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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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