Breast - nonmalignant
Benign tumors / changes
Syringomatous tumor of nipple

Author: Mary Ann Gimenez Sanders, M.D., Ph.D. (see Authors page)

Revised: 8 January 2018, last major update October 2017

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Syringomatous tumor nipple

Cite this page: Sanders, M.A.G. Syringomatous tumor of nipple. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastsyringomatousadenomanipple.html. Accessed January 20th, 2018.
Definition / general
Terminology
  • Also called syringomatous adenoma of nipple or infiltrating syringomatous adenoma of nipple
Epidemiology
  • Rare
  • Age at diagnosis ranges from 11 to 67 years (average 40 years)
  • Mostly females; at least 2 cases reported in males
Etiology
  • May originate from eccrine sweat ducts of the nipple
Clinical features
  • Presents as a mass in the nipple or subareolar region
  • May be associated with pain, skin changes (crusting or ulceration), nipple discharge or nipple retraction
Case reports
Treatment
  • Excision with adequate margins (may require nipple areolar resection)
  • May recur if incompletely excised
Clinical images

Images hosted on other servers:

Firm subareolar mass, 17 mm in diameter

Gross description
  • Firm, discrete mass, 1 - 3 cm, present in the nipple or subareolar region
Gross images

Images hosted on PathOut server:

Images contributed by Dr. Mark R. Wick:
Microscopic (histologic) description
  • Situated in the dermis of the nipple areolar complex
  • May focally involve the subcutaneous tissue; does not involve the epidermis
  • Infiltrative haphazard proliferation of elongated ductules and tubules lined by a two layer epithelium (luminal and basal)
  • Ducts have teardrop, comma or branching shapes
  • Identical to cutaneous syringoma
  • Tumor cells are bland with absent or rare mitoses
  • Background of hyalinized or myxoid fibrous stroma
  • Infiltrates around smooth muscle bundle and lactiferous ducts of nipple
  • Perineural invasion may be present
  • Variable squamous metaplasia with small keratinizing cysts with calcifications
Microscopic (histologic) images

Images hosted on PathOut server:

Keratinization in syringomatous duct



Images contributed by Dr. Mark R. Wick:

Perineurial invasion



Images hosted on other servers:

Acanthotic epidermis

Small, solitary, evenly spaced duct-like structures

Layers of cuboidal or squamoid epithelial cells

Small, dark tumor cells

Keratotic cysts


Comma shaped tubules

Various images

Positive stains
Differential diagnosis
Board review question #1
A 35 year old woman presents with a nipple mass. An excisional biopsy is performed and histomorphology is consistent with syringomatous tumor. Of the following, which histologic description best describes what was seen on the histologic slide of the nipple mass?

  1. Angulated tubules lined by a single layer of epithelial cells
  2. Bland tumor cells in a background of mucin
  3. Comma or teardrop shaped ducts infiltrating stroma
  4. Ducts with squamous metaplasia communicating with a fistula track to the skin surface
  5. High grade tumor cells with perineural invasion
Board review answer #1
C. Comma or teardrop shaped ducts infiltrating stroma. Syringomatous tumor (SyT) of the nipple is identical to syringoma of the skin. These tumors are characteristically described as having comma or teardrop shaped ducts. Although perineural invasion can be seen with SyT, the tumor cells are bland. Option A is a description of tubular carcinoma. Tubules of SyT have more than 1 epithelial layer. Option B is a description of mucinous carcinoma. SyT has a background stroma that can be either myxoid or sclerotic. Option D is a description of squamous metaplasia of lactiferous ducts (SMOLD). Although SyT can have keratin cysts, fistula tracks out to the skin surface is not a feature.