INTRAPAPILLARY DUCT DILATION: A NEW ULTRASONOGRAPHY SIGN / Dilatação ductal intrapapilar: um novo sinal ultrassonográfico

Objective: To evaluate a not yet described ultrasound finding, the dilation of the intra-papillary portion of the lactiferous duct in patients with or without abnormal nipple discharge Methods: 24 patients with pathological nipple discharge and intrapapillary duct dilation and 1,255 asymptomatic patients (control group) were studied. Results: Just one asymptomatic patient had intrapapillary duct dilation. Among the symptomatic patients, 19 were biopsied: ten with exclusively percutaneous approach, six with exclusively surgical approach, and three with an initial percutaneous and then a surgical approach. There was one invasive carcinoma and two carcinomas in situ (15.8% of the biopsied patients). In 11 patients, a papilloma was found, three of them with atypia. In one patient, ultrasonography identified intrapapillary extension of microcalcifications, and another patient a changed duct diametrically opposite to the duct which had a trigger point. In these two patients, the examination changed the treatment strategy. In two other patients, an extra-papillary finding was identified only after the intrapapillary duct dilation has been encountered. Conclusion: The intrapapillary duct dilation is a new ultrasonography sign that adds sensitivity to the evaluation of the patient with pathological nipple discharge, besides helping to find the lesion and to guide the treatment. Further research is needed to determine its prevalence and its positive and negative predictive values for cancer, atypia and papilloma

Objetivo: Avaliar um achado de ultrassonografia inédito (dilatação intrapapilar do duto lactífero) em pacientes portadoras de fluxo papilar patológico e em pacientes assintomáticas. Métodos: Foram estudadas 24 portadoras de fluxo papilar patológico e dilatação ductal intrapapilar e 1.255 pacientes assintomáticas (grupo controle). Resultados: Apenas uma paciente assintomática apresentou dilatação ductal intrapapilar. Entre as pacientes sintomáticas, 19 foram biopsiadas, 10 com abordagem exclusivamente percutânea, 6 com abordagem exclusivamente cirúrgica e 3 com abordagem inicialmente percutânea e depois cirúrgica. Houve um carcinoma invasor e dois carcinomas in situ (15,8% das pacientes biopsiadas). Em 11 pacientes foi encontrado papiloma, 3 deles com atipias. Em uma paciente a ultrassonografia identificou extensão intrapapilar de microcalcificações e em outra, um duto alterado diametralmente oposto ao duto com sinal do gatilho clínico. Nessas duas pacientes o exame mudou a estratégia de tratamento. Em duas pacientes, um achado extrapapilar só foi identificado após o encontro da dilatação ductal intrapapilar. Conclusão: A dilatação ductal intrapapilar é novo sinal ultrassonográfico que agrega sensibilidade à avaliação da paciente com fluxo papilar patológico, além de ajudar a encontrar a lesão e a orientar o tratamento. São necessárias pesquisas adicionais para determinar sua prevalência e seus valores preditivos positivo e negativo para câncer, atipias e papilomas.

Ectasia ductal mamaria en niños, a propósito de un caso clínico: A case report / Mammary duct ectasia in children

Introducción: La telorragia es un síntoma poco frecuente en pacientes pediátricos, la causa más frecuente en esta población es la ectasia ductal mamaria (EDM), que es una afección benigna y autolimitada, caracterizada por la dilatación del conducto mamario, fibrosis e inflamación periductal. Objetivo: Presentar un caso de EDM, para facilitar el rápido reconocimiento por parte de los médicos, y evitar estudios y tratamientos agresivos. Caso clínico: Lactante de sexo masculino de 6 meses de edad, sano, alimentado por lactancia materna exclusiva; consultó por un nódulo retroareolar derecho y telorragia unilateral. Se realizó una ecografía Doppler que mostró una lesión multiquística, sugerente de una EDM. Se planteó tratamiento expectante y acudió a control a los 6 meses con excelente evolución. Conclusiones: La EDM es la principal causa de telorragia en niños, corresponde a una afección benigna, y la resolución generalmente es espontánea, antes de los 9 meses. Por lo que su conocimiento es de gran relevancia para el adecuado diagnóstico y manejo de estos pacientes.

Introduction: Bloody nipple discharge is an infrequent symptom during childhood. The most common cause in this population is mammary duct ectasia (MDE), which is a benign and self-limiting condition, that is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. Objective: Report of a case of MDE in order to improve physicians’ diagnosis accuracy and avoid aggressive studies and treatments. Case report: Six-months old male healthy infant, exclusively breastfeeded, that visited our clinic with a lump beneath his right nipple and bloody discharge from the same nipple. An ultrasound was performed which showed a multicystic lesion suggestive of MDE. Watchful waiting was decided as treatment, with good evolution after six months of follow up. Conclusions: The MDE is the leading cause of bloody discharge in pediatric population, being a benign condition that resolves spontaneously before nine months. The knowledge of this condition is essential so as to accurately diagnose and treat it.

Bloody Nipple Discharge in Infants: Case Series.

Bloody nipple discharge very rarely occurs in infants and often is associated with benign mammary duct ectasia. Just because it is a rare symptom and frequently associated with adults’ mammary cancer, it is inadequately managed: inappropriate diagnostic tools are used, consequently inappropriate treatments are given. We here describe four cases of bloody nipple discharge, which resolved spontaneously within a few weeks of diagnosis and we present a review of the literature. In conclusion, a “wait and see” approach is enough and avoids unnecessary invasive diagnostic procedures.

Diagnosis and treatment of mammary duct ectasia:a report of 59 cases / 中国医师进修杂志

Objective To explore the diagnosis and treatment strategy of mammary duct ectasia.Methods The clinical data of 59 cases with mammary duct ectasia from January 2006 to December 2013 were analyzed retrospectively.Results The main clinical manifestations of mammary duct ectasia were mammary inflammatory mass in 46 cases,nipple discharge in 21 cases,nipple retraction in 18 cases,mammary abscess and mammary fistula in 8 cases.Definite diagnosis of mammary duct ectasia depended on pathology.All the patients were treated by operation,followed up for 3 months to 6 years,and none of them had recurrence.Conclusions Operation is the main method of curing mammary duct ectasia.To select proper operation time and method according to disease type,lesion size,location and scope.Thorough resection,repeat rinsing,wound clearance and immediate breast shape can not only cure disease,but also reserve breast configuration as possible.Therapeutic effect is satisfactory.

Advances in diagnosis and treatment of plasma cell mastitis / 国际外科学杂志

Plasma cell mastitis,also known as periductal mastitis or mammary duct ectasia,always occurs in young women.Because of It's Complicated and varied clinical manifestations,it is easily misdiagnosed as breast cancer.Early diagnosis and staging helps to avoid unnecessary surgery.At present,There is no unified understanding to this kind of disease.Modern medicine mainly treated it by surgery while Traditional Chinese medicine believes it shoull be treated internally and externally.Complete resection of the lesion and the cosmetic effect is the focus of current research.This article reviews the progress of research in plasma cell mastitis etiology,pathology,diagnosis and treatment.

A CLINICAL ANALYSIS OF MAMMARY DUCT ECTASIA——REPORT OF 51 CASES / 西安交通大学学报(医学版)

This paper analyses and discusses of the mammary duct ectasia. The review of 51 cases of mammary diagnostic name and pathogenesis duct ectasia shows that mammary duct ectasia and plasma cell mastitis are the two stages of one disease. It is generally caused by disturbance in the secretion of mammary glands. It is difficult to distinguish it from breast neoplasms. Therefor, we also analyse why the disease is more likely to be misdiognosed as breast cancer and also represent its differential diagnosis. The paper involves some measures of treatment.