Squamous metaplasia of lactiferous ducts (SMOLD): an under-recognised entity

Abstract

Breast abscesses are a common surgical problem, typically occurring secondary to lactation mastitis. Recurrent subareolar abscesses are rarely reported and may be poorly recognised as a presentation of squamous metaplasia of lactiferous ducts, known eponymously as ‘Zuska’s disease’. Other synonyms include subareolar breast abscess and lactiferous or mammary fistulas. Recognition of this painful entity is crucial for optimal outcomes since typical breast abscess management of recurrent aspiration or incision and drainage can lead to recurrence and chronic complications, such as fistula formation.

Nontender white papule of the areola in a middle-aged female

“…Answer: SMOLD – Correct. Formerly called Zuska’s disease, 1 SMOLD is a rare, underrecognized, benign breast disease which classically presents as an erythematous, painful, often purulent periareolar mass which may be associated with areolar sinus or mastitis. 2 Epidermal inclusion cyst – Incorrect.…”

“… 2 Clinicopathologic correlation may be needed as pathologists may attribute these cytologic findings to a nonspecific abscess, delaying the correct diagnosis and treatment. 1 Necrotizing breast malignancy – Incorrect. The differential diagnosis of ruptured SMOLD may include inflammatory carcinoma, retroareolar abscess, intraductal papilloma, and necrotizing breast malignancy.…”

“… 2 Clinicopathologic correlation may be needed as pathologists may attribute these cytologic findings to a nonspecific abscess, delaying the correct diagnosis and treatment. 1 …”

“…This metaplasia replaces the lactiferous duct’s normal cuboidal epithelium with keratinizing squamous epithelia, leading to accumulation of keratinocytes, duct obstruction, and potentially duct rupture. 1 , 3 …”

“…Early recognition minimizes unnecessary suffering and chronic complications such as fistula formation. 1 , 3 , 4 Warm compress and gentle self-massage – Incorrect. …”