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Breast-nonmalignant
Benign tumors / changes
Syringomatous adenoma of nipple
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 9 October 2012, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Tumor of nipple area with sweat gland differentiation
● First described by Rosen in 1983 (Am J Surg Pathol 1983;7:739)
Terminology
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● Also called infiltrating syringomatous adenoma of nipple, syringomatous tumor (AFIP fascicle, 4th series)
Epidemiology
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● Rare
● Median age 36 years but wide range
Sites
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Etiology
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● May originate from sweat glands of nipple-areola complex
Clinical features
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● Benign but locally infiltrative
● Resembles syringomatous tumors of lip, salivary glands, head and neck
Prognostic factors
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Case reports
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● 32 year old woman with 0.5 cm subareolar nodule (Cases J 2009 Nov 30;2:9118)
● 40 year old woman with tumor in supernumerary breast (J Cutan Pathol 2009;36:1206)
● 71 year old woman with micrometastases in sentinel node (Arch Pathol Lab Med 2003;127:e155)
Treatment
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● Excision with adequate margins (may require nipple resection)
● May recur if incompletely excised
Clinical images
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Gross description (Macroscopy)
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● Subareolar, 2-4 cm, ill-defined, firm gray-tan tissue, may have small cystic areas
Gross images
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Micro description (Histopathology)
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● 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
● Ducts have teardrop, comma or branching shapes with open lumens
● Fibrous stroma
● Perineural invasion common
● Variable squamous metaplasia with keratinizing cysts and calcification
● No apparent myoepithelial cells (but identifiable with immunostains), no intraductal hyperplasia, no atypia, no/rare mitotic figures
Micro images
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Various images
Keratinization in syringomatous duct
Comma shaped tubules
Various images
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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Myoepithelial cells: actin, p63, S100
Negative stains
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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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● Nipple adenoma: rounded outline of haphazard bilayered tubules in papillary pattern, often with fibrosis, continuous with squamous epithelium of epidermis; may resemble adenosis
● Tubular carcinoma: desmoplastic stroma, glands lack myoepithelium and are not comma shaped, no squamous metaplasia, invades fat at periphery (Arch Pathol Lab Med 2009;133:1487)
● Low grade adenosquamous carcinoma: larger tumors (0.6 to 8.6 cm), associated with intraductal papillary tumors
Additional references
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● Am J Surg Pathol 1989;13:197, Stanford University
End of Breast-nonmalignant > Benign tumors / changes > Syringomatous adenoma of nipple
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