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Breast-nonmalignant
Benign tumors / changes
Nipple adenoma / florid papillomatosis of nipple
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 15 April 2010, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Compact proliferation of small tubules lined by epithelial and myoepithelial cells, near collecting ducts of nipple
Terminology
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●
Epidemiology
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● Rare; age 30-49 years
Sites
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Etiology
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● Variant of intraductal papilloma involving terminal portion of ducts
Clinical features
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● 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
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●
Case reports
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● 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
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● Local excision; may recur if incompletely excised
Clinical images
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Small papule (arrow) on nipple
Gross description (Macroscopy)
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● Ill defined nodule of nipple
Gross images
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Firm, circumscribed tan-gray lobulated nodule
Micro description (Histopathology)
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● 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
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Circumscribed and polypoid lesion Proliferation of epithelial and myoepithelial cells
Complex architecture with continuity
with overlying squamous epithelium
Various images Frozen section (fig A) resembling
invasive carcinoma
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
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Videos
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Cytology description
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Cytology images
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Positive stains
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● Epithelium: keratin 34betaE12 (Zhonghua Bing Li Xue Za Zhi 2009;38:614)
● Myoepithelium: p63, smooth muscle actin, calponin
Negative stains
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● p53, HER2
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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● 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
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● Am J Surg Pathol 1986;10:87, Stanford University
End of Breast-nonmalignant > Benign tumors / changes > Nipple adenoma / florid papillomatosis
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