| Backgrounds:In Breast Surgery, Mammary Duct Ectasia is a common inflammatory disease, and accounting for about1.1%～75%of benign breast disease by different diagnosis method. The normal diameter of mammary duct is0.5-1.0mm, it named duct ectasia when diameter of duct over1mm. This disease usually occurs at childbearing age of young women, the peak morbidity is located in the50year old female and postmenopausal, but less common in adolescent females. Males and child can also being attack (must pay attention to the identification from male breast cancer), even infant was reported. The clinical manifestations of this disease are various, and have different name, such as comedomastitis, plasma cell mastitis, periductal mastitis, granulomatous mastitis etc.. The pathogenesis of mammary duct ectasia is not clear, this disease was first proposed by C.D. Haagensen et al in1951, that the pathological characteristics of this disease was because of mammary duct ectasia of unknown cause initially. Some scholars also think that plasma cell mastitis and mammary duct ectasia is two kinds of different diseases, should be diagnosis distinguish. Currently, the most acceptable idea is that the different names is reflected in the pathology of the disease at different stages. Mammary duct ectasia was still the most fundamental pathological changes. Patients with this disease often have congenital nipple retraction. Initial symptoms often is palpable mass at unilateral breast or near areola, accompany tenderness. Some patients with nipple discharge (serous, milk or cheese like), then an areolar abscess formation. Improper treatment or incision and drainage lead to ulceration or fistula. This process can be use ductal ectasia, inflammation, abscess, fistula to summarize.The research hot spot in this disease focus on:1. Etiologic research. At present, the cause of this disease is not clear, domestic and foreign scholars have proposed many hypothesis, there is endogenous or exogenous causes mammary duct drainage block up, accumulation of secretions, some scholars believe that related to hormonal imbalance, some people think that associated with bacterial infection.2. The operation principle of treatment. This disease need extensive operation after abscess formation. Slightly lesion tissue residue easily lead to relapse, when young females need operation, doctor should as far as possible to ensure the balance between breast appearance and reduce the recurrence.3. Differential diagnosis between mammary duct ectasia and breast benign or malignant diseases should be make clearly. Clinical manifestations of this disease in different periods are similar with breast cancer.doctor should pay attention to differential diagnosis carefully, to improve the rate of correct diagnosis.Objective:Because of the etiology of mammary duct ectasia is not very clear, this study plan to collection serum and test the sexual hormone levels from patient who need to operation to treat MDE in the Shandong University Qilu Hospital. The date will be analyzed statistically compare to the normal population. We will investigate whether the changes of sex hormone levels are related to mammary duct ectasia, or can be consider as the cause of MDE. In addition, the sex hormone levels between patients with different pathological stages were compared, to investigate the correlation between sex hormone levels and Pathological stages of mammary duct ectasia. Methods:Collected breast surgery patients serum with preliminary diagnosis of MDE (luteal phase, in the morning and stomach empty).then the sample need to further screening. Inclusion criteria:first treatment, premenopausal women, with regular menstrual, postoperative pathological diagnosis is MDE. Exclusion criteria: pregnancy, lactation, and postmenopausal women, have history of thyroid tumor, diabetes, blood system and the immune system such as serious primary diseases. Duct ectasia period11cases, inflammation period35cases, abscess period23cases, fistula period11cases).we get80patients serum accords with mentioned conditions. Randomly selected30cases of healthy premenopausal women as normal control group (normal group).Using statistical analysis to find out whether there is statistical difference between two groups. Besides80cases of patients with different pathological stage were seperated into4groups.sexual hormone levels were compared between them to investigate whether there is statistically significant. All the statistical analysis use SPSS19.0statistical software.Results:1. MDE patients’serum estrogen levels (180.45±80.25) and normal group (124.66±55.23),there was a·significant difference (p=0.01), prolactin levels of MDE patients (29.84±17.56) and the normal group (17.26±13.15) there is a significant statistical difference (p=0.001), progesterone levels (9.65±5.24) and normal group (9.98±6.27) in patients with MDE was not significant (p=0.8)2.MDE patients in ductal ectasia period:estrogen levels (179.89±79.12), progesterone (9.43±5.11), prolactin (28.13±15.56); Inflammation period: estrogen levels (180.56±80.45), progesterone (9.13±6.11), prolactin (29.25±16.02); Abscess period:estrogen levels (178.45±78.15), progesterone (10.02±5.89), prolactin (30.03±14.47); Fistula period:estrogen levels (182.64±77.56), progesterone (8.96±4.25), prolactin (28.44±14.58). Between any two period there is no significant difference in statistical。(p=0.8)3. Eight cases in80MDE preoperative diagnosis is breast cancer (10%),10cases diagnosed as intraductal papilloma (12.5%),4cases diagnosed as fibro adenoma (5%),。4. Preoperative imaging findings of16patients showed calcifications mammography (20%), including12cases of coarse calcifications single, four cases scattered in small calcifications.46cases showed heterogeneous echo ultrasound shows (57.5%).18cases showed dilatation of ductal tortuosity (22.5%).Conclusion:1Estrogen and prolactin levels in patients with MDE significantly higher than the control group, there is a significant difference. MDE progesterone levels in patients with normal control group was not significant. It shows that there is a certain correlation between human serum estrogen and prolactin levels change and MDE2Sex hormone levels in patients with various stages of MDE statistical analysis showed no differences. MDE patients regardless of which pathological staging, estrogen and progesterone levels remain high overall,。3. MDE is common breast disease and have various clinical manifestations, and a variety of breast disease manifestations similar, the initial diagnosis of breast disease is high rate of misdiagnosis of the disease, clinical work should enhance the understanding of the disease... |
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