Table of ContentsDefinition / general | Essential features | Terminology | Epidemiology | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosis | Board review question #1 | Board review answer #1
Cite this page: Sanders, M. Nipple adenoma / florid papillomatosis of nipple. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastnipplead.html. Accessed February 20th, 2018.
Definition / general
- Benign epithelial proliferation arising near the collecting ducts of the nipple
- Presents as either nipple discharge, a nipple mass or with skin changes similar to Paget disease (erosion, crusting)
- Initial diagnosis is usually on skin punch biopsy of the nipple
- Histologic patterns include sclerosing adenosis, papillomatosis, epithelial hyperplasia and mixed pattern
- Epithelial proliferation with retained myoepithelial cell layer
- Rare cases associated with carcinoma (Mod Pathol 1995;8:633)
- Synonyms include erosive adenomatosis, florid papillomatosis, nipple duct adenoma, subareolar duct papillomatosis
- Rare; occurs in males and females
- Age range is 20 - 87 years
- Local excision; may recur if incompletely excised
- Ill defined nodule of nipple
- Crusting, erythema, erosion of nipple skin
Microscopic (histologic) description
- Adenosis or ducts with usual hyperplasia or papillomatosis just below the nipple epidermis
- Often in a background of fibrosis and often continuous with squamous epithelium of the epidermis
- May have cysts and keratin cysts
- May have focal necrosis associated with usual ductal hyperplasia, may have florid usual ductal hyperplasia but no atypia
- Myoepithelial cell layer is retained
Microscopic (histologic) images
Images hosted on PathOut server:
Nipple adenoma, mixed pattern and florid usual ductal hyperplasia. Images contributed by Mary Ann Gimenez Sanders, M.D., Ph.D.
Images hosted on other servers:
Board review question #1
- A 43 year old woman presents with a nipple mass and undergoes skin punch biopsy. Histologic section demonstrates numerous tubules composed of duct epithelium in a background of fibrosis throughout the superficial and deep dermis of the biopsy. Which immunohistochemical stain will confirm the diagnosis of nipple adenoma?
- AE1 / AE3
Board review answer #1
The main differential diagnosis for the sclerosing adenosis pattern of nipple adenoma is a well differentiated invasive ductal carcinoma. Nipple adenoma is a benign epithelial proliferative lesion of the breast and therefore retains a myoepithelial cell layer. Performing a myoepithelial cell marker like p63 can rule out the possibility of invasive carcinoma and confirm the diagnosis of nipple adenoma. The epithelial (luminal) cell layer in the sclerosing adenosis pattern of nipple adenoma is positive for AE1 / AE3, CK7, ER and negative for HER2.