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 features

Acute episodic inflammatory changes:

• Pain
• Bloody and/or purulent nipple discharge
• Fistulation
• Nipple retraction and distortion

Investigations

• Mammography: duct ectasia can be identified by mammography by dilated calcified ducts without any other features of malignancy
• Biopsy: not usually necessary but 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