Mammary duct ectasia with bloody nipple discharge in a child

Abstract

Mammary duct ectasia is a rare disease in children and often presents as a cystic mass with bloody nipple discharge. The pathophysiology of mammary duct ectasia is unclear, and the differential diagnosis of other cystic masses with hemorrhage, such as complicated lymphangioma, is necessary. Here, we report a 14-month-old boy who exhibited unilateral mammary duct ectasia with bloody nipple discharge that was treated with surgical excision. Because some authors have reported that mammary duct ectasia can be often be resolved without surgery, conservative therapy should be considered first when a child presents with a cystic mass with bloody nipple discharge. However, the optimal duration of follow-up and timing of surgical excision have not yet been established.

Bloody Nipple Discharge in Infants

“…Bloodstained nipple discharge is an extremely uncommon but distressing finding in children. Although milky nipple discharge is frequently seen in neonates and infants, usually associated with a palpable breast enlargement, bloody nipple discharge is rarely seen in children (3,4). The underlying pathology of BND differs by age group.…”

“…The underlying pathology of BND differs by age group. In adulthood, BND is associated with benign pathologies, such as intraductal papilloma, mammary ductal ectasia (MDE), and breast nodularity, as well as malignant pathology, such as invasive or intraductal carcinoma (4,5). Possible causes of bloody nipple discharge in children include benign conditions such as an abnormal response of the breast tissue to maternal hormones, high levels of progesterone, MDE, intraductal papilloma, intraductal cyst or mammary ductal hyperplasia.…”

Ectasia ductal mamaria, una entidad poco frecuente en la edad pediátrica. A propósito de un caso

“…9 El tratamiento electivo es conservador; se mantiene una actitud expectante y se tranquiliza a la familia, ya que, a menudo, el cuadro se resuelve de uno a nueve meses. 10,11 Se aconseja efectuar un cultivo de la secreción y, si existen signos sugerentes de sobreinfección, con sospecha de inicio de mastitis, comenzar con antibioterapia empírica, teniendo en cuenta que el germen más frecuentemente implicado en dicho proceso es el Staphylococcus aureus. 12,13 Se desaconseja la manipulación o masaje del área afectada, ya que aumenta la ulceración del epitelio ductal, la hemorragia, y favorece la colonización bacteriana.…”

Comparative study of ultrasound-guided microwave ablation and traditional surgery in the treatment of plasma cell mastitis: a multicenter study

“…Kessler et al (4) believed that the occurrence of PCM was related to its own immune system. In addition, sex hormone disorders (5), long-term use of antipsychotic drugs (6), long-term smoking (7), and obesity (8) were associated with PCM. However, PCM has many clinical manifestations and complex pathophysiological mechanisms, and thus an array of causes can give rise to lesions of the mammary duct.…”