Mondor Disease

Mondor Disease

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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, as diagrammed in the image below. Fage in 1870 has been credited with delineating cording as a sign of superficial thrombophlebitis.}

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. [1]

Subcutaneous penile vein thrombosis (penile Mondor disease) has also been described. [2, 3] Its pathogenesis is unknown. It appears suddenly as almost painless indurations on the penile dorsal surface. Similar cording may rarely occur in the groin, abdomen, arm, and axilla. [4] In the latter site, it has been termed the axillary web syndrome and may be evident after axillary lymph node dissection and sentinel lymph node biopsy.

A related article is Superficial Thrombophlebitis.

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. [5] . An tight bra may be implicated by causing direct trauma. [6] Bodybuilders using intense thoracoabdominal exercise training may also develop it. [7]

Mondor disease may only involve one or more of three venous channels: the thoracoepigastric vein, the lateral thoracic vein, and the superior epigastric vein. The upper, inner portions of the breast are never involved. Mondor disease can also occur on the penis, groin, antecubital fossa, and posterior cervical region. [8, 9]

Although most often linked with breast cancer surgery and anesthetic mammaplasties, [10] it may also occur as a result of excision of axillary nodes after gel silicone breast implant rupture. [11] It may also be a complication of ultrasound-guided core needle biopsy. [12]

Fewer than 400 cases have been described worldwide. [13] . However, its incidence after breast cancer surgery and aesthetic mammaplasties has been estimated at 1%. [11]

No racial or ethnic predilection is evident.

Mondor disease is 3 times more common in women than in men. [14]

The disease can occur in persons of any age, but most patients are aged 30-60 years. [14]

Mondor disease has proven to be self-limited and benign. Its significance lies in the clinician’s recognition and differentiation of it from primary, recurrent, or metastatic carcinoma, or an abscess of the breast. As are other forms of migratory thrombophlebitis, Mondor disease may be an indication of an occult carcinoma elsewhere in the body. Patients with this condition should continue to be observed.

Explaining to the patient that no instance of Mondor disease has reportedly preceded or eventuated in breast cancer may be beneficial. However, patients with a history of Mondor disease should have periodic breast examinations, mammography, and additional tests searching for cancer elsewhere.

For patient education resources, see the Circulatory Problems Center and Cancer and Tumors Center, as well as Phlebitis, Breast Cancer, and Breast Self-Exam.

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Al-Mwalad M, Loertzer H, Wicht A, Fornara P. Subcutaneous penile vein thrombosis (Penile Mondor’s Disease): pathogenesis, diagnosis, and therapy. Urology. 2006 Mar. 67(3):586-8. [Medline].

Kostrzewa O, Kołodziej P, Majdan M, Zwolak R, Górak A, Bar K. [Mondor’s disease or systemic sclerosis – diagnostic and therapeutic dilemmas]. Wiad Lek. 2018. 71 (1 pt 1):93-95. [Medline].

Shoham Y, Rosenberg N, Krieger Y, Silberstein E, Arnon O, Bogdanov-Berezovsky A. [Axillary web syndrome–a variant of Mondor’s disease, following excision of an accessory breast]. Harefuah. 2011 Dec. 150(12):893-4, 937, 936. [Medline].

Hogan GF. Mondor’s disease. Arch Intern Med. 1964 Jun. 113:881-5. [Medline].

Vincenza Polito M, De Cicco P, Apicella R. Tight Bra in a 34-Year-Old Woman: An Unusual Cause of Mondor’s Disease. Ann Vasc Dis. 2014. 7(2):149-51. [Medline]. [Full Text].

Tröbinger C, Wiedermann CJ. Bodybuilding-induced Mondor’s disease of the chest wall. Phys Ther Sport. 2017 Jan. 23:133-135. [Medline].

Alvarez-Garrido H, Garrido-Rios AA, Sanz-Munoz C, Miranda-Romero A. Mondor’s disease. Clin Exp Dermatol. 2009 Oct. 34(7):753-6. [Medline].

Marsaudon E, Legal C, Gayoux D, Weber O. [Mondor’s disease of penis: A case report]. Rev Med Interne. 2016 Mar 10. [Medline].

Pignatti M, Loschi P, Pedrazzi P, Marietta M. Mondor’s disease after implant-based breast reconstruction. Report of three cases and review of the literature. J Plast Reconstr Aesthet Surg. 2014 Jun 4. [Medline].

Khan UD. Mondor disease: a case report and review of the literature. Aesthet Surg J. 2009 May-Jun. 29(3):209-12. [Medline].

Salemis NS, Vasilara G, Lagoudianakis E. Mondor’s disease of the breast as a complication of ultrasound-guided core needle biopsy: Management and review of the literature. Breast Dis. 2014 Jul 2. [Medline].

Quehe P, Saliou AH, Guias B, Bressollette L. [Mondor’s disease, report on three cases and literature review]. J Mal Vasc. 2009 Feb. 34(1):54-60. [Medline].

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Stephan F, Maatouk I, Moutran R, Wehbe J, Obeid G. A case of idiopathic Mondor disease. Dermatol Online J. 2012 Jan 15. 18(1):14. [Medline].

Suganthan N, Ratnasamy V. Mondor’s disease – a rare cause of chest pain: a case report. J Med Case Rep. 2018 Jan 9. 12 (1):4. [Medline].

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Loos B, Horch RE. Mondor’s disease after breast reduction surgery. Plast Reconstr Surg. 2006 Jun. 117(7):129e-132e. [Medline].

Talhari C, Mang R, Megahed M, Ruzicka T, Stege H. Mondor disease associated with physical strain: report of 2 cases. Arch Dermatol. 2005 Jun. 141(6):800-1. [Medline].

Oldfield MC. Mondor’s disease. A superficial phlebitis of the breast. Lancet. 1962 May 12. 1:994-6. [Medline].

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Bauer-Hack K. [Contribution to Mondor’s disease.]. Med Welt. 1962 Oct 13. 41:2152-6. [Medline].

Manimala NJ, Parker J. Evaluation and Treatment of Penile Thrombophlebitis (Mondor’s Disease). Curr Urol Rep. 2015 Jun. 16 (6):39. [Medline].

Kadioglu H, Yildiz S, Ersoy YE, Yücel S, Müslümanoglu M. An unusual case caused by a common reason: Mondor’s disease by oral contraceptives. Int J Surg Case Rep. 2013 Aug 3. 4(10):855-857. [Medline].

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Kondo T. Traumatic funicular phlebitis of the thoracic wall resembling Mondor’s disease: a case report. J Med Case Reports. 2011 Mar 30. 5(1):127. [Medline]. [Full Text].

Schuppisser M, Khallouf J, Abbassi Z, Erne M, Vettorel D, Paroz A, et al. Abdominal Mondor disease mimicking acute appendicitis. Int J Surg Case Rep. 2016. 20:37-40. [Medline].

Papeš D, Altarac S, Antabak A, Savić I. Nonvenereal Sclerosing Lymphangitis of the Penis. Acta Dermatovenerol Croat. 2015 Jul. 23 (2):1501-151. [Medline].

Dicuio M, Pomara G, Ales V, Fabris FM, Dahlstrand C, Morelli G. Doppler ultrasonography in a young patient with penile Mondor’s disease. Arch Ital Urol Androl. 2005 Mar. 77(1):58-9. [Medline].

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Pasta V, D’Orazi V, Sottile D, Del Vecchio L, Panunzi A, Urciuoli P. Breast Mondor’s disease: Diagnosis and management of six new cases of this underestimated pathology. Phlebology. 2014 Sep 26. [Medline].

Shirah BH, Shirah HA, Alonazie WS. The Effectiveness of Diclofenac Sodium in the Treatment of Mondor’s Disease of the Breast: The Topical Patch Compared to the Oral Capsules. Breast J. 2017 Jan 12. [Medline].

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Julie C Harper, MD Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham

Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Received honoraria from Stiefel for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Intendis for speaking and teaching; Received honoraria from Coria for speaking and teaching; Received honoraria from Sanofi-Aventis for speaking and teaching.

Matthew J Trovato, MD Fellow, Division of Plastic Surgery, Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.

Mondor Disease

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