Nipple adenoma

Signs and symptoms

Nipple adenomas may be felt as a lump under the nipple or areola. They may come to attention because of nipple pain, ulceration, swelling or discharge.

Diagnosis

Definition

A nipple adenoma is a type of intraductal papilloma that arises within the lactiferous ducts that are located within the nipple.

Differential diagnosis

The microscopic appearance of a nipple adenoma can be mistaken for carcinoma. Other conditions that have similar symptoms and signs as nipple adenoma include Paget's disease of the breast, other intraductal papillomas, ductal carcinoma in situ (DCIS), syringomatous adenoma of the nipple and subareolar sclerosing duct hyperplasia.

Imaging

Lesions of the nipple and areola, such as nipple adenoma, may be difficult to image clearly on routine mammogram or ultrasonography. Nipple adenomas can be imaged using magnetic resonance imaging (MRI) and conventional or MR ductogram.

Biopsy

Once excised, the macroscopic appearance of nipple adenomas is of a poorly defined nodular mass. The microscopic appearance can be quite bizarre, and may be misinterpreted as a carcinoma. Nipple adenomas usually have a rounded outline at low magnification, and at higher magnification can be seen to consist of a haphazardly arranged mass of proliferating tubular structures composed of epithelial and myoepithelial cells within varying amounts of fibrous stroma. The epithelial cells are usually columnar, but the columnar epithelial cells can undergo apocrine or squamous metaplasia. Mitotic figures and necrosis are not commonly seen.

Treatment

The appropriate treatment in contemporary western medicine is complete surgical excision of the abnormal growth with a small amount of normal surrounding breast tissue.

Prognosis

Nipple adenomas are non-cancerous growths, which can recur if not completely surgically removed.

Epidemiology

Nipple adenomas most commonly occur in 30- to 40-year-old women, They can also occur at any age, including in the elderly, in adolescence, and in infants.

References

References

1. Stoler, Mark A.. (2009). "Sternberg's Diagnostic Surgical Pathology". Lippincott Williams & Wilkins.
2. Pfeifer, John D.. (2008). "The Washington Manual of surgical pathology". Wolters Kluwer Health/Lippincott Williams & Wilkins.
3. (July 2010). "Evaluation of nipple-areola complex with ultrasonography and magnetic resonance imaging". J Comput Assist Tomogr.
4. (2010). "Male nipple adenoma with DCIS followed 9 years later by invasive carcinoma". The Breast Journal.
5. (2010). "Nipple adenoma in an adolescent". Pediatr Dermatol.
6. (November 2009). "Nipple adenoma in infancy". J. Pediatr. Surg..