LACTIFEROUS FISTULA

Lactiferous fistula, or Zuska's disease, is a rare recurrent condition characterized by draining abscesses about the nipple on one or both b reasts. Because little is known about the disease, it is often misdiag nosed and inappropriately treated. We reviewed the medical records of 51 women diagnosed as having lactiferous fistula at The Cleveland Clin ic Foundation between 1961 and 1991. The clinical features were tabula ted. An experienced breast pathologist reviewed the specimens of all t he patients, and surgical techniques were compared. Patients ranged in age from 14 to 66 years, with a mean age of 40 years. Thirty-six pati ents had a swelling or mass at the areola, 51 had a draining fistula f rom the subareolar tissue, 40 had a chronic thick, pasty discharge fro m the nipple and 35 reported pain with the discharge. Fourteen patient s 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 postoperative ly was 51 months. On histologic examination, we found that, in all ins tances, keratinizing squamous epithelium had replaced the lining of on e or more lactiferous ducts for a variable distance into the subareola r tissue. Core excision of the fistula and all of the retroareolar fib roglandular tissue and the ductal tissue within the nipple proved to b e the definitive therapy in 47 of the 48 patients who had follow-up ev aluation.