Lactiferous fistula

Lactiferous fistula, or Zuska's disease, is a rare recurrent condition characterized by draining abscesses about the nipple on one or both breasts. Because little is known about the disease, it is often misdiagnosed and inappropriately treated. We reviewed the medical records of 51 women diagnosed as having lactiferous fistula at The Cleveland Clinic Foundation between 1961 and 1991. The clinical features were tabulated. An experienced breast pathologist reviewed the specimens of all the patients, and surgical techniques were compared. Patients ranged in age from 14 to 66 years, with a mean age of 40 years. Thirty-six patients had a swelling or mass at the areola, 51 had a draining fistula from the subareolar tissue, 40 had a chronic thick, pasty discharge from the nipple and 35 reported pain with the discharge. Fourteen patients had unsuccessful operations elsewhere, including four women who had subcutaneous mastectomies before coming to us. The average duration of symptoms was 3.2 years and the average follow-up period postoperatively was 51 months. On histologic examination, we found that, in all instances, keratinizing squamous epithelium had replaced the lining of one or more lactiferous ducts for a variable distance into the subareolar tissue. Core excision of the fistula and all of the retroareolar fibroglandular tissue and the ductal tissue within the nipple proved to be the definitive therapy in 47 of the 48 patients who had follow-up evaluation.