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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Ductal Adenoma of the Breast

Definition

  • Circumscribed breast mass with a prominent fibrotic capsule and a bilayered tubular component

Diagnostic Criteria

  • Combines morphologic features of sclerosing adenosis and papilloma
  • Circumscribed, encapsulated
    • Surrounded by fibrous capsule
    • Single or multiple nodules
      • May be discrete or in continuity within a ductal system
  • Prominent hyalinizing fibrosis
    • Frequently denser in center
    • May form stellate scar but periphery still circumscribed
    • Lacks papillary structure
  • Intermixed bland ducts
    • Lined by epithelial and myoepithelial layers
    • Peripheral ducts frequently dilated
    • Central ducts may be compressed or obliterated
    • Apocrine metaplasia frequent
      • Nuclei and nucleoli may be enlarged in apocrine areas
    • Apical snouts may be prominent
    • Lumenal calicification may be present
  • May demonstrate myoepithelial overgrowth
  • Peripiheral lymphoid infiltrate may be present

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

Immunohistology

  • Tubule lumenal cells
    • Keratin positive
    • Actin, S100, p63 negative
  • Tubule basal cells
    • Keratin positive
    • Actin, S100, p63 positive
  • Stromal cells in fibrotic areas
    • Actin, vimentin 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

 

Ductal Adenoma Adenomyoepithelioma
Hyalinized stroma Cellular stroma
Circumscribed, encapsulated Capsule unusual
Ductal adenoma may have myoepithelial overgrowth

 

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

 

Ductal Adenoma Infiltrating Ductal Carcinoma
Circumscribed, expansile Infiltrating
Cytologically bland Cytologically atypical
Myoepithelial cells present, frequently prominent No myoepithelial cells

Clinical

  • Age range 22-77 years
  • 0.25-6 cm in size
  • Variable reports regarding preferential subareolar location
  • No recurrences if completely excised
  • One report of occurence in 4 women with Carney complex

Grading / Staging / Report

  • Grading and staging are not applicable

Lists

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)

Bibliography

  • Rosen PP, Oberman HA. Tumors of the Mammary Gland, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 7, 1993
  • Azzopardi JG, Salm R. Ductal adenoma of the breast: a lesion which can mimic carcinoma. J Pathol. 1984 Sep;144(1):15-23.
  • Lammie GA, Millis RR. Ductal adenoma of the breast--a review of fifteen cases. Hum Pathol. 1989 Sep;20(9):903-8.
  • Guarino M, Reale D, Squillaci S, Micoli G. Ductal adenoma of the breast. An immunohistochemical study of five cases. Pathol Res Pract. 1993 Jun;189(5):515-20.
  • Gusterson BA, Sloane JP, Middwood C, Gazet JC, Trott P, Taylor-Papadimitriou J, Bartek J. Ductal adenoma of the breast--a lesion exhibiting a myoepithelial/epithelial phenotype. Histopathology. 1987 Jan;11(1):103-10.
  • Carney JA, Toorkey BC. Ductal adenoma of the breast with tubular features. A probable component of the complex of myxomas, spotty pigmentation, endocrine overactivity, and schwannomas. Am J Surg Pathol. 1991 Aug;15(8):722-31.
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