Causes
There is no consensus on its etiology, which may be related to ductal drainage disorders, abnormal hormonal stimulation, and infection.
The etiology of this disease is not clear, but because it is common in middle-aged and elderly people, it may be a degenerative change associated with invagination or malformation of the nipple, extension of squamous epithelium into the duct lining, causing obstruction by keratinized scales, or irritation of the duct wall by lipid secretions, resulting in inflammation, scarring and secondary infection. Autoimmune disease is also possible, because in the later stages of the disease, it is often combined with plasmacytoid mastitis, in which a large number of plasma cell infiltrates are common in the pathology and the lesions are recurrent, so it is thought to be an autoimmune disease.
Pathogenesis
Ductal dilation of the breast is associated with inflammation
The pathogenesis of ductal dilatation of the breast is controversial in the academic community, but in general there are several views as follows.
1. Ductal drainage disorders.
(1) such as congenital nipple deformity, depression, unclean or foreign hair, fibers, etc. causing blockage of the milk pore, abnormal duct development, poor breast structure, resulting in epithelial hyperplasia, inflammation, injury, etc. causing ductal narrowing, interruption or occlusion. Poor ductal drainage is often the main cause of the development of the overflow phase to the lump phase.
(2) Accumulation of secretions in the ducts, causing dilation of the ducts.
(3) In some middle-aged and elderly women, the ducts of the breast are degenerated due to ovarian hypofunction, the walls of the ducts are relaxed, and the contractility of the myoepithelial cells is reduced, resulting in the accumulation of secretions in the ducts and ductal dilatation causing this disease.
2, abnormal hormone stimulation.
Abnormal sex hormone stimulation can prompt the duct epithelium to produce abnormal secretion, and the duct is obviously dilated.
Generally speaking, the presence of obstruction alone without abnormal hormonal stimulation prompting epithelial secretion does not lead to ductal dilation.
3.Infection.
It may be related to anaerobic bacterial infection or infection in the areola.
In a more detailed study, it was found that in the later stages of the disease, the ductal secretions not only stimulate ductal dilation, but can also overflow out of the ducts and produce chemical substances after decomposition, causing chemical irritation and antigenic reactions in the surrounding tissues, resulting in an inflammatory reaction with plasma cell infiltration around the ducts, and named “plasmacytoid mastitis”.
Clinical features
The disease is most commonly seen in non-lactating or menopausal women over 40 years of age, often with a history of impaired lactation. The lesion is usually limited to one side, but there are cases where both mammary glands are involved at the same time. Nipple discharge is sometimes the first symptom of the disease and is the only sign. Multiple sites of pressure on the breast can cause discharge from the nipple, and the lesion often involves a large number of milk ducts and can occupy a large portion of the areola. Nipple discharge is often intermittent and intermittent.
The above clinical manifestations do not occur in all patients according to their developmental pattern, i.e., the first symptom may not necessarily be nipple discharge or acute inflammatory manifestations, but may be a subareolar mass or a persistent parareolar fistula.
In addition, according to the pathological changes and course of the disease, the clinical manifestations can be divided into 3 phases.
1.Acute stage
(1) Early stage.
The symptoms are not obvious, there may be spontaneous or interstitial nipple overflow, only when squeezed there is discharge overflow, the overflow is brownish yellow or bloody or purulent discharge, this symptom can last for many years.
(2) Development.
The skin within the areola is red, swollen, warm and painful to touch. Enlarged lymph nodes may be palpable in the axilla with tenderness. Chills and hyperthermia may be present throughout the body.
This acute inflammatory-like symptoms will soon subside.
2.Sub-acute stage
A lump with mild pain and tenderness is formed in the areola area. The edges of the lump are indistinct and resemble a breast abscess, and the size of the lump varies. Pus can often be extracted by puncturing the mass. Sometimes the swelling naturally ulcerates and forms an abscess fistula. After the abscess is broken or incised, it does not heal for a long time, or a new small abscess is formed again after healing, so that the inflammation continues to develop.
3.Chronic stage
The duration of this period varies, from several months to several years or longer. When the disease recurs, one or more hard nodules with unclear boundaries may appear, mostly located within the areola, which are firm in texture and adherent to the surrounding tissue, resulting in duct shortening and nipple retraction by pulling. Sometimes there are “orange peel” changes due to localized skin edema, and in severe cases there may be breast deformation.
Single or multiple portions of fluid may be seen, which may be plasma or bloody in nature. Axillary lymph nodes may be felt.
Related tests
X-ray mammography, needle aspiration cytology and pathological examination after removal of the swelling can be performed to clarify the diagnosis.
Precautions
Prevention
1. Women should have regular annual mammograms to achieve early detection, early diagnosis and early treatment.
2. Pay attention to personal hygiene, especially the hygiene of the pubic area during menstruation and puerperium. Attention should be paid to keep the nipple areola area clean, appropriate help to remove secretions, and avoid wearing tight tops and bras.
3. Enhance physical fitness and improve your immunity: pay attention to the combination of work and rest, participate in more physical exercise, and eat more fresh fruits and vegetables rich in vitamins.
Pre-operative preparation
One should have a detailed understanding of the symptoms of the disease and the related contraindications, etc.
Preoperative correct diagnosis of microscopic lesions in the milk ducts clarifies the indications for surgery in patients with breast diseases manifested by nipple overflow without lumps, and provides favorable conditions for differentiating normal ducts or ductal dilatation from breast cancer.
How to care
Prognosis.
Ductal dilatation of the breast is a benign disease with a slow course, prone to recurrence, and not significantly related to breast cancer.