Abstract

Zuska disease is an often-misdiagnosed non-neoplastic condition of the breast characterized by recurrent nonpuerperal subareolar abscesses, first described in 1951 by Zuska et al [1]. We describe the case of a 52-year-old man with 30-pack-year smoking history who presented with a two-year history of recurrent draining abscesses of the bilateral breasts despite repeated courses of oral antibiotics. Mammography revealed dense subareolar tissue reminiscent of gynecomastia, and left breast ultrasound showed hypoechoic tissue in the subareolar area. Punch biopsy of the left breast revealed mixed granulomatous dermatitis, and subsequent excision of the left breast mass revealed inflammation and debris with cystic squamous epithelial elements. Six months after biopsy of the left breast mass, he presented with new onset right breast tenderness and swelling without fevers or chills. Culture of nipple discharge revealed growth of Staphylococcus lugdunensis, and he received a three-month course of oral doxycycline 100mg bid. Clinicopathologic correlation led to a diagnosis of Zuska disease [2,3]. Also known as squamous metaplasia of lactiferous ducts (SMOLD), this entity may mimic other inflammatory and neoplastic breast diseases. Average age of onset is 47 years; the clinical differential diagnosis includes mastitis, ductal ectasia, inflammatory breast carcinoma, and mammary Paget disease. [2-4]. Suspected pathogenesis is obstruction of lactiferous ducts from squamous metaplasia and subsequent bacterial invasion leading to fistula formation. Vitamin A deficiency may play a role, and smokers are at increased risk for recurrence, raising a potential role for hypoxia [5]. Treatment of infection and surgical excision of affected region are recommended. This case highlights the role of clinicopathologic correlation and histology in diagnosis of an entity rarely seen by dermatopathologists.

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