Definition
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
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
Original posting:: May 15, 2006
Supplemental studies
Immunohistology
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 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
Clinical
Mean age of reported series 43-66 years
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
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)
Lesions Preferentially Localized to the Nipple and Subareola
Bibliography
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.
