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Surgical Pathology Criteria

Infiltrating Syringomatous Adenoma of the Nipple


  • Infiltrating subareolar neoplasm with small compressed duct-like structures

Alternate/Historical Names

  • Syringomatous adenoma
  • Syringomatous carcinoma
  • Syringomatous tumor of the nipple

Diagnostic Criteria

  • Located in dermis and subcutis of nipple and areola
  • Infiltrating round to irregular tubules, often compressed and comma shaped
    • Resembles syringoma
    • Lumens may contain amorphous, eosinophilic material or keratin
    • Infiltrates into smooth muscle bundles
    • Perineural invasion may be present
  • Myoepithelial cells present around tubules
    • Results in a prominent expanded, at least double cell layer
  • Squamous differentiation variable (5-80% of tubules)
    • Superficial keratin filled cysts may be present
  • Abundant desmoplastic collagenous stroma
  • Bland cytology
    • Mitotic figures rare
    • No necrosis
  • It has been proposed that this is the same lesion as low grade adenosquamous carcinoma of the breast differing only in location
    • Adenosquamous carcinoma rarely may metastasize but this has not been reported for syringomatous adenoma

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

    Original posting: May 1, 2006

Supplemental studies


  • Myoepithelial layer present around tubules
    • Actin positive
    • S100 negative to sparse

Differential Diagnosis

Infiltrating Syringomatous Adenoma of the Nipple Low Grade Adenosquamous Carcinoma
Involves dermis and subcutis Parenchymal lesion
No metastases reported Infrequent metastases reported

  • Some consider these to be the same entity in different locations
  • Histologic appearance is identical
  • Small numbers of cases and differences due to superficiality could account for the difference in behavior reported

    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


    Tubular Carcinoma Infiltrating Syringomatous Adenoma of the Nipple
    Uniform, gaping tubules Irregular, frequently compressed lumens
    Tubules frequently have pointed ends Tubules frequently have long comma-shaped tails
    No squamous differentiation At least focal squamous differentiation
    No myoepithelial component Myoepithelial cells present around tubules


    • Age 11-76, mean 46 years
    • Presents as subareolar mass
      • May have pain and nipple discharge
    • Size 0.5 to 3.5 cm
    • One case reported in male
    • Frequent recurrence if incompletely excised
    • No metastases reported
    • A single case has been reported of isolated keratin positive intravascular cells in a sentinel node removed following biopsy of the lesion


    Lesions Preferentially Localized to the Nipple and Subareola

    Breast Tumors and Lesions Exhibiting Reactivity for Muscle/Myoepithelial Markers

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


    • Rosen PP. Syringomatous adenoma of the nipple. Am J Surg Pathol. 1983 Dec;7(8):739-45.
    • Jones MW, Norris HJ, Snyder RC. Infiltrating syringomatous adenoma of the nipple. A clinical and pathological study of 11 cases. Am J Surg Pathol. 1989 Mar;13(3):197-201.
    • Carter E, Dyess DL. Infiltrating syringomatous adenoma of the nipple: a case report and 20-year retrospective review. Breast J. 2004 Sep-Oct;10(5):443-7.
    • Ward BE, Cooper PH, Subramony C. Syringomatous tumor of the nipple. Am J Clin Pathol. 1989 Nov;92(5):692-6.
    • Chang CK, Jacobs IA, Calilao G, Salti GI. Metastatic infiltrating syringomatous adenoma of the breast. Arch Pathol Lab Med. 2003 Mar;127(3):e155-6.

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