Fine-Needle AspirationCytodiagnosis of NippleAdenoma (Papillomatosis) in aMan and WomanRaj K. Gupta, M.D., F.I.A.C.,1* Carl S. Dowle, M.B., Ch.B., F.R.C.S., F.R.A.C.S.,2Sarla Naran, B.Sc., C.F.I.A.C.,3 and Sharda Lallu, B.Sc., C.F.I.A.C.3

Dear Dr. Bedrossian:Nipple adenoma, also known as florid papillomatosis,

subareolar duct papillomatosis, erosive adenomatosis,and papillary adenoma, is a rare benign tumour thatoccurs beneath the nipple and subareolar region. Clini-cally, it can be mistaken for Paget’s disease becauseulceration and crusting of nipple is sometimes presentand histologically it may simulate an adenocarcinoma.1–3

A potential for local recurrence is known. Recognition ofthis benign lesion with the use of a noninvasive methodof fine-needle aspiration cytology (FNAC) seems valu-able in planning conservative management and a fewstudies attest to the fact.1,4 – 6 In this communication, wedescribe two cases of this uncommon tumour in a femaleand male patient in which FNAC diagnosis of a papillaryadenoma was suggested and confirmed on a subsequentsurgical biopsy.

Case 1. A 39-yr-old woman was found to have a 1 �0.5 cm firm left nipple nodule of 3-mo duration. Noulceration or crusting of the nipple was present. FNA ofthe nodule was done using a size 22 needle.

Case 2. A 57-yr-old man was found to have a 0.6 �0.4 cm solid hypoechoic lesion of 6-mo duration in theright breast at the nipple-areolar margin. No microcal-cification, ulceration, crusting, or pain was present.

FNA of the lesion was performed under ultrasoundguidance.

After aspiration, a few smears were made in both cases andimmediately fixed in 95% alcohol and the needle and syringecontents were washed in a cytology container containing 30%ethyl alcohol in physiological saline. This was accomplishedby withdrawing the 30% ethyl alcohol into the syringe barrelwith the needle attached and gently flushing the contents intothe cytology container. From half of these washings, filterpreparations were made on 25-mm Schleicher and Schuellfilters (Dassel, Germany), pore size 3 microns. The smears andfilter preparations were stained by Papanicolaou method. Fromthe remaining half of the washings, cell blocks were made afterspinning and sections were cut after routine processing andstained with hematoxylin-eosin. The surgical excision biopsytissue after fixation was routinely processed, sectioned, andstained with hematoxylin-eosin stain.

The findings in both cases were similar in the cytologicalpreparations, cell blocks and surgical biopsy and were com-prised of a cellular sample with several epithelial cells bothsingly and in cohesive papillary clusters of variable sizewith or without a vascular core (Figs. 1 and 2). The epithe-lial cell nuclei were uniform with fine chromatin, mostlyinconspicuous nucleoli, some naked nuclei, and few hemo-siderin-containing macrophages. In conjunction with theclassical site of the lesion, clinically, the cytohistologicalfindings were interpreted as a benign nipple adenoma(papillomatosis).

Nipple adenoma needs to be distinguished from otherlesions that may cause diagnostic confusion such as Paget’sdisease, infiltrating carcinoma, fibrocystic process, intraduc-tal papilloma, duct ectasia, fibroadenoma, and subareolarabscess. Paget’s disease is characterized by pleomorphic,hyperchromatic cells with multiple variable-sized nucleoli,shows mucin positivity, and, generally, is associated with an

1Wellington Hospital and Valley Diagnostic Laboratory, Ltd., LowerHutt, New Zealand

2Hutt and Wellington Hospital, Lower Hutt, New Zealand3The Cytology Unit, Wellington Hospital, Wellington, New Zealand*Correspondence to: Raj K. Gupta, M.D., F.I.A.C., Valley Diagnostic

Laboratory, Ltd., 22-Kings Crescent, P.O. Box 30–044, Lower Hutt, NewZealand. E-mail: raj.gupta@xtra.co.nz

Received 8 April 2004; Accepted 25 June 2004DOI 10.1002/dc.20168Published online in Wiley InterScience (www.interscience.wiley.com).

432 Diagnostic Cytopathology, Vol 31, No 6 © 2004 WILEY-LISS, INC.

underlying carcinoma. A malignancy involving the nipple-usually is a poorly differentiated infiltrating carcinoma andshows significant cytological abnormalities with a generallack of cell cohesiveness and significant increase of singlemalignant cells. The cytological features of nipple adenomamay overlap with other benign lesions and certain featuresassist in differentiation. These include, e.g., the presence ofwhite cells in duct ectasia, cell balls in intraductal papil-loma, monolayering and fronds in fibroadenoma, and apo-crine cells and foam cells in lesions associated with fibro-cystic process. Malignant transformation in nipple adenomais extremely rare.7 We also feel that the increasing use ofcellular samples in breast lesions underscores the impor-tance of recognising this uncommon benign neoplasm withits cytological findings, because it can be treated by alimited resection.

References

1. Pintom RG, Mandrekar S.Fine needle aspiration cytology of adenomaof nipple. A case report. Acta Cytol 1996;40:789–791.

2. Masood S. Cytopathology of the breast: the ASCP theory and practiceof cytopathology series, vol. 5. Chicago: ASCP Press; 1996. p 83–84,117–118.

3. Perzin KH, Lattes R. Papillary adenoma of the nipple (florid papillo-matosis, adenoma, adenomatosis): a clinico-pathologic study. Cancer1972;29:996–1009.

4. Mazzara PF, Flint A, Naylor B. Adenoma of nipple. Cytopathologicfeatures. Acta Cytol 1989;33:188–190.

5. Sood N, Jayaram G. Cytology of papillary adenoma of nipple: a casediagnosed on fine-needle aspiration. Diagn Cytopathol 1990;6:345–348.

6. Stromby N. Bondeson L. Adenoma of the nipple. An unusual diagnosisin aspiration cytology. Acta Cytol 1984;28:729–732.

7. Gudjonsdottir A, Hagerstrand I, Ostberg G. Adenoma of the nipple withcarcinomatous development. Acta Pathol Microbiol Scand 1971;79:676–680.

Fig. 2. Hematoxylin-eosin-stained section of a cell block from an aspirateshown in Fig. 1 showing papillary cluster with vascular core (originalmagnification, �160). [Color figure can be viewed in the online issue,which is available at www.interscience.wiley.com]

Fig. 1. Papanicolaou-stained filter preparation of aspirate showing a cel-lular sample in a male patient with epithelial cells both singly and incohesive papillary clusters of variable size (original magnification, �160).[Color figure can be viewed in the online issue, which is available atwww.interscience.wiley.com]

FNA CYTODIAGNOSIS OF NIPPLE ADENOMA

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