Nipple Lesions: Adenoma and Pathology

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Questions and Answers

What is the typical age range for nipple adenoma to occur?

Eighth or ninth decade

Second or third decade

Sixth or seventh decade

Fourth or fifth decade (correct)

What is the characteristic pattern seen in nipple adenoma microscopically?

Papillomatous changes with dense stroma (correct)

Squamous cell pattern

Cribriform pattern

Adenosis pattern

What is the typical clinical presentation of nipple adenoma?

Redness and swelling of the nipple

Itching sensation on the nipple

Painful lump in the breast

Serous or bloody discharge from the nipple (correct)

What is the key feature to identify nipple adenoma as benign?

Presence of a dual population of epithelial and myoepithelial cells Signup and view all the answers

What is the term used to describe the pattern of nipple adenoma characterized by papillomatous changes with dense stroma?

Sclerosing papillomatosis pattern Signup and view all the answers

What is the differential diagnosis for nipple adenoma?

Paget disease Signup and view all the answers

What is the significance of adenosquamous nests in nipple adenoma?

They may be overinterpreted Signup and view all the answers

What is the key distinction between nipple adenoma and intraductal papilloma?

Location of the lesion Signup and view all the answers

What type of carcinomas can occur in the location of nipple adenoma?

Papillary DCIS and invasive ductal carcinomas Signup and view all the answers

What is the typical treatment for uncomplicated nipple adenoma?

Local excision Signup and view all the answers

What is the characteristic feature of Squamous Metaplasia of Lactiferous Ducts (SMOLD)?

Extension of squamous epithelium of the nipple beyond 1-2 mm down the lactiferous ducts Signup and view all the answers

What is the usual management of patients with SMOLD?

Wide excision of the involved duct with a wedge resection of the nipple Signup and view all the answers

What is Paget disease?

A crusted lesion of the nipple caused by breast carcinoma in the nipple epithelium Signup and view all the answers

What is the underlying carcinoma usually associated with Paget disease?

High-grade DCIS with or without associated stromal invasion Signup and view all the answers

What is the typical clinical appearance of Paget disease?

Weeping, eczematous lesions centered on the nipple Signup and view all the answers

What is the prognosis of Paget disease dependent on?

The in situ versus invasive nature of the underlying carcinoma and the presence or absence of axillary lymph node involvement Signup and view all the answers

Study Notes

Nipple Lesions

Nipple adenoma is a benign proliferation of glands embedded in a fibrotic stroma, usually occurring in the 4th or 5th decade, and is often accompanied by serous or bloody discharge from the nipple.
It is nearly always unilateral and can be confused with Paget disease clinically.
Microscopically, it is characterized by marked papillomatous changes, often associated with distortion induced by the dense stroma present.
The features used to identify this lesion as benign include the presence of a dual population of epithelial and myoepithelial cells, oval nuclear shape, lack of atypia, "streaming," and the formation of peripheral clefts.

Nipple Adenoma Patterns

Rosen and Caicco identified three patterns: sclerosing papillomatosis, papillomatosis (without sclerosis), and adenosis (the least common).
The sclerosing papillomatosis pattern is the most common.

Warning

Not all intraductal papillary lesions located in or close to the nipple are benign nipple adenomas.
Papillary DCIS and invasive ductal carcinomas can also occur in this location.

Treatment of Nipple Adenoma

The treatment of uncomplicated nipple adenoma is local excision.

Squamous Metaplasia of Lactiferous Ducts (SMOLD)

SMOLD presents clinically as recurrent abscess with or without fistula formation.
It is characterized by the extension of squamous epithelium of the nipple further than the usual 1-2 mm down the lactiferous ducts.
The resulting accumulation of keratinaceous debris leads to duct rupture with consequent inflammatory response.

Diagnosis and Management of SMOLD

The diagnosis should be considered in patients with recurrent abscess and/or fistula formation.
The management of SMOLD involves wide excision of the involved duct, often with a wedge resection of the nipple.

Paget Disease

Paget disease is a crusted lesion of the nipple caused by breast carcinoma in the nipple epithelium.
It is accompanied by an underlying breast carcinoma, typically high-grade DCIS, with or without associated stromal invasion in nearly all instances (>95%).
The management and prognosis depend on the in situ versus invasive nature of the underlying carcinoma, and on the presence or absence of axillary lymph node involvement.

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Description

Quiz on nipple adenoma, a benign proliferation of glands in the nipple, its symptoms, diagnosis, and microscopic patterns. Learn about its characteristics, differential diagnosis, and more.