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Breast-nonmalignant

Benign tumors / changes

Ductal adenoma of breast

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 6 October 2012, last major update March 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Well circumscribed, benign glandular proliferation in part within a duct lumen

● First described in 1984 (J Pathol 1984;144:15)

 

Terminology

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● Also called sclerosing papilloma

 

Epidemiology

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● Uncommon; usually age 60+ years

● Ductal adenomas with tubular features may occur as part of Carney’s complex (Am J Surg Pathol 1991;15:722, Am J Surg Pathol 1996;20:1154)

 

Sites

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Etiology

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May evolve by sclerosis of intraductal papillary lesion (Hum Pathol 1989;20:903)

 

Clinical features

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● Presents as palpable lump or mammographic abnormality

● May resemble carcinoma at imaging, frozen or permanent section (Breast Cancer 2006;13:354)

 

Prognostic factors

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Case reports

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● 68 year old woman with ductal adenoma containing chondromyxoid change (Pathol Int 2002;52:239)

 

Treatment

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● Excision is curative

 

Gross description (Macroscopy)

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● Single or multiple rounded lesions

● Gritty texture and elastic streaks mimic carcinoma

 

Gross images

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Micro description (Histopathology)

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● Well circumscribed, bounded by dense fibrous wall of medium to large duct from which it arises

● Composed of proliferating epithelial tubules but no papillary component (or it would be a papilloma)

● Has both epithelial and myoepithelial cell types

● May have pseudoinfiltrative pattern due to compressed tubules, which resembles invasion in a core biopsy

● Also focal dilated tubules, epithelial hyperplasia, cysts, squamous or apocrine metaplasia, myxoid change, calcification

 

Micro images

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Central fibrosis and           Nodular lesion composed                Spindle cells mixed

peripheral bland ducts      primarily of spindle cells                  with residual ducts

 

 

               

Spindled myoepithelial      Ducts are lined by apocrine cells,

cells surround a                 may be confused with carcinoma

peripheral duct 

 

 

      

Other - Ductal adenoma, partially sclerosed

 

Virtual Slides

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Videos

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Cytology description

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● May resemble lactating adenoma, intraductal papilloma or carcinoma

● Highly cellular with monolayered sheets of ductal cells with cytoplasmic vacuoles that are small and punched out

● Numerous large fragments of purple stroma are adjacent to epithelial cells, forming finger-like hyaline structures or globules between cells

● Nuclei are round/oval with bland chromatin

● Occasional cells have enlarged nuclei with prominent nucleoli

● Also naked oval nuclei (Diagn Cytopathol 1994;10:143, Diagn Cytopathol 1995;13:252)

 

Cytology images

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Positive stains

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Tubular luminal cells – keratin

Tubular basal cells - S100, actin, p63

Basement membrane - laminin, type IV collagen

Stromal spindle cells (myofibroblasts) - actin and vimentin (Pathol Res Pract 1993;189:515)

 

Negative stains

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Electron microscopy descriptions

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Electron microscopy images

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Molecular / cytogenetics description

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Molecular / cytogenetics images

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Differential Diagnosis

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Intraductal papilloma: papillary, not hyperplastic

 

Additional references

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Stanford University

 

End of Breast-nonmalignant > Benign tumors / changes > Ductal adenoma of breast

 

 

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