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Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Etiology | Clinical features | Radiology description | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Differential diagnosis | Additional referencesCite this page: Ductal adenoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastductaladenoma.html. Accessed July 14th, 2017.
Definition / general
- Sclerotic intraductal papilloma with pronounced adenomatous featuers (Breast Cancer 2006;13:354)
- First described in 1984 (J Pathol 1984;144:15)
Essential features
- Well circumscribed benign intraductal proliferation of tubules (no papillary component)
- May show calcification, hemorrhage, infarction, squamous or apocrine metaplasia or myxoid change
- May show pseudoinfiltrative pattern (exclude invasion by showing intact myoepithelial marker staining, eg. p63, SMMA)
- Excision is curative
Terminology
- Also called sclerosing papilloma
Epidemiology
- Uncommon
- Usually age 60+ years
- Ductal adenomas with tubular features may occur as part of Carney complex (Am J Surg Pathol 1991;15:722, Am J Surg Pathol 1996;20:1154)
Etiology
- May evolve by sclerosis of intraductal papillary lesion (Hum Pathol 1989;20:903)
Clinical features
- Presents as palpable lump or mammographic abnormality
- May resemble carcinoma at imaging, frozen or permanent section (Breast Cancer 2006;13:354)
Radiology description
- Mammography shows well to ill defined mass with/without calcification
Case reports
- 32 and 64 year old women with ductal adenoma of the breast (Breast Cancer 2006;13:354)
- 66 year old woman with ductal adenoma of the breast with chondromyxoid change (Pathol Int 2002;52:239)
Treatment
- Excision is curative
Gross description
- Single or multiple rounded lesions
- Gritty texture and elastic streaks mimic carcinoma
Microscopic (histologic) description
- 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
Microscopic (histologic) images
Images hosted on PathOut server:
Central fibrosis, peripheral bland ducts
Nodular lesion, primarily spindle cells
Spindle cells with residual ducts
Spindled myoepithelial cells around peripheral duct
Ducts lined by apocrine cells
Images hosted on Other servers:
Ductal adenoma, partially sclerosed
Cytology description
- 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)
Positive stains
- 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)
Differential diagnosis
- Intraductal papilloma: papillary, not hyperplastic
Additional references
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