Duct Ectasia and Periductal Mastitis in Indian Women

Abstract

There is very little awareness of the general physicians and surgeons about the benign breast conditions such as duct ectasia (DE) and periductal mastitis (PDM) causing nipple discharge. Not only that these benign breast diseases ring a false alarm of cancer, they are also the second most common cause of benign breast diseases. The objective was to study the clinical and microbiological profiles of duct ectasia and periductal mastitis in Indian women for better understanding of the disease process, in order to be able to treat them well. Forty-one consecutive patients presenting to the Surgical Out-Patient Department with non-bloody nipple discharge with clinical and radiological features suggestive of DE or PDM were included. Microbial culture and cytopathological study of the nipple discharge were done. Histopathological studies and culture of the ductal tissue taken intraoperatively were carried out. There is no significant difference in the age distribution among women with DE and PDM. Smoking is not associated with DE and PDM of Indian patients in contrast to the Western literature evidence. Infective etiology was present in nearly 46 % of the patients in the study population more so in the periductal mastitis cases. The most common isolated pathogens were Staphylococcus aureus and Staphylococcus epidermidis, unlike in Western population where nearly 50 % were anaerobes. Since the isolated organisms were resistant to the routinely used antibiotics in high proportion of cases, culture and sensitivity should be done in all possible cases for appropriately treating the subareolar sepsis before proceeding with the definitive treatment in the form of duct excision.

Periductal Mastitis: An Inflammatory Disease Related to Bacterial Infection and Consequent Immune Responses?

“…Periductal mastitis (PDM) is histopathologically defined as a chronic inflammation of the breast, with dilation of the mammary duct, plasma cell infiltration, and abscess formation. A variety of different terms, including mammary ductal ectasia and plasma cell mastitis, have been used for this condition [ 1 , 2 ]. The use of different terms probably reflects different stages in the disease process.…”

Nipple hypersensitivty—An unusual symptom of duct ectasia

“…A risk factor that is commonly associated with duct ectasia is smoking. However, studies conducted in the Indian subcontinent did not show this association to be true . Also, culture of the nipple discharge often yields microorganisms such as Staphylococcus aureus, Staphylococcus epidermidis, and Klebsiella pneumoniae among others .…”

“…However, studies conducted in the Indian subcontinent did not show this association to be true. 4 Another condition which is often clubbed together or confused with MDE is periductal mastitis (PDM). However, latest studies show that both these entities may be separate with different pathophysiology.…”

Mastitis in Autoimmune Diseases: Review of the Literature, Diagnostic Pathway, and Pathophysiological Key Players

“…A hypothetical mechanism is that periductal inflammatory infiltrates, consisting of lymphocytes and histiocytes, may lead to subsequent destruction of the duct's basal membrane, leading to ductal dilatation. This pathophysiological process might be triggered by recurrent breast infections [66]. However, ductal dilatation has also been described as a normal involution of breast tissue in women over 80 years old [67,68].…”

“…Indeed, the pathophysiology of MDE is unclear and several potential causes have been suggested. Environmental factors (such as smoking, with conflicting data), local factors (inflammation linked to breast infections), or hormonal status (lactation and pregnancy, or hyperprolactinemia) may all play a role in the origin of MDE [66,68]. Finally, ductal dilatation may also be secondary to an obstruction caused by papilloma or carcinoma.…”