Mondor disease of the breast is rare and is a superficial thrombophlebitis of the lateral thoracic or superior thoraco-epigastric veins.

Clinical Features
Patients usually present with a tender subcutaneous cord along the distribution of one or other of these veins, and there may be some dimpling of the overlying skin, particularly on elevation of the arm. It can occur secondary to trauma or excessive physical strain.

Management
Since the condition is self-limiting no intervention is required. Symptomatic relief in the form of topical anti-inflammatory agents may be prescribed.

First described in detail by Henri Mondor in 1939, this condition is a rare entity characterized by a sclerosing thrombophlebitis of the subcutaneous veins of the anterior chest wall. The sudden appearance of a subcutaneous cord, which is initially red and tender and subsequently becomes a painless, tough, fibrous band that is accompanied by tension and skin retraction, is characteristic. The condition, though benign and self-limited, has been associated with breast cancer. It requires only symptomatic therapy. However, the physician must be aware of its existence to properly diagnose it and to rule out the presence of systemic disorders, especially breast cancer.

Pathophysiology

The pathophysiology has been explained as pressure on the vein with stagnation of blood or as direct trauma to the vein itself. In cases that do not show such evidence, the most reasonable explanation is on the basis of repeated movement of the breast along with the contracting and relaxing pectoral muscles, which causes stretching and relaxing of the veins.

Mondor disease may only involve 1 or more of 3 venous channels: the thoracoepigastric vein, the lateral thoracic vein, and the superior epigastric vein. The upper, inner portions of the breast are never involved.

Race
No racial or ethnic predilection is evident.

Sex
Mondor disease is 3 times more common in women than in men.

Age
The disease can occur in persons of any age, but most patients are aged 30-60 years.

Other Causes
Mondor disease may be distinguished from inflammatory cancer of the breast by the presence of sudden pain, early skin adherence, and progressive improvement. These symptoms are not commonly associated with carcinoma of the breast.

The distinction from a breast abscess is made by discerning the quality of tenderness. Mondor disease is ascribed to a soreness, while an abscess presents with an exquisite tenderness.

Mondor disease may mimic a strangulated spigelian hernia. Mondor disease may be evident in the spigelian hernia belt and cause diagnostic confusion.

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School

Robert A Schwartz is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Coauthor(s): Matthew J Trovato, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School

A.D. Purushotham, P. Britton and L. Bobrow
A prospective study of benign breast disease and the risk of breast cancer. JAMA 2002

References

Subcutaneous penile vein thrombosis (penile Mondor disease) has also been described.2 Its pathogenesis is unknown. It appears suddenly as almost painless indurations on the penile dorsal surface.