Breast Cancer - Moose and Doc

A breast cancer explanations website

 

By Dr. Halls

Duct Ectasia or comedo mastitis

Duct Ectasia is a chronic inflammatory condition affecting the subareolar periductal (an area beneath the nipple and beside the ducts) region on the breast.

If left untreated, it can eventually lead to the obliteration of a breast duct.  However, in the early stages, this condition causes the terminal ducts to ‘dilate‘ (widen).

When the ducts dilate, they may contain cholesterol crystals, calcification, protein secretions, and polyps containing histiocytes.  This, in turn, produces an inflammatory reaction, which may result in nipple discharges.
 

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Duct ectasia usually shows up on Clinical Examination

In the context of screening for breast cancer, duct ectasia is something that often shows as a tubular mass below the nipple on a clinical exam.

Mammogram X-ray does not always show duct ectasia.  A 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.

Duct Ectasia is Benign (not breast cancer)

duct ectasia
duct ectasia

Duct ectasia is completely benign and is not breast cancer. It often occurs around the time of menopause and is most common in older women. The development of this condition 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 inflammatory cells or comedomastitis surround it.
  

Nipple discharge

Duct ectasia can produce a sticky, multicoloured discharge, almost like toothpaste. Sometimes duct ectasia causes pain, itching, and possibly swelling of the nipple.  Furthermore, if it progresses a mass, or lump can develop.

In the early stages, the condition is not serious. If a lump is present, or if the discharges become bloody, it will probably be necessary to surgically remove it.

Duct ectasia, or plasma cell mastitis, accounts for about 1% of all lesions that are surgically treated. Due to the location,  surgeons may have to remove the nipple. From a cosmetic standpoint, this is unfortunate, but the condition is not likely to resolve on its own.  If medics do not treat the condition,  fibrosis and shortening of the major ducts can occur.

Comedomastitis and Plasma Cell Mastitis

 There are three alternate names and these are:-

  1. Comedomastitis
  2. Peridcutal mastitis
  3. Plasma cell mastitis.

In advanced stages, specialists may call the lesion  “mastitis obliterans” for an ‘obliterated duct‘.  So, tissue staining during a histological evaluation will reveal this condition.

The term ‘plasma cell mastitis’ also tends to refer to the more advanced stages of the condition where a pseudo mass has developed. (Note: it is still, however, misnamed.  This is because 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 )

Medics use the term ‘comedomastitis’, in general, to indicate the acute presence of the sticky discharge.  Medics also use another term, ‘periductal mastitis interchangeably, but now specialists tend to view this as a separate entity.

Does duct ectasia increase the risk of 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.

Furthermore, duct ectasia does not increase the risk of subsequent breast cancer development.

What tends to happen, however, is that women who are already at a higher risk for breast cancer due to heredity or family reasons, panic when there is a discharge or a lump in the breast.

Often doctors will refer high-risk patients more readily for 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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About Steven Halls

Dr Halls has 25 years experience as a radiologist. He worked for 13 years at Cross Cancer Institute in Edmonton, a world-class cancer treatment facility. He has had high-volume experience with cancer, interventional procedures, clinical trials and his own phase 1 and 2 research in MRI and breast cancer staging.