Breast nonmalignant
Benign tumors
Syringomatous tumor of nipple

Editorial Board Member: Emily S. Reisenbichler, M.D.
Mary Ann Gimenez Sanders, M.D, Ph.D.

Topic Completed: 1 October 2017

Minor changes: 9 September 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Syringomatous tumor nipple

Mary Ann Gimenez Sanders, M.D, Ph.D.
Page views in 2019: 2,011
Page views in 2020 to date: 1,047
Cite this page: Sanders MAG. Syringomatous tumor of nipple. website. Accessed May 29th, 2020.
Definition / general
  • Also called syringomatous adenoma of nipple or infiltrating syringomatous adenoma of nipple
  • Rare
  • Age at diagnosis ranges from 11 to 67 years (average 40 years)
  • Mostly females; at least 2 cases reported in males
  • May originate from eccrine sweat ducts of the nipple
Clinical features
  • Presents as a mass in the nipple or subareolar region
  • May be associated with pain, skin changes (crusting or ulceration), nipple discharge or nipple retraction
Case reports
  • Excision with adequate margins (may require nipple areolar resection)
  • May recur if incompletely excised
Clinical images

Images hosted on other servers:

Firm subareolar mass, 17 mm in diameter

Gross description
  • Firm, discrete mass, 1 - 3 cm, present in the nipple or subareolar region
Gross images

Contributed by Dr. Mark R. Wick:

Syringomatous tumor

Microscopic (histologic) description
  • Situated in the dermis of the nipple areolar complex
  • May focally involve the subcutaneous tissue; does not involve the epidermis
  • Infiltrative haphazard proliferation of elongated ductules and tubules lined by a two layer epithelium (luminal and basal)
  • Ducts have teardrop, comma or branching shapes
  • Identical to cutaneous syringoma
  • Tumor cells are bland with absent or rare mitoses
  • Background of hyalinized or myxoid fibrous stroma
  • Infiltrates around smooth muscle bundle and lactiferous ducts of nipple
  • Perineural invasion may be present
  • Variable squamous metaplasia with small keratinizing cysts with calcifications
Microscopic (histologic) images

Contributed by Emily S. Reisenbichler, M.D.

Syringomatous tumor of nipple

 AFIP images

Keratinization in syringomatous duct

 Contributed by Dr. Mark R. Wick

Syringomatous tumor

Perineurial invasion

Images hosted on other servers:

Acanthotic epidermis

Small, solitary, evenly spaced duct-like structures

Layers of cuboidal or squamoid epithelial cells

Small, dark tumor cells

Keratotic cysts

Comma shaped tubules

Various images

Positive stains
Differential diagnosis
Board review style question #1
A 35 year old woman presents with a nipple mass. An excisional biopsy is performed and histomorphology is consistent with syringomatous tumor. Of the following, which histologic description best describes what was seen on the histologic slide of the nipple mass?

  1. Angulated tubules lined by a single layer of epithelial cells
  2. Bland tumor cells in a background of mucin
  3. Comma or teardrop shaped ducts infiltrating stroma
  4. Ducts with squamous metaplasia communicating with a fistula track to the skin surface
  5. High grade tumor cells with perineural invasion
Board review answer #1
C. Comma or teardrop shaped ducts infiltrating stroma. Syringomatous tumor (SyT) of the nipple is identical to syringoma of the skin. These tumors are characteristically described as having comma or teardrop shaped ducts. Although perineural invasion can be seen with SyT, the tumor cells are bland. Option A is a description of tubular carcinoma. Tubules of SyT have more than 1 epithelial layer. Option B is a description of mucinous carcinoma. SyT has a background stroma that can be either myxoid or sclerotic. Option D is a description of squamous metaplasia of lactiferous ducts (SMOLD). Although SyT can have keratin cysts, fistula tracks out to the skin surface is not a feature.

Reference: Breast nonmalignant - Syringomatous tumor of nipple

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