Nephron

Nipple Adenoma

Article
Women's Health
Diseases & Conditions
+1
Contributed byKrish Tangella MD, MBADec 09, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Erosive Adenomatosis of Nipple
  • Papillary Adenoma of Nipple
  • Subareolar Duct Papillomatosis of Breast

What is Nipple Adenoma? (Definition/Background Information)

  • Nipple Adenoma (NA) can be described as an abnormal collection of a special type of cells that forms a mass around the nipple ducts. It is a benign condition that is mostly seen in adult women of a wide age range
  • The cause of Nipple Adenoma is unknown, but the risk factors may include gender (women are affected more than men), the use of birth control pills, obesity, and one’s reproductive history
  • The signs and symptoms of Nipple Adenoma may include discharge from the nipple and thickening of skin around the nipple. Small-sized tumors may be asymptomatic and show no signs and symptoms
  • Nipple Adenoma is treated through a surgical excision, per the healthcare provider’s recommendation. The prognosis is excellent with its complete removal, since it is a benign tumor. However, periodic checkups and screening mammograms are advised

Who gets Nipple Adenoma? (Age and Sex Distribution)

  • Nipple Adenoma is an uncommon tumor that occurs in females between 20 and 87 years; this tumor is known to occur in males too
  • In very rare cases, very young children and infants have also been reported with this tumor type
  • All racial and ethnic groups are affected and no specific predilection is seen

What are the Risk Factors for Nipple Adenoma? (Predisposing Factors)

The definitive risk factors for Nipple Adenoma are not well-understood. However, the following risk factors increase one’s chances of getting benign breast tumors, and these include:

  • Gender: Women have a higher risk for developing the condition than men
  • Obesity: Being overweight or obese increases the risk
  • Alcohol consumption
  • Menstrual cycle: Women who got their period before the age of 12 years, and those who reached menopause after age 55 have a higher risk. The longer the duration between menarche and menopause, the greater is the risk. This is due to hormonal influences during the reproductive period on the breast tissue
  • Postmenopausal hormone therapy: Women taking hormone replacement therapy medications containing both estrogen and progesterone for menopause, have a higher risk
  • Reproductive history: Having the first child after the age of 35, or never having a child
  • Birth control pills
  • Physical inactivity: A lack of physical exercise (leading a sedentary life) can increase one’s risk
  • Not breastfeeding the child

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Nipple Adenoma? (Etiology)

The exact cause of development of Nipple Adenoma is currently not clearly understood.

  • Some research studies show that these adenomas may be a form of intraductal papillomas of the end ducts (terminal ducts of breast)
  • Studies have shown that such tumors may be caused by hormonal influence
  • Certain gene mutations have also been reported in the tumors. Research is being performed to determine how these mutations contribute to the formation of the tumors

What are the Signs and Symptoms of Nipple Adenoma?

The signs and symptoms of Nipple Adenoma may include:

  • A poorly-defined lesion affecting the nipple may be observed
  • Discharge from the nipple, which may consist of a fluid or blood, is often seen
  • Nipple erosion is seen in some cases, which can sometimes affect the skin too
  • Thickening or swelling of part of the breast may be seen; change in the size or shape of the breast
  • Typically, only one breast is affected
  • Changes to the skin covering the breast or nipple area, including dimpling, irritation, redness, scaling, peeling, or puckering
  • In some cases, pain in the breast

Nipple Adenoma may show similarity with Paget’s disease of the breast/nipple.

How is Nipple Adenoma Diagnosed?

Nipple Adenoma may be diagnosed in the following manner:

  • Complete physical examination with comprehensive medical and family history evaluation
  • Breast exam to check for any lumps or unusual signs in the breasts
  • Mammogram: A mammogram uses x-rays to provide images of the breast. These benign tumors are identified as a mammogram mass, which may or may not be associated with microcalcification. The mammography findings may raise enough suspicion to warrant a tissue biopsy
  • Galactography: A mammography using a contrast solution, mostly used to analyze the reason behind a nipple discharge
  • Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast, the type of tumor, whether fluid-filled cyst or solid mass type, may be identified
  • Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
  • Breast biopsy:
    • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
    • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
    • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

  • Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue. FNAB cannot help definitively diagnose Nipple Adenoma. It only helps determine if the tumor is malignant or benign. This can help the healthcare provider discuss and plan the next steps (with respect to diagnosis and treatment)
  • Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast. A definitive diagnosis on a core biopsy may be difficult. Hence, a follow-up surgical procedure to obtain a larger breast biopsy specimen (such as through a lumpectomy) is often performed
  • Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Nipple Adenoma?

There may not be any significant complications of Nipple Adenoma.

  • Following treatment, occasional recurrence of the tumor has been noted
  • Rarely, Nipple Adenomas have been associated with malignant tumors
  • The condition may cause cosmetic issues and lead to severe emotional stress

How is Nipple Adenoma Treated?

The following treatment methods for Nipple Adenoma may be considered:

  • A ‘wait and watch’ approach may be considered for asymptomatic adenomas
  • A simple surgical excision and removal of the entire Nipple Adenoma is normally sufficient treatment
    • The surgical procedure performed is known as a breast lumpectomy. It is a surgical procedure to remove the breast lump, which may be done under a general anesthetic
    • During the surgery, a small incision is made in the skin of the breast and a hollow probe that is connected to a vacuum, inserted
    • The breast tissue is sucked through the probe, using vacuum, until the lump has been removed 
  • Follow-up care with frequent breast self-examinations and screening mammograms may be recommended by the healthcare provider

How can Nipple Adenoma be Prevented?

Nipple Adenoma is difficult to prevent, because it is most likely caused by abnormal or fluctuating reproductive hormone levels. Since prevention is generally not possible, it is important to be aware of the risk factors of breast lumps.

  • The individual must regularly conduct breast self-exams, to ensure that no lumps are present
  • Maintain a healthy body weight and exercise regularly
  • Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
  • Drink alcohol in moderation; limit to one or (maximum) two drinks a day
  • Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of hormone therapy

What is the Prognosis of Nipple Adenoma? (Outcomes/Resolutions)

  • The prognosis of Nipple Adenoma is generally excellent on a complete surgical excision and removal of the tumor
  • Some adenomas are known to recur due to incomplete removal of the tumor
  • Periodic follow-up check-ups with screening is required

Additional and Relevant Useful Information for Nipple Adenoma:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/

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Krish Tangella MD, MBA picture
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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