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Surgical Pathology Criteria

Nipple Adenoma of the Breast


  • Florid benign proliferation of nipple ductal epithelium

Alternate / Historical names

  • Erosive adenomatosis of the nipple
  • Florid papillomatosis of the nipple ducts
  • Nipple duct adenoma
  • Papillary adenoma of the nipple

Diagnostic Criteria

  • Florid epithelial proliferation with papillomatosis, adenosis or mixed pattern
    • Papillomatosis
      • Papillary hyperplasia of duct lining cells
        • Solid tufts and growths
        • Lacks true fibrovascular cores
      • Crowded, distorted
      • Occasional necrosis
        • May be central, comedo
    • Adenosis
      • Densely packed small glands or tubules
  • May have prominent sclerosing component
    • Distorts epithelial component
    • Frequently zonal, with central sclerosis
      • Epithelial component accentuated in periphery
  • Cytologically bland
  • Myoepithelial cells uniformly present
    • Surround papillomatous growths
    • Surround small glands/tubules
  • Features frequently seen in all patterns
    • Apocrine metaplasia
    • Extension of glandular component onto surface epithelium
    • Squamous cysts at junction with surface
    • Acanthosis
    • Intralumenal multinucleated giant cells
    • Lesion centered on lactiferous ducts
  • Identical lesion in subareolar location is sometimes termed Subareolar Sclerosing Duct Hyperplasia
    • Lacks squamous cysts
    • Typically more nodular than stellate

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: May 15, 2006

Supplemental studies


  • Tubule lumenal cells
    • Keratin positive
    • Actin, p63 negative
  • Tubule basal cells
    • Keratin positive
    • Actin, p63 positive

Differential Diagnosis

Radial Scar, Sclerosing Adenosis, Ductal Adenoma and Nipple Adenoma

  • May be considered a spectrum of lesions differing in location and predominant pattern
  • All are benign


Nipple Adenoma Infiltrating Syringomatous Adenoma of the Nipple
May have compressed ducts at edges but predominantly papillomatous Irregular, frequently compressed lumens throughout
Localized although not completely circumscribed Infiltrative
Stroma non-reactive Desmoplastic stroma
Squamous metaplasia may be present in papillomatosis resulting in confusion with syringomatous adenoma


Nipple Adenoma Intraductal Papilloma
Hyperplastic lesion with papillomatosis and/or adenosis Papillary fronds lacking florid hyperplasia


Nipple Adenoma Tubular Adenoma
Frequent prominent sclerosing stroma Scant stroma
Localized but not completely circumscribed Completely sharply circumscribed
Papillomatosis or adenomatosis with variable small glands Uniform glands


  • Mean age of reported series 43-66 years
    • Range: birth to 89
  • Reported in males as <5% of cases
  • Infrequently recur
  • No metastases
  • Concurrent and metachronous carcinomas have been reported
    • Very rarely existing at same site
  • Clinically may resemble Paget disease or present as a mass


Breast Adenomas (not all are true adenomas)

Breast Tumors and Lesions Exhibiting Reactivity for Muscle/Myoepithelial Markers

(Most benign lesions with an epithelial component will have a myoepithelial cell layer)

Lesions Preferentially Localized to the Nipple and Subareola


  • Jones MW, Tavassoli FA. Coexistence of nipple duct adenoma and breast carcinoma: a clinicopathologic study of five cases and review of the literature. Mod Pathol. 1995 Aug;8(6):633-6.
  • Diaz NM, Palmer JO, Wick MR. Erosive adenomatosis of the nipple: histology, immunohistology, and differential diagnosis. Mod Pathol. 1992 Mar;5(2):179-84.
  • Brownstein MH, Phelps RG, Magnin PH. Papillary adenoma of the nipple: analysis of fifteen new cases. J Am Acad Dermatol. 1985 Apr;12(4):707-15.
  • Rosen PP, Caicco JA. Florid papillomatosis of the nipple. A study of 51 patients, including nine with mammary carcinoma. Am J Surg Pathol. 1986 Feb;10(2):87-101.
  • Rosen PP. Subareolar sclerosing duct hyperplasia of the breast. Cancer. 1987 Jun 1;59(11):1927-30.
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