Breast - nonmalignant
Inflammatory / infectious
Duct ectasia of breast

Author: Hind Nassar, M.D. (see Authors page)

Revised: 26 July 2017, last major update March 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Breast duct ectasia [title]

Cite this page: Duct ectasia of breast. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastductectasia.html. Accessed September 26th, 2017.
Definition / general
  • Dilated large ducts with fibrous thickening of wall, elastic fibers in wall and foamy macrophages in lumen; often calcifications
Terminology
  • Also called periductal mastitis, although some believe they are different entities (Br J Surg 1996;83:820)
  • Late stage is ductitis obliterans or mastitis obliterans with total occlusion of ducts (Breast J 2007;13:599)
Epidemiology
  • Usually women in reproductive years
  • Dilated ducts also occur in some neonates (see neonatal breast)
Sites
  • Major ducts, may be bilateral
Etiology
  • May be a response to stagnant colostrum
Clinical features
  • Painful, erythematous, subareolar mass, may have fistulous tract
  • Often nipple discharge
  • Associated with smoking (Int J Clin Pract 2005;59:1045), possibly pituitary adenomas and increased prolactin levels (Am J Surg Pathol 1988;12:130)
  • Recurrences may cause nipple inversion or discharge, resembling carcinoma
Case reports
Treatment
  • Excise duct and fistulous tract in continuity
Gross description
  • Dilated large ducts with fatty (cheesy) material in lumen
Microscopic (histologic) description
  • Dilated large ducts with fibrous thickening of wall, elastic fibers in wall and foamy macrophages in lumen; often calcifications
  • Additional inflammatory infiltrate that varies from acute (early) to lymphoplasmacytic (late), then is replaced by fibrosis
  • Keratin goes deep within ductal system causing dilation and rupture of duct with intense chronic and granulomatous inflammation
  • May have associated epithelial hyperplasia or apocrine metaplasia
Microscopic (histologic) images

Images hosted on PathOut server:

Ducts are dilated with sparse secretions,
lower duct is partially disrupted releasing
material into stroma and causing
periductal fibrosis and elastosis

Dilated duct has amorphous
stasis material and lymphoid
nodules at at sites of
secondary duct branching

Periductal lymphocytes,
thickened basement
membrane and lack of
cells in duct contents

Narrowed duct
lumen due to
periductal collagen
and elastic tissue



Images hosted on other servers:

Foamy macrophages below luminal epithelium

Periductal scarring (late)

Late stage with hemosiderin laden macrophages

Dilated ducts with
foamy macrophages
and periductal
inflammatory infiltrate


Other images

Cytology description
  • Paucicellular, with few scattered cohesive clusters of ductal epithelial cells with mild atypia and peripheral myoepithelial cells
  • Also CD68+ macrophages with finely vacuolated cytoplasm (Acta Cytol 2001;45:1027)