Breast
Other benign tumors
Nipple adenoma
Author: Mary Ann G. Sanders, M.D, Ph.D.
Editorial Board Member: Emily S. Reisenbichler, M.D.
Topic Completed: 1 September 2017
Minor changes: 29 December 2021
Copyright: 2003-2022, PathologyOutlines.com, Inc.
PubMed Search: Nipple adenoma [title]
Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosis | Board review style question #1 | Board review style answer #1Cite this page: Sanders MAG. Nipple adenoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breastnipplead.html. Accessed January 28th, 2022.
Definition / general
- Benign epithelial proliferation arising near the collecting ducts of the nipple
Essential features
- 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)
Terminology
- Synonyms include erosive adenomatosis, florid papillomatosis, nipple duct adenoma, subareolar duct papillomatosis
Epidemiology
- Rare; occurs in males and females
- Age range is 20 - 87 years
Case reports
- Infant with nipple adenoma (J Pediatr Surg 2009;44:2219)
- 53 year old woman with nipple adenoma presenting with persistent erythema of the nipple skin (BMC Dermatol 2016;16:4)
- Four cases of adenoma of the nipple (Diagn Cytopathol 2015;43:664)
Treatment
- Local excision; may recur if incompletely excised
Gross description
- 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
Contributed by Mary Ann Gimenez Sanders, M.D., Ph.D.
Nipple adenoma, mixed pattern and florid usual ductal hyperplasia
AFIP images
With myoepithelial hyperplasia
Duct hyperplasia
with minimal sclerosis
at recent biopsy site
Epithelium without
atypia in dilated
(upper), duct
below nipple
Mixed pattern with
papilloma (upper),
sclerosis (center) and
adenosis (right side)
Focal necrosis in hyperplastic duct
Papillomatosis with adenosis
With DCIS and Paget disease (arrow) in adult man
Compact arrays of
ductules in adenosis
lesion beneath intact
nipple epidermis
With atypical
hyperplasia due to
disorderly growth
pattern without stroma
Contributed by Dr. Mark R. Wick
Various images
Positive stains
Differential diagnosis
Board review style 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
- CK7
- ER
- HER2
- p63
Board review style answer #1
E. p63
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.
Comment here
Reference: Nipple adenoma
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.
Comment here
Reference: Nipple adenoma
