Womens Health

Mammary duct ectasia is a benign disease of the mammary gland, characterized by a frequently long history of tumour formation, nipple discharge, nipple retraction and mastalgia.

Non-puerperal mammary abscess, which may be the presenting symptom, is also part of the syndrome. Diagnosis can often be made on the basis of the history and the clinical findings of nipple discharge, nipple retraction, tenderness on palpation, fistula formation and suareolar (sub?) tumour/abscess formation.

Mammography may guide diagnosis. Breast cancer is the most important differential diagnosis. If the clinical picture resembles cancer, it is necessary to perform diagnostic biopsy. Causal therapy of mammary duct ectasia is not available.

Until now excision of the central mammary tissue and larger ducts has been used as treatment for the clinical manifestations of abscess, fistula and nipple discharge, apparently with good results.

Subareolar dissection for duct ectasia and periareolar sepsis 
Hartley MN, Stewart J, Benson EA, Department of General Surgery, General Infirmary, Leeds, UK.
Br J Surg 1991 Oct;78(10):1187-8.

Excision of the major duct system of the breast for symptoms owing to mammary duct ectasia may be curative, but recent reports have been less optimistic. A retrospective study (1978-1990) of 46 women (median age 38 years, range 18-78 years) who underwent subareolar dissection with antibiotic cover for symptoms associated with duct ectasia is presented. Thirty-three women presented without symptoms of overt sepsis (periareolar lump, nipple discharge or nipple retraction). Following subareolar dissection, six developed recurrent symptoms and five required further surgery. Thirteen women presented initially with abscesses. Eight abscesses recurred following incision and drainage, and one developed a mammillary fistula. Following subareolar dissection, six developed recurrent sepsis requiring further surgery.

Nipple discharge and elevated prolactin level

My troubles started last year when I had breast discharge at the same time that I missed two monthly periods in a row. I had never missed a period ever and have always been regular as clock-work, give or take a period or two when I was late/early by a week or so. Pregnancy tests were negative and my first prolactin level was 130, next was 110, next was 170.

My doctor said I had a prolactinoma but not to worry because it was benign. I also had a CAT scan which was reported to be negative. I was referred to an endocrine doctor who repeated the same blood work. The endocrine doctor did not give a diagnosis of any sort, but did prescribe Parlodel which I am now taking. After six weeks of Parlodel the breast discharge has stopped, my prolactin level last tested at 26, and I have no side effects other than the initial dizziness.

However, I have never had an official diagnosis. When I asked my doctor, she said I should never rule out the possibility of a prolactinoma. What does this mean? Do I have a prolactinoma or just hyperprolactinemia or are they the same? Also, there is a history of thyroid disease on my mother's side. Every single female has some sort of thyroid problem, low/high/goiter or menstrual problem. I am the only one who tests normal for thyroid function and has normal periods. Is it possible that my high prolactin levels are really thyroid-related even if my thyroid test is normal?

A diagnosis of prolactinoma is made by the presence of two factors - 1) elevated prolactin levels and 2) the secreting tissue has to be big enough to enlarge an area in the brain, the sella turcica.

Since they did not see that enlarged area on the CAT scan, they could not "officially" diagnose a prolactinoma. However, because the prolactin level was so high, they are treating you under the assumption that there is "hyperplasia" of prolactin secreting cells even though that area is not big enough to enlarge the sella.

In view of your normal thyroid tests, your elevated prolactin levels and missed periods are probably not related to any thyroid disfunction.

Table of Contents
1. Mammary duct ectasia
2. What are my options?
3. Itchy nipples
4. Bleeding nipples
5. Green discharge
6. Is brown discharge serious?
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