Mammary duct ectasia is the abnormal widening of one or more breast ducts to greater than 2 mm diameter, or 3 mm at the ampulla. It can be due to benign or malignant processes.
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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
It is more common in females in an age group of 50-60 years (i.e. postmenopausal). It is very rarely seen in males. It can occasionally be seen in children 14.
Clinical presentation
Ductal ectasia is often asymptomatic, especially when benign. However, patients with ductal ectasia may present with nonspecific breast symptoms:
nipple discharge
nipple retraction
pain/tenderness
palpable mass
Pathology
Benign duct ectasia is characterized by chronic inflammatory and fibrotic changes. 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.
Intraductal malignancy can also cause duct ectasia.
Radiographic features
Mammography
dilated linear branching densities in subareolar region
variably present rod-like calcifications pointing towards the nipple
Ultrasound
distended branching or tubular structures with anechoic contents measuring more than 2 mm diameter
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.
Treatment and prognosis
Most treatments are aimed at symptom relief and excluding more malicious pathologies. If there is a mastitis element, antibiotics may be considered.
Differential diagnosis
For dilated ducts see: differential diagnosis of dilated ducts on breast imaging.
Practical points
Bilateral, subareolar findings of duct ectasia may confidently be assessed as benign (BI-RADS 1 or 2).
A unilateral (asymmetric) mammographic finding of duct ectasia without demonstrated stability on prior studies warrants further evaluation with ultrasound 15. Features that on ultrasound should raise suspicion for malignancy include nonsubareolar location, hypoechoic intraluminal contents, ductal wall irregularity or indistinctness, or solid parenchymal mass 9,15.
A solitary dilated duct, a rare type of asymmetric duct ectasia, is suspicious for malignancy and biopsy should be considered (BI-RADS 4) 15.
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