Difference between revisions of "Nipple adenoma"

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#redirect [[Breast_pathology#Nipple_adenoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Nipple_adenoma_-_very_high_mag.jpg
| Width      =
| Caption    = Nipple adenoma. [[H&E stain]].
| Synonyms  =
| Micro      = proliferation of epithelial and myoepithelial elements that extends into the breast stroma; not encapsulated; lacks true fibrovascular cores, +/-focal necrosis
| Subtypes  =
| LMDDx      = [[intraductal papilloma of the breast]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[breast]] - nipple
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = [[Paget's disease of the breast]]
| Tx        =
}}
'''Nipple adenoma''' is a benign pathology of the [[breast]].
 
It is also known as '''nipple duct adenoma''', '''nipple adenoma of breast''', '''adenoma of the nipple''' and '''florid papillomatosis of the nipple'''.<ref name=pmid22342578>{{Cite journal  | last1 = Boutayeb | first1 = S. | last2 = Benomar | first2 = S. | last3 = Sbitti | first3 = Y. | last4 = Harroudi | first4 = T. | last5 = Hassam | first5 = B. | last6 = Errihani | first6 = H. | title = Nipple adenoma in a man: An unusual case report. | journal = Int J Surg Case Rep | volume = 3 | issue = 5 | pages = 190-2 | month =  | year = 2012 | doi = 10.1016/j.ijscr.2011.05.008 | PMID = 22342578 }}</ref>
 
==General==
*A benign lesion with papillary architecture arising at the nipple. 
*Rare.<ref>{{Cite journal  | last1 = Shinn | first1 = L. | last2 = Woodward | first2 = C. | last3 = Boddu | first3 = S. | last4 = Jha | first4 = P. | last5 = Fouroutan | first5 = H. | last6 = Péley | first6 = G. | title = Nipple adenoma arising in a supernumerary mammary gland: a case report. | journal = Tumori | volume = 97 | issue = 6 | pages = 812-4 | month =  | year =  | doi = 10.1700/1018.11102 | PMID = 22322852 }}</ref>
*Reported in men.<ref name=pmid22342578/>
 
Clinical DDx:
*[[Paget's disease of the breast]].<ref name=pmid13904317>{{Cite journal  | last1 = HANDLEY | first1 = RS. | last2 = THACKRAY | first2 = AC. | title = Adenoma of nipple. | journal = Br J Cancer | volume = 16 | issue =  | pages = 187-94 | month = Jun | year = 1962 | doi =  | PMID = 13904317 | PMC = 2070922 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2070922/?tool=pubmed  }}</ref>
 
==Microscopic==
Features:
*Not encapsulated.<ref name=pmid2123505/>
*Proliferation of epithelial and myoepithelial elements that extends into the breast stroma.<ref name=pmid2123505>{{Cite journal  | title = Adenoma of Nipple. | journal = Br Med J | volume = 1 | issue = 5330 | pages = 563 | month = Mar | year = 1963 | doi =  | PMID = 20789667 | PMC = 2123505 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2123505/?page=1 }}</ref>
*Arborising papillomatous epithelial proliferation within duct
*(Papillae have fibrovascular cores) at least as far as I can see but not according to Stanford. 
*Florid epithelial hyperplasia can be seen
*Can see haphazard arrangement of proliferating tubular structures
 
Notes:
*Lacks true fibrovascular cores.<ref>URL: [http://surgpathcriteria.stanford.edu/breast/nippleadenoma/printable.html http://surgpathcriteria.stanford.edu/breast/nippleadenoma/printable.html]. Accessed on: 6 August 2011.</ref>
*Focal necrosis may be present.<ref name=Ref_APBR307>{{Ref APBR|307 Q16}}</ref>
 
DDx:
*[[Intraductal papilloma of the breast]].
**Found within the duct '''not''' the stroma.
**Often deeper - one should '''not''' see skin in the histologic section.
*Syringomatous adenoma
*Intraductal carcinoma - the proliferation in nipple adenoma should be no more atypical than that seen with usual intraductal hyperplasia or intraductal papillomatosis.  Cribriforming glands should be absent
*Invasive ductal carcinoma - IHC is useful (see below) the ducts should all be lined by myoepithelium.
 
===Images===
<gallery>
Image:Nipple_adenoma_-_low_mag.jpg | Nipple adenoma - low mag. (WC/Nephron)
Image:Nipple_adenoma_-_intermed mag.jpg | Nipple adenoma - intermed. mag. (WC/Nephron)
Image:Nipple_adenoma_-_very_high_mag.jpg | Nipple adenoma - very high mag. (WC/Nephron)
Image:Breast NippleAdenoma LP SNP.jpg|Breast Nipple Adenoma - low power (SKB)
Image:Breast NippleAdenoma MP SNP.jpg|Breast Nipple Adenoma - medium power (SKB)
Image:Breast NippleAdenoma MP2 SNP.jpg|Breast Nipple Adenoma - medium power (SKB)
Image:Breast NippleAdenoma LP2 14BR***.jpg|Breast Nipple Adenoma - low power (SKB)
Image:Breast NippleAdenoma LP 14BR***.jpg|Breast Nipple Adenoma - low power (SKB)
Image:Breast NippleAdenoma MP 14BR***.jpg|Breast Nipple Adenoma - medium power (SKB)
Image:Breast NippleAdenoma CK5 14BR***.jpg|Breast Nipple Adenoma - CK5 (SKB)
Image:Breast NippleAdenoma CK14 14BR***.jpg|Breast Nipple Adenoma CK14 (SKB)
Image:Breast NippleAdenoma SMA 14BR***.jpg|Breast Nipple Adenoma - SMA (SKB)
Image:Breast NippleAdenoma p63 14BR***.jpg|Breast Nipple Adenoma -  p63 (SKB)
</gallery>
www:
*[http://www.breastpathology.info/sub-pages-benign-prolif/florid-papillomatosis-ex1-1.html Florid papillomatosis of the nipple - several images (breastpathology.info)].
 
==See also==
*[[Breast pathology]].
*[[Intraductal papilloma of the breast]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Breast pathology]]

Latest revision as of 21:17, 9 May 2016

Nipple adenoma
Diagnosis in short

Nipple adenoma. H&E stain.
LM proliferation of epithelial and myoepithelial elements that extends into the breast stroma; not encapsulated; lacks true fibrovascular cores, +/-focal necrosis
LM DDx intraductal papilloma of the breast
Site breast - nipple
Prevalence uncommon
Prognosis benign
Clin. DDx Paget's disease of the breast

Nipple adenoma is a benign pathology of the breast.

It is also known as nipple duct adenoma, nipple adenoma of breast, adenoma of the nipple and florid papillomatosis of the nipple.[1]

General

  • A benign lesion with papillary architecture arising at the nipple.
  • Rare.[2]
  • Reported in men.[1]

Clinical DDx:

Microscopic

Features:

  • Not encapsulated.[4]
  • Proliferation of epithelial and myoepithelial elements that extends into the breast stroma.[4]
  • Arborising papillomatous epithelial proliferation within duct
  • (Papillae have fibrovascular cores) at least as far as I can see but not according to Stanford.
  • Florid epithelial hyperplasia can be seen
  • Can see haphazard arrangement of proliferating tubular structures

Notes:

  • Lacks true fibrovascular cores.[5]
  • Focal necrosis may be present.[6]

DDx:

  • Intraductal papilloma of the breast.
    • Found within the duct not the stroma.
    • Often deeper - one should not see skin in the histologic section.
  • Syringomatous adenoma
  • Intraductal carcinoma - the proliferation in nipple adenoma should be no more atypical than that seen with usual intraductal hyperplasia or intraductal papillomatosis. Cribriforming glands should be absent
  • Invasive ductal carcinoma - IHC is useful (see below) the ducts should all be lined by myoepithelium.

Images

  • Nipple adenoma - low mag. (WC/Nephron)

  • Nipple adenoma - intermed. mag. (WC/Nephron)

  • Nipple adenoma - very high mag. (WC/Nephron)

  • Breast Nipple Adenoma - low power (SKB)

  • Breast Nipple Adenoma - medium power (SKB)

  • Breast Nipple Adenoma - medium power (SKB)

  • Breast Nipple Adenoma - low power (SKB)

  • Breast Nipple Adenoma - low power (SKB)

  • Breast Nipple Adenoma - medium power (SKB)

  • Breast Nipple Adenoma - CK5 (SKB)

  • Breast Nipple Adenoma CK14 (SKB)

  • Breast Nipple Adenoma - SMA (SKB)

  • Breast Nipple Adenoma - p63 (SKB)

www:

See also

References

  1. ↑ 1.0 1.1 Boutayeb, S.; Benomar, S.; Sbitti, Y.; Harroudi, T.; Hassam, B.; Errihani, H. (2012). "Nipple adenoma in a man: An unusual case report.". Int J Surg Case Rep 3 (5): 190-2. doi:10.1016/j.ijscr.2011.05.008. PMID 22342578.
  2. ↑ Shinn, L.; Woodward, C.; Boddu, S.; Jha, P.; Fouroutan, H.; Péley, G.. "Nipple adenoma arising in a supernumerary mammary gland: a case report.". Tumori 97 (6): 812-4. doi:10.1700/1018.11102. PMID 22322852.
  3. ↑ HANDLEY, RS.; THACKRAY, AC. (Jun 1962). "Adenoma of nipple.". Br J Cancer 16: 187-94. PMC 2070922. PMID 13904317. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2070922/?tool=pubmed.
  4. ↑ 4.0 4.1 "Adenoma of Nipple.". Br Med J 1 (5330): 563. Mar 1963. PMC 2123505. PMID 20789667. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2123505/?page=1.
  5. ↑ URL: http://surgpathcriteria.stanford.edu/breast/nippleadenoma/printable.html. Accessed on: 6 August 2011.
  6. ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 307 Q16. ISBN 978-1416025887.
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