الفهرس 
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Abstract
Mammary duct ectasia is defined as a dilated duct larger than 2 mm in diameter or a dilated ampullary portion larger than 3 mm in diameter. Duct ectasia affects the major ducts in the subareolar region, but sometimes the smaller segmental ducts can be involved. Mammary duct ectasia is a pathological finding which could be found in either benign diseases (e.g. Mammary duct ectasia with inflammatory changes (periductal mastitis), fibrocystic disease, ductal epithelial hyperplasia or intra ductal papilloma), or malignant diseases e.g. Ductal carcinoma in situ or invasive duct carcinoma.It is believed that the underlying problem with duct ectasia with inflammatory changes and recurrent subareolar abscesses is epidermalization (transformation into keratinized stratified squamous epithelium) of the ductal columnar epithelium and the obstruction of the duct secondary to squamous metaplasia. Although the exact process that causes this to occur is unclear, there are several factors that have been found to be associated with this process. There may be hormonal influences related to prolactin or estrogen levels. Diabetes mellitus, immunocompromisation and after chemotherapy are still a concomitant association.
Vitamin A deficiency is a likely suspect because this also leads to keratinizing squamous metaplasia on multiple mucosal surfaces. Experimental evidence shows that vitamin A has a significant biologic effect on the epithelial differentiation and proliferation. Vitamin A deficiency also impairs blood clearance of bacteria and phagocytic activity, and thus may also be a contributing factor to infection.The causative factor with the strongest link to both squamous metaplasia and recurrent subareolar abscesses is smoking. The incidence of disease rises dramatically with smoking and with the degree of smoking (heavy versus light). Ninety percent of patients with recurrent breast abscess had been exposed to cigarette smoke for many years before the onset of symptoms. Although the association is extremely strong, the mechanisms acts remain unclear.Smoking was reported to inhibit gram positive bacterial growth in vivo and vitro, leading to an over growth of gram negative aerobic and anaerobic bacteria which usually found in periductal mastitis and duct ectasia. Mammary duct ectasia with inflammatory changes, also called periductal mastitis is a distinctive clinical entity that can mimic invasive carcinoma clinically, usually presents with nipple discharge, a palpable subareolar mass, noncyclic mastalgia, recurrent subareolar infection or nipple inversion or retraction’One-stop’ clinics allow rapid and comprehensive preliminary assessment of patients. Triple assessment includes clinical examination, breast imaging and biopsy (when indicated) on the same day. In a patient with a worrisome discharge (discharge with blood (either by report or a positive guiac), any unilateral, spontaneous clear discharge, or any com-plaint of discharge in the face of a personal history of cancer or strong family history of breast or ovarian cancer), duct excision has been considered the gold standard and is generally recommended. This procedure is both diagnostic and therapeutic. This recommendation is based on the 3% to 10% incidence of finding occult cancer in patients with worrisome discharge. Mammary duct ectasia with inflammatory changes generally does not require surgery and should be managed conservatively (1- stop smoking, 2-Vitamin A supple-mentation, 3- Applying warm compresses, 4- Wearing a support bra, 5- Wearing a bra pad). However sometimes surgery may be required, for example in the presence of a suspicious mass, if the discharge is serosanguineous or sanguineous, or the presence of an abscess which requires incision and drainage, followed by a 2-week course of antibiotics consisting of a cephalosporin and intravenous metronidazole, If the patient presents in the early stage, with an indurated mass without fluctuation, then just the 2 weeks of antibiotics should be given. Once the acute infectious process has been addressed, definitive surgical treatment will involve excision of either the entire involved duct or multiple ducts.