| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Hospital of the University of Pennsylvania, Philadelphia, PA 19104
Nipple adenoma is an uncommon benign disorder that can simulate Paget's disease clinically and adenocarcinoma histologically. We describe the MR findings of a case of proven nipple adenoma. A 68-year-old woman presented with spontaneous left-sided clear nipple discharge, left nipple enlargement, and a cherry red pigmentation in the areolar region. Mammographic findings of the left breast were negative.
MR imaging performed at 1.5 T revealed a 9 x 8 mm masslike lesion in the inferior aspect of the nipple that was hyperintense relative to suppressed fat and mildly hyperintense relative to fibroglandular tissue on T2-weighted MR images (Figs. 2A and 2B). This area of the nipple showed intense arterial enhancement that persisted on delayed fat-saturated dynamic sagittal three-dimensional fast spoiled gradient-echo images (Fig. 2C). The patient underwent left nipple exploration and nipple biopsy. The biopsy specimen contained a raised pink area that was found to be a benign nipple adenoma at histologic examination. The patient's nipple discharge resolved after surgery.
|
|
|
Nipple adenoma, a benign clinicopathologic entity that is also known as florid papillomatosis and papillary adenoma [1], is a tumor of the lactiferous ducts that develops in the superficial portion of the nipple. Most lesions present during the patient's fifth decade of life and are associated with serosanguinous nipple discharge, skin ulceration, erythema, and nipple enlargement, symptoms resembling those of Paget's disease [1]. Nipple adenomas are well-circumscribed, nonencapsulated nodules that vary in size between 0.5 and 1.5 cm. Histologically, the major feature is ductal proliferation with a double layer of outer myoepithelial and inner glandular cells. However, the histologic appearance can be confused with well-differentiated carcinoma [1]. Because it is not a precancerous lesion, local excision of the tumor is sufficient [1, 2].
Owing to its small size and location, a nipple adenoma is usually not revealed on mammography but can appear as an indistinct oval density that is contiguous with the nipple [3]. Because of its indistinct margins on mammography and sonography, the lesion can be indistinguishable from breast carcinoma and other solid masses [3].
Nipple abnormalities may be overlooked on breast MR imaging because of the prominent enhancement of the normal nipple (Fig. 3) [4]. In our patient, the focal region of hyperenhancement in the nipple was greater than that seen in women with normal nipples. The enhancement was initially intense but persisted over time without washout, a pattern more commonly seen with benign entities of the breast parenchyma. A benign vascular neoplasm was considered because of the marked enhancement. The lack of suspicious ductal enhancement or mass in the breast suggested benignity. The differential diagnosis based on imaging findings included a periareolar fibroadenoma, intraductal papilloma, or an abscess. The lack of high T2 signal intensity made an abscess or fibroadenoma unlikely. Abscesses usually show rim enhancement and are readily diagnosed at clinical examination.
|
In a postmenopausal woman, a new mass arising in conjunction with nipple discharge and abnormal findings at physical examination warrants biopsy. However, the identification of a focus of hypervascular enhancement without washout can suggest the presence of nipple adenoma and obviate radical surgery. If an abnormality is detected in the nipple, the breast tissue that is deep relative to the area in question can be evaluated for the presence of abnormal ductal or parenchymal enhancement that may indicate malignancy.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  J J Echevarria, J A Lopez-Ruiz, D Martin, I Imaz, and M Martin Usefulness of MRI in detecting occult breast cancer associated with Paget's disease of the nipple-areolar complex Br. J. Radiol., December 1, 2004; 77(924): 1036 - 1039. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
