Syringomatous adenoma of the nipple: report of a case

Syringomatous adenoma of the nipple: A case series and systematic review

Key Clinical Message

SAN should be considered in the setting of nipple discharge or morphology changes with typical histological findings. There are limited published cases of SAN, and workup of this pathology is still not clear to date.

Abstract

Syringomatous adenoma of the nipple (SAN) is known to be a rare benign breast neoplasm. With a few cases documented in the literature, preoperatively diagnosing this tumor is a challenge, which often leads to invasive procedure such as mass excision with nipple removal. This study was aimed at presenting a case report of SAN and to conduct a review of published cases. Literature search was conducted through PubMed databases. Articles published from year 1983 to March of 2022 were included. Only histologically confirmed cases of SAN were included. The review was performed according to the PRISMA guidelines. Twenty-eight cases, including the newly reported case, were included in the review after going through inclusion criteria. The mean age at diagnosis was 44 ± 16 years. 7% were male. The most common presentation was palpable mass. Preoperative biopsy was done for 9 cases, out of which 7 did not indicate typical histopathological characteristic of SAN. Most common treatment was wide local excision with nipple removal. Immunohistochemical staining of the resected tumor was performed in 16 cases postoperatively. 32.1% (9/28) utilized p63 in constellation with histologic findings. Five cases that utilized staining also used Estrogen Receptor (ER) marker, while three used progesterone receptor (PR) marker. SAN should be considered in the setting of nipple discharge or morphology changes with typical histological findings. There are limited published cases of SAN, and workup of this pathology is still not clear to date. The case presented here and our comprehensive literature review suggest that pathohistological findings of SAN can be heterogeneous. Clinicians would also benefit from recognizing these variances. Further research and reported cases are needed to confidently diagnose SAN, which may open doors for less aggressive surgical treatment or surveillance option for asymptomatic patients.

Asymptomatic syringomatous adenoma of the nipple: A rare nipple neoplasm

Syringomatous adenoma of the nipple is a very rare benign tumor, with radiographic and clinical characteristics that are difficult to differentiate from malignant tumors. Less than 60 cases have been identified thus far and most studies have not included radiographic findings. As such, the neoplasm requires more characterization within the literature. The usual clinical presentation of syringomatous adenoma of the nipple is symptomatic with a solitary, unilateral nipple mass within the subareolar region which may be tender and/or painful and may cause nipple inversion or discharge. We present a case of a 43-year-old woman that is unique, as the patient was asymptomatic and only presented following standard screening mammography. Moreover, we offer further characterization of the neoplasm through documented imaging and histologic findings.

Syringomatous Adenoma of the Nipple in a Male Breast: A Case Report With a Brief Review of Literature and Histomorphological Approach to Diagnosis

Syringomatous adenoma of the nipple (SAN) is a benign and locally infiltrative lesion possibly arising from the sweat gland ducts in the nipple-areolar region. This rare lesion has been reported in the female breast; however, reports on the male breast are extremely rare. Although benign, SAN has a high risk of recurrence. The clinical presentation and histomorphological features often mimic a malignancy. Hence, an awareness of this lesion is required to make a correct diagnosis. In this report, we describe the histomorphological features of SAN in a male breast.

Syringomatous Adenoma of the Nipple on Screening Mammography: A Case Report

Syringomatous adenoma of the nipples, first reported in 1983, is an extremely rare benign tumor extending to the subareolar area and, pathologically, has a shape similar to that of sweat gland tumors. Radiologically, infiltrating patterns and calcifications can cause misdiagnosis of malignant tumors. The authors report a case of syringomatous adenoma that shows only calcifications of the nipple in a screening mammography.

Syringomatous adenoma of the nipple: a case report

Introduction

Syringomatous adenoma of the nipple is a very rare benign tumor. To the best of our knowledge, there are no reports of a syringomatous adenoma of the nipple metastasizing, although these tumors are known to infiltrate locally and to recur if not totally resected.

Case presentation

Our patient was a 41-year-old Japanese woman who complained of stiffness of her right nipple with abnormal discharge. Local resection of the tumor was performed. The pathological diagnosis was syringomatous adenoma of the nipple, and the resection margin was found to be positive. Accordingly, additional resection was recommended, but our patient did not allow another operation. After 1.5 years of careful follow-up, no local recurrence or distant metastasis has been observed.

Conclusion

The optimal initial management of syringomatous adenoma of the nipple demands complete resection with histologically negative margins. However, from a cosmetic viewpoint, nipple-sparing resection could represent an alternative option for the treatment of syringomatous adenoma of the nipple.

[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]

OBJECTIVES

To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning rare benign breast tumors: Abrikossoff (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma.

METHODS

Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and international databases.

RESULTS

For erosive adenomatosis of the nipple, surgical excision is recommended to exclude Paget's disease or cancer (grade C). When surgery is performed for breast desmoid tumor or syringomatous adenoma, free margins are recommended (grade C). Without clinico-radio-histologic discordance, surgical abstention may be proposed for Abrikossoff tumor (granular cell tumor), cytosteatonecrosis, galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma (grade C).

Infiltrating syringomatous adenoma of the nipple: Sonographic and mammographic features with pathologic correlation

We report the case of a 39-year-old woman complaining of painless unilateral nipple enlargement for 3 weeks. She had no family history of breast cancer. Clinical examination revealed left nipple enlargement without pain, erythema, or skin changes m no associated palpable breast or axillary masses. Ultrasound showed several bright foci in the left nipple suggestive of microcalcifications. Neither solid nor cystic masses were detected. The mammogram performed subsequently confirmed the presence of multiple pleomorphic microcalcifications within the nipple. Wedge biopsy showed a syringomatous adenoma. Wide local excision of the nipple was performed. The postoperative course was uneventful.

Small Glandular Proliferations of the Breast

This article discusses the most common small glandular proliferations, namely sclerosing lesions (sclerosing adenosis and radial scar), tubular carcinoma, and epithelial displacement after needle core biopsy, as well as less common entities, such as low-grade adenosquamous carcinoma, microglandular adenosis, and syringomatous adenoma. Due to significant morphologic overlap, these entities are easily mistaken for one another. The similarities and differences among these lesions in their clinicopathologic features, radiologic findings, and immunohistochemical profiles are emphasizesd.

Infiltrating syringomatous adenoma of the nipple: clinical presentation and literature review

Infiltrating syringomatous adenoma of the nipple is a rare neoplasm of the breast. Syringomatous adenoma of the nipple is often misdiagnosed because clinical examination and mammographic findings of syringomatous adenoma of the nipple mimic carcinoma. Despite its benign behavior, syringomatous adenoma of the nipple usually shows infiltrative expansile proliferation into adjacent tissue and underlying breast tissue. Up until now, to our knowledge, there has been no reported case of regional or distant metastasis. Histologically and clinically, syringomatous adenoma of the nipple is often confused with tubular carcinoma as well as low-grade adenosquamous carcinoma of the breast. Special attention given to this tumor by pathologists and clinicians can avoid misdiagnosis and unnecessary treatment.

Skin-type adnexal tumor with trichoblastic germinative differentiation in the breast: a case report

Adnexal tumors with follicular differentiation in the breast parenchyma are rarely encountered. The authors present a unique case arising in a 64-year-old woman, in whom they observed composite differentiation toward follicular germinative cells of the hair follicle with focal areas of outer root sheath differentiation and pilar-type keratinization. The histogenesis of this tumor is analyzed in light of the peculiar pathological, immunohistochemical, and molecular genetic findings.

Skin-type hidradenoma of the breast parenchyma with t(11;19) translocation: hidradenoma of the breast

Skin adnexal type tumors situated in the parenchyma of the breast are very rare. We report herein a case of solid-cystic hidradenoma of the breast. The tumor was situated in the parenchyma of the breast of a 55-year-old female and showed no connection to the overlying skin on ultrasound and radiology investigations, grossly and microscopically. Histologically, the tumor was identical to its cutaneous counterpart and was surrounded by breast tissue. The neoplasm was composed of solid and cystic areas. The cystic component, which predominated in the lesion, was filled with homogeneous eosinophilic material. The solid component consisted of several nodules with vague lobulated architecture protruding into the cystic spaces. The nodules were composed of cuboidal monomorphous cells that were continuous with larger polygonal cells and rare, large mucinous cells with basophilic granular cytoplasm. Several mammary ducts in close proximity to the tumor showed features of columnar cell hyperplasia. A 120-bp METC1/MAML2 fusion transcript was identified by RT-PCR and subsequent sequencing technique. This t(11;19) translocation has been reported in approximately 50% of hidradenomas of the skin.

Syringomatous adenoma of the nipple: A case report

We present a case of a 33-year-old woman who underwent excisional breast biopsy due to a left nipple mass. Histological examination revealed the morphologic and immunohistochemical pattern of syringomatous adenoma of the nipple. This is a rare lesion of the breast that can clinically mimic breast carcinoma, but harbors a benign and only locally aggressive course. Awareness of both the clinician and the pathologist for the possibility of diagnosing this tumor in the nipple region is mandatory to avoid mastectomy and lymph node dissection.

Infiltrating Syringomatous Adenoma of the Nipple: A Case Report and 20-Year Retrospective Review

Infiltrating syringomatous adenomas are rare lesions of the nipple that were first described in 1983. The exact origin of these lesions is uncertain, although derivation from eccrine structures of the nipple has been postulated because the lesions are microscopically reminiscent of other tumors of eccrine origin, such as syringomatous carcinoma. The lesions are usually infiltrative, showing an expansile pattern of proliferation into adjacent tissues of the nipple and underlying breast. Involvement of the epidermis, however, has not been described. The lesions behave in a benign fashion, with no evidence of regional or distant metastasis in any of the reported cases. Complete local excision appears to be sufficient therapy, with only incompletely excised cases showing recurrence. We report an additional case of infiltrating syringomatous adenoma of the nipple and review the medical literature related to this lesion published in the 20 years since its initial description.