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