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Presented by Pedram Argani, M.D. and prepared by Lynette S. Nichols, M.D.
Case 5: The patient is a 68-year old female with an ulcerated nipple.
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1. Question
Week 133: Case 5
The patient is a 68-year old female with an ulcerated nipple.images/Lyn’s/2p-5a.jpg
images/Lyn’s/2p-5b.jpg
images/Lyn’s/2p-5c.jpgCorrect
Answer: Nipple Duct Adenoma
Histology: The lesion is composed of dilated ducts containing multiple papillary structures projecting into the lumens. On higher power magnification, the epithelium overlying the papillae is typical of florid type usual duct hyperplasia in that it has a “streaming” appearance, forms slit-like lumina, has indistinct intracellular borders and lacks nuclear hyperchromasia. The lesion focally connects with the overlying nipple skin.
Discussion: In situ papillary carcinoma typically affects the large ducts of older women. The epithelium overlying the fibrovascular cores of papillary carcinoma should resemble that of other forms of ductal carcinoma in situ (DCIS), such as cribriform or micropapillary DCIS, or should show stratified, hyperchromatic, elongated, rectangular-shaped nuclei. Myoepithelial cells are classically absent within these fibrovascular cores. Paget’s Disease usually presents similarly to Nipple Duct Adenoma, but is characterized by DCIS cells colonizing the overlying nipple epidermis. Intraductal papillomas are morphologically similar to the current lesion, but involve the large extralobular ducts of the breast parenchyma, and do not connect with the nipple epidermis.
Nipple duct adenoma (Florid Papillomatosis of the Nipple) may recur if incompletely excised, and is associated with carcinoma in a subset of cases (approximately 16%), so most suggest complete excision of these lesions. These lesions have multiple patters, including a sclerosing papilloma pattern, a classic papilloma pattern, an adenosis pattern and a mixed pattern.
Incorrect
Answer: Nipple Duct Adenoma
Histology: The lesion is composed of dilated ducts containing multiple papillary structures projecting into the lumens. On higher power magnification, the epithelium overlying the papillae is typical of florid type usual duct hyperplasia in that it has a “streaming” appearance, forms slit-like lumina, has indistinct intracellular borders and lacks nuclear hyperchromasia. The lesion focally connects with the overlying nipple skin.
Discussion: In situ papillary carcinoma typically affects the large ducts of older women. The epithelium overlying the fibrovascular cores of papillary carcinoma should resemble that of other forms of ductal carcinoma in situ (DCIS), such as cribriform or micropapillary DCIS, or should show stratified, hyperchromatic, elongated, rectangular-shaped nuclei. Myoepithelial cells are classically absent within these fibrovascular cores. Paget’s Disease usually presents similarly to Nipple Duct Adenoma, but is characterized by DCIS cells colonizing the overlying nipple epidermis. Intraductal papillomas are morphologically similar to the current lesion, but involve the large extralobular ducts of the breast parenchyma, and do not connect with the nipple epidermis.
Nipple duct adenoma (Florid Papillomatosis of the Nipple) may recur if incompletely excised, and is associated with carcinoma in a subset of cases (approximately 16%), so most suggest complete excision of these lesions. These lesions have multiple patters, including a sclerosing papilloma pattern, a classic papilloma pattern, an adenosis pattern and a mixed pattern.
