Mammary duct ectasia

Mammary duct ectasia is characterized by chronic inflammatory and fibrotic changes leading to clogging of debris within the duct. It is of primary importance because of its features mimicking to that of malignancy.

Terminology

Some publications use this term synonymously with periductal mastitis ⁷ or plasma cell mastitis ^10,11, while others suggest that they are distinct entities with a different pathogenesis ^8,9 .

Epidemiology

More common in females in an age group of 50-60 years (i.e. post menopausal). Very rarely seen in males. It can occasionally be seen in children ¹⁴.

Clinical presentation

• nipple discharge
• nipple retraction
• pain/tenderness
• palpable mass

Pathology

Pathological features include chronic periductal inflammatory changes with fibrosis. Inspissation of debris and secretions within the dilated ducts and later calcification of these ductal contents occurs. There is a known association between ductal ectasia and smoking ¹².

Radiographic features

Mammography

• dilated linear branching densities in subareolar region
• calcifications are rod like or cigar or broken needle like which are pointing towards the nipple

Ultrasound

• dilated, fluid filled subareolar ducts with moving echogenic particulate matter (debris) on real time sonography without mass
• normal ducts are collapsed and are usually around 1-2 mm in diameter ⁹.
• these findings often mimic an intraductal tumor (papilloma)

MRI

On T1 and T2 weighted images it appears as dilated increased signal intensity branching ducts converging towards the nipple without an overlying mass. Hyperintense signals are due to thick proteinaceous fluid or blood.

History and etymology

It was first described by Haagensen in the year 1951 ³.

Differential diagnosis

For dilated ducts see: differential diagnosis of dilated ducts on breast imaging.