Home   Chapter Home   Jobs   Conferences   Fellowships   Books

 

 

Advertisement 

 

Breast-nonmalignant

Benign tumors / changes

Nipple adenoma / florid papillomatosis of nipple

 

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

Revised: 8 October 2012, last major update April 2010

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

 

Definition

=========================================================================

● Compact proliferation of small tubules lined by epithelial and myoepithelial cells, near collecting ducts of nipple

 

Terminology

=========================================================================

 

Epidemiology

=========================================================================

● Rare; age 30-49 years

 

Sites

=========================================================================

 

Etiology

=========================================================================

● Variant of intraductal papilloma involving terminal portion of ducts

 

Clinical features

=========================================================================

● Benign

● Unilateral, associated with serous/bloody nipple discharge

● May clinically resemble Paget’s disease of nipple

● May have associated carcinoma (Mod Pathol 1995;8:633) or metaplastic spindle cell lesions of variable malignancy (Mod Pathol 2003;16:893)

 

Prognostic factors

=========================================================================

 

Case reports

=========================================================================

● Infant with nipple adenoma (J Pediatr Surg 2009;44:2219)

● 45 year old woman with underlying carcinoma (Breast Cancer 2007;14:234)

● 47 year old woman with underlying carcinoma (Breast Cancer 1998;5:87)

 

Treatment

=========================================================================

● Local excision; may recur if incompletely excised

 

Clinical images

=========================================================================

 

Small papule (arrow) on nipple

 

Gross description (Macroscopy)

=========================================================================

Ill defined nodule of nipple


Micro description (Histopathology)

=========================================================================

● Rounded outline of haphazard bilayered tubules in papillary pattern, often with fibrosis, continuous with squamous epithelium of epidermis

● Peripheral clefting, oval nuclei, streaming

● Epithelial hyperplasia and sclerosing adenosis types

● May have keratin cysts or focal necrosis within proliferating ducts

● Associated with bland cells in epidermis that are scattered or in small aggregates which are CAM5.2+, CK7+, CEA-, HER2- (Am J Surg Pathol 1999;23:1349)

● No atypia, no cribriform component

 

Micro images

=========================================================================

 

      

Circumscribed and polypoid lesion               Proliferation of epithelial and myoepithelial cells



                                                                                               

With myoepithelial                                             Complex pattern of duct hyperplasia with minimal

hyperplasia                                                          sclerosis at site of recent biopsy

 

 

                                               

Epithelium without atypia in dilated               Mixed pattern with papilloma (upper),

duct below nipple                                               sclerosis (center) and adenosis (right side)

 

 

                                                               

Compact arrays of ductules in                       Focal necrosis in hyperplastic duct

adenosis lesion beneath intact

nipple epidermis

 

 

Papillomatosis with adenosis

 

 

                                                                  

With atypical hyperplasia due to disorderly                With DCIS and Paget’s disease (arrow)      

growth pattern without stroma                                      in adult man

 

 

                               

p63 shows intact myoepithelial layer                           Patchy CK 5/6 staining of myoepithelium

 

Virtual Slides

=========================================================================

 

Videos

=========================================================================

 

Cytology description

=========================================================================

 

Cytology images

=========================================================================

 

Positive stains

=========================================================================

Epithelium: keratin 34betaE12 (Zhonghua Bing Li Xue Za Zhi 2009;38:614)

Myoepithelium: p63, smooth muscle actin, calponin

 

Negative stains

=========================================================================

● p53, HER2

 

Electron microscopy descriptions

=========================================================================

 

Electron microscopy images

=========================================================================

 

Molecular / cytogenetics description

=========================================================================

 

Molecular / cytogenetics images

=========================================================================

 

 

Differential Diagnosis

=========================================================================

Syringomatous adenoma of nipple: haphazard proliferation of oval / elongated ductules and tubules composed of small basophilic cells infiltrating dermis of skin, nipple stroma and nipple smooth muscle bundles, resembling cutaneous syringoma; has desmoplastic stroma

Subareolar sclerosing duct hyperplasia: central sclerosis that entraps and distorts ducts, resembling radial scar

 

Additional references

=========================================================================

Am J Surg Pathol 1986;10:87, Stanford University

 

End of Breast-nonmalignant > Benign tumors / changes > Nipple adenoma / florid papillomatosis

 

 

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment.  This website should not be used as a substitute for the advice of a licensed physician.

 

All information on this website is protected by copyright of PathologyOutlines.com, Inc.  Information from third parties may also be protected by copyright.  Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).