Breast - nonmalignant
Benign tumors / changes
Nipple adenoma / florid papillomatosis of nipple

Author: Mary Ann Gimenez Sanders, M.D., Ph.D. (see Authors page)
Editorial Board Member Review: Emily Reisenbichler M.D. (see Authors page)

Revised: 26 September 2017, last major update September 2017

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Nipple adenoma [title]
Cite this page: Sanders, M. Nipple adenoma / florid papillomatosis of nipple. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastnipplead.html. Accessed October 22nd, 2017.
Definition / general
  • Benign epithelial proliferation arising near the collecting ducts of the nipple
Essential features
  • Presents as either nipple discharge, a nipple mass or with skin changes similar to Paget disease (erosion, crusting)
  • Initial diagnosis is usually on skin punch biopsy of the nipple
  • Histologic patterns include sclerosing adenosis, papillomatosis, epithelial hyperplasia and mixed pattern
  • Epithelial proliferation with retained myoepithelial cell layer
  • Rare cases associated with carcinoma (Mod Pathol 1995;8:633)
Terminology
  • Synonyms include erosive adenomatosis, florid papillomatosis, nipple duct adenoma, subareolar duct papillomatosis
Epidemiology
  • Rare; occurs in males and females
  • Age range is 20 - 87 years
Case reports
Treatment
  • Local excision; may recur if incompletely excised
Gross description
  • Ill defined nodule of nipple
  • Crusting, erythema, erosion of nipple skin
Microscopic (histologic) description
  • Adenosis or ducts with usual hyperplasia or papillomatosis just below the nipple epidermis
  • Often in a background of fibrosis and often continuous with squamous epithelium of the epidermis
  • May have cysts and keratin cysts
  • May have focal necrosis associated with usual ductal hyperplasia, may have florid usual ductal hyperplasia but no atypia
  • Myoepithelial cell layer is retained
Microscopic (histologic) images

Images hosted on PathOut server:
Missing Image

Nipple adenoma, mixed pattern and florid usual ductal hyperplasia. Images contributed by Mary Ann Gimenez Sanders, M.D., Ph.D.


With myoepithelial hyperplasia

Duct hyperplasia
with minimal sclerosis
at recent biopsy site

Epithelium without
atypia in dilated
(upper), duct
below nipple

Mixed pattern with
papilloma (upper),
sclerosis (center) and
adenosis (right side)

Focal necrosis in hyperplastic duct

Papillomatosis with adenosis


With DCIS and Paget disease (arrow) in adult man

Compact arrays of
ductules in adenosis
lesion beneath intact
nipple epidermis

With atypical
hyperplasia due to
disorderly growth
pattern without stroma

Contributed by Dr. Mark R. Wick



Images hosted on other servers:

Circumscribed and polypoid lesion

Proliferation of epithelial and myoepithelial cells

p63 shows intact myoepithelial layer

Patchy CK5 / 6 staining of myoepithelium

Positive stains
Negative stains
Differential diagnosis
Board review question #1
    A 43 year old woman presents with a nipple mass and undergoes skin punch biopsy. Histologic section demonstrates numerous tubules composed of duct epithelium in a background of fibrosis throughout the superficial and deep dermis of the biopsy. Which immunohistochemical stain will confirm the diagnosis of nipple adenoma?

  1. AE1 / AE3
  2. CK7
  3. ER
  4. HER2
  5. p63
Board review answer #1
    E. p63

    The main differential diagnosis for the sclerosing adenosis pattern of nipple adenoma is a well differentiated invasive ductal carcinoma. Nipple adenoma is a benign epithelial proliferative lesion of the breast and therefore retains a myoepithelial cell layer. Performing a myoepithelial cell marker like p63 can rule out the possibility of invasive carcinoma and confirm the diagnosis of nipple adenoma. The epithelial (luminal) cell layer in the sclerosing adenosis pattern of nipple adenoma is positive for AE1 / AE3, CK7, ER and negative for HER2.