Non-lactation areola fistula
Introduction
Introduction to non-lactating areola The non-lactating areola of the areola is a local infectious lesion of the large duct of the breast that occurs in the areola area, and both men and women can develop the disease. Clinically, it is characterized by recurrent fistula in the areola area, also known as non-prolactinous breast abscess, abscess around non-lactating areola, abscess under chronic areola, mammary gland, large ductal granuloma of the breast. Zusks et al. named the milk duct fistula according to the histological changes of the disease. Due to repeated attacks of the disease, the course of disease has been delayed, reported 0.5 to 102 months, the longest 20 years, most of the course of disease is 1 to 3 years. Simple antibiotic treatment is ineffective and must be treated surgically. basic knowledge Sickness ratio: 0.0002%-0.0008% Susceptible people: women Mode of infection: non-infectious Complications: intraductal papilloma
Cause
Non-lactating areola tuberculosis
(1) Causes of the disease
The mechanism of non-lactating areola infection and even the formation of fistula is still inconsistent. Patey is inferred to be associated with congenital malformation of the main duct. Others believe that the local infection of the large duct is ruptured outward. Some people think that the skin infection is eroded. Caused by the milk duct, some authors believe that the external mouth of the fistula is in the vicinity of the areola area, because the skin in the areola area is rich in sebaceous glands, sweat glands and multiple areola glands (generally 5 to 10), and the secretion is strong, if the lactiferous duct is far The end (ie, the areola) atresia combined with the infection of the local skin can not be discharged to develop the disease.
(two) pathogenesis
1. Pathogenesis: The breast is composed of skin, mammary gland, supporting connective tissue and protective adipose tissue. The center of the breast is the nipple, the opening of the mammary duct, the skin on the nipple surface is thin and delicate, and the surrounding ring pigment The stagnation area is the areola, the areola area is rich in sebaceous glands, sweat glands and areola glands, but the subcutaneous tissue is relatively poor. When the isola gland causes obstruction and infection, the bacteria in the lesion are easily spread to the surrounding area and invade the nearby large breast tube. The subcutaneous lesion is collided with the milk duct to form a fistula.
2. Pathology: Zusks (1951) found that most of the fistulas were covered with thick squamous epithelium. Patey (1958) observed that the fistulas were composed of inflammatory granulation tissue and communicated with the main duct under the areola. Most scholars believe that the disease and malignancy Tumors are not related, but some authors have reported some phenomena such as: most of the fistula wall is composed of chronic inflammatory granulation tissue (including tuberculous granuloma), and only a few cases are covered with well-differentiated stratified squamous epithelium, which is related to Patey et al. The observations were basically the same. At the same time, the lesions and surrounding tissues, ductal epithelium, glandular epithelium, and myoepithelial cells were observed. As the disease progressed, the volume and cytoplasmic ratio of proliferating cells increased, and the number and level of cells increased. Deepening, the nucleus changes from small round to large round, rod-shaped, nucleoli is prominent, in which ductal epithelium and myoepithelial cells react significantly, and there is a tendency to form intraductal papilloma and intraductal cancer, Rueden is studying breast duct When reviewing pathological data of internal cancer, it is also considered that cancer is transformed from glandular lobules and ductal epithelial hyperplasia. Therefore, some authors believe that if the fistula is not treated in time, There is a possibility of malignant transformation under the stimulation of long-term inflammation.
Prevention
Non-lactating areola fistula prevention
According to the cause of targeted prevention, early detection and early diagnosis is the key to the prevention and treatment of this disease.
Complication
Non-lactating areola fistula complications Complications intraductal papilloma
If the fistula is not treated in time, there is a possibility of malignant transformation under the stimulation of long-term inflammation. Such as papilloma and intraductal cancer.
Symptom
Non-lactating areola fistula symptoms Common symptoms Abscess nipple retraction
(1) Painless mass: The chronic abscess formed in the areola area is not punctured before it is worn or cut. It can only reach the painless mass with clearer boundaries.
(2) Nipple retraction: Most cases are accompanied by nipple retraction, and the nipple retraction is mostly biased to the affected side (87% to 92.3%), also known as "biased invagination".
(3) recurrent fistula: after the abscess is worn or cut, there may be sebum-like secretions; the ulceration is not cured for a long time, or the abscess and ulceration occur repeatedly, forming a local repeated incision and drainage healing ulceration again Heal rupture again.
2. Physical examination
(1) palpation of the areola or the root of the nipple has a cord.
(2) Under the local anesthesia, the ulcer or the penetrating abscess is gently probed into the nipple with a metal probe, which can be detected through the opening of the milk duct.
(3) If it is not possible to detect, use a blunt soft plastic tube (plastic tube with infusion needle or an epidural catheter with a diameter of 1 mm instead) for multi-directional exploration to confirm the diagnosis.
Examine
Non-lactating areola fistula examination
1. Blood routine: The total number of white blood cells is slightly elevated, and the proportion of neutrophils is increased.
2. Bacteriology culture and drug susceptibility test: sputum secretion or puncture pus for bacteriological culture and drug sensitivity test, provide a basis for the selection of antibiotics.
In the methylene blue injection test, a small amount of methylene blue was injected through the milk duct and massaged in the direction of the nipple. When the fistula was formed, the methylene blue overflowed in the opening of the milk duct.
Diagnosis
Diagnosis and identification of non-lactating areola fistula
Diagnostic criteria
The following clinical features are the basis for the diagnosis of this disease:
1. Repeated infection of the areola in non-lactation, abscess, nipple overflow.
2. Abscess formation incision healing re-rupture re-healing.
3 antibiotic treatment is ineffective, incision drainage or resection of fistula healing is a distinguishing point from cancer.
4. Insert the probe through the abscess rupture, or inject methylene blue, which can be found or overflowed in the milk duct opening.
Differential diagnosis
1. Breast tuberculosis: The breast tuberculosis is far away from the areola and the large tube of lactation, so the nipple retraction is very rare, and most cases of this disease are accompanied by nipple retraction, and anti-tuberculosis treatment is invalid.
2. Breast cancer: Before the chronic abscess has not been worn, the disease can only reach the painless mass with clear boundary and the biased nipple retraction, so it is easy to be confused with breast cancer. After local puncture, the disease can be Take out the pus, which is the basis for the exclusion of cancer.
