A Clinical And Bacteriological Study On Mammary Duct Ectasia

Backgrounds:Mammary Duct Ectasia is a common inflammatory disease in the strategies of Breast Surgery. It has also been called Plasma Cell Mastitis. Periductal Mastitis, Comedomastitis, Cholesterol Granuloma, Mastitis Obliterans, Granulomatous Mastitis,Mammary Duct Ectasia-Periductal Mastitis Complex etc. The disease usually occurs in women of child-bearing period. However some literatures suggest that the highest incidence is in young parous women less than fifty years or within six years of pregnancy, with a second peak in post-menopausal age. Rare cases reported occur in puberty girls, children and males. The typical clinical manifestations include unilateral or bilateral (synchronous or metachronous) periareolar mass, mastalgia, nipple discharge, congenital or slowly progressive nipple line-like inversion, peri-areolar abscess and mammary fistula relapses. There is even a case reported in mamma accessoria. The aetiology and pathogenesis are still unclear. C.D.Haagensen etc. in1951introduced the term "Mammary Duct Ectasia" for the primary change-dilated ducts and revealed the pathological pictures of this disease. He considered the initial pathological change is dilated ducts in the retroareolar region, thus the term "Mammary Duct Ectasia" has persisted so far. The domestic literature divided the whole pathological evolution into four stages:duct-ectasia stage, inflammatory-mass stage (or granulomatous stage), abscess stage and mammary fistula stage. At present, the domestic and foreign researches about this disease focus on the following points:①the causal relationship between duct ectasia and periductal mastitis;②the role played by bacteria infection in the inflammation process of Mammary Duct Ectasia;③surgical therapy principle and how to reduce the recurrent rate of mammary fistula;④the clinical differentiation between Mammary Duct Ectasia and other benign or malignant mammary diseases.Objective:1. By retrospective analysis of the medical records of the in-patients’who have received surgical treatment in the Breast Surgery of Qilu hospital, we expect to explore the clinical features of mammary duct ectasia occurred in local patients and the efficiency of antibiotics;2.By analyzing the bacterial cultural results of samples collected from the lesions, we aim at offering some references for clinical experiential treatment of antibiotics.Methods:Between1October2011and31January2013, a total of1874patients were treated by surgery and diagnosed by pathological examination at the Breast Surgery department Qilu hospital Shandong University. Among these cases,155medical records of patients who were diagnosed with mammary duct ectasia were reviewed (patients in whom dilated duct was chance histological findings on breast pathological biopsy have been excluded.). A detailed study on history, clinical manifestations, progress notes and pathological results were made. During the operation processes for70patients who were diagnosed with mammary duct ectasia by pathology, samples including the pus and the necrotic tissues were collected by swabs or special anaerobic cultural containers as aerobic or anaerobic culture requested. Once collected, the samples were sent to Bacteriology Laboratory in Qilu hospital within two hours to be cultured and microscopic tested.All the data was managed by Microsoft Office Excel2007and analyzed by IBM SPSS Statistics19.Results:1. Average age of mammary duct ectasia is34.24-year(range from12to55). When compared with the ages of patients who suffer from malignant tumor(49.92-years,P=0.000)、intraductal papilloma(44.41-years,P=0.000) and fibroma(36.05year,P=0.015)separately, mammary duct ectasia has a statistically significant difference.2. When analyzed by stages, the age of inflammatory-mass stage(37.44-year) is significantly different from the age of abscess stage (30.91-year,P=0.000) and fistula stage(31.30,P=0.000),but there is no significantly difference between abscess stage and fistula stage(P=0.823).3. The inflammatory-mass stage is more acute than abscess stage(P=0.003) with a significant difference.4.The main manifestations of mammary duct ectasia include mammary lump or scleroid region (85.16%)、noncyclical mastalgia (78.71%)、nipple retraction (58.71%) redness (49.68%)、lymphadenectasis (25.81%)、nipple discharge(20.65%).4.The rate of nipple retraction or inversion of inflammatory-mass stage(42.65%) is significantly different from that of abscess(P=0.013) and fistula stage(P=0.000).6. The clinical corresponding rate of inflammatory-mass stage(60.29%) is significantly different from that of abscess(P=0.001) and fistula stage(P=0.000).7.The antibiotics efficiency in abscess and fistula stage is significantly different (P=0.012).8. The β-lactams+Nitroimidazole program is more efficient than (3-lactams only with a significant difference (P=0.014).9.The positive microorganisms include staphylococcus epidermidis、Staphylococcus aurcus、Stenotrophomonas maltophilia、 Gram positive coccus/Streptococcus、Gram negative bacillus and Gram positive bacillus.10.The positive cultural rates among different stages have no significant difference (P=0.365)Conclusion:1. Mammary duct ectasia has developed to the fourth largest disease following malignant tumor, fibroadenoma, intraductal papilloma. And the age sequence is malignant tumor＞intraductal papilloma＞fibroadenoma＞mammary duct ectasia.2. The initial pathological change is dilated duct and periductal inflammation. Mammary abscess and fistula both derive from dilated duct and periductal inflammation.3. Mammary duct ectasia is a sterile disease while the bacteria act as a secondary factor. M. tuberculosis is considered to be unrelated. Both aerobe and anaerobe can be detected but there is no special pathogen. 4. Antibiotic therapy is most efficiency in abscess stage while the combination of β-lactams and Nitroimidazole is preferred choice.5. The aim of surgery therapy is to clean all the lesions to capacity to gain primary closure.