventually lead to the obliteration of a breast duct, but in early stages it causes the terminal ducts to ‘dilate‘ (widen). When the ducts dilate, they may contain cholesterol crystals, calcification, protein secretions, and polyps containing histiocytes.
The produces an inflammatory reaction, which may result in nipple discharges.
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duct ectasia will usually be found on a mammogram
In the context of screening for breast cancer, duct ectasia is something which may be found as a tubular mass below the nipple on a clinical exam. It will probably not be found on the mammogram X-ray. I tubular mass of sorts can often be felt, which is likely the result of a retracting nipple. A followup investigation with excisional biopsy is usually initiated, as a fine needle aspiration tends to be inconclusive.
unrelated to breast cancer
Duct ectasia is completely benign and unrelated to breast cancer. It often occurs around the time of menopause, and is most common in older women. The development of duct ectasia has also been linked to the use of breast implants.
The image above shows a normal breast duct, lined with about 2 to 3 layers of normal cells, and surrounded by collagen. But in the image below, the duct is dilated and surrounded by inflammatory cells or comedomastitis.
Duct ectasia can produce a sticky, multicolored discharge, almost like toothpaste. Sometimes duct ectasia causes pain, itching, and possibly swelling of the nipple, and if it progresses a mass can develop. In early stages the condition is not serious. If a mass has developed or if the discharges become bloody, it will probably be surgically removed. Duct ectasia or plasma cell mastitis acounts for about 1% of all surgically treated lesions. Due to its location, the nipple will likely have to be removed. From a cosmetic standpoint this is unfortunate, but the condition will not likely resolve on its own and left untreated can result in fibrosis and shortening of the major ducts.
Comedomastitis and Plasma Cell Mastitis
Alternate names for duct ectasia include comedomastitis, peridcutal mastitis, and plasma cell mastitis. In advanced stages the lesion may be termed “mastitis obliterans” for an ‘obliterated duct‘, which would likely be revealed by tissue staining during a histological evaluation. The term “plasma cell mastitis” tends to refer to the more advanced stages of the condition where a pseudo mass has developed. (Note: it is still misnamed, plasma cells begin to infiltrate the discharge, but there is nothing wrong with the plasma cells, and they are not the cause of the condition ) The term ‘comedomastitis‘, is generally used to indicate the acute presence of the sticky discharge. Another term, “periductal mastitis” is often used interchangably, but is now tending to be viewed as a separate enitity.
Are duct ectasia, comedomastis, plasma cell mastitis increased risk factors for breast cancer?
No, breast cancer is the result of a genetic mutation. Duct ectasia is a health condition related to the ‘mechanics‘ of breast functioning and is completely unrelated to breast cancer, and is absolutely not an increased risk factor for subsequent breast cancer development. What tends to happen, however, is that women who are thought to be of higher risk for breast cancer due to heredity or family reasons, become alarmed by any discharges or bumps in the breast, and therefore are referred for a breast cancer screening. The discovery that the situation is the result of duct ectasia and not breast carcinoma is generally a pleasant one.
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