Introduction
Nipple adenomas arise from the terminal end of mammary gland ducts. Usually, they are benign in nature and rarely show malignancy. These masses are believed to arise from medium-sized ducts in the nipple areas. It usually occurs due to a stromal repair process in breast tissue. It can also be seen as calcified masses. It rarely invades the surrounding tissue or shows signs of cancer.
What Is a Nipple Adenoma?
Nipple adenomas are lesions arising on the nipples. It is more commonly seen among middle-aged women. Other names like erosive adenomatosis and florid papillomatosis of the nipple also know for it. Adenomas are a group of cells that abnormally club together to form tumors. Depending on the type of multiplication of cells, they are categorized as benign or malignant masses. The adenoma of nipples arises from the free end of the ductal system, which opens towards the nipple. These tumor cells are well-defined in structure. They comprise glandular, epithelial, fibrous, and fatty tissues. The distribution of these cells varies in proportion. Therefore, adenomas are known after a specific cell type name, which is more in number than other cells. For example, tubular adenomas - are made of dominating round tubular, bilayered ductal, and myoepithelial cells with little background stroma.
Who Is More at Risk of Developing Nipple Adenomas?
People at more risk of developing nipple adenomas are as follows:
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It is more commonly seen in middle-aged women, especially premenopausal women.
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It is also seen among childbearing age.
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In children below the age of twenty-two, breast adenomas develop due to clogged milk ducts and during puberty and pregnancy when the breast increases in size. It is also observed in hormonal imbalances, especially the estrogen hormone.
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Most of the cases occur at an age below forty years.
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They rarely occur before menarche and after menopause.
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Genetic factors.
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History of immunocompromised conditions.
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Recurrent fat deposition or lipomatous mass.
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Cholesterol deposits can also trigger this condition.
Types of Nipple Adenomas
What Is a Tubular Adenoma?
These are benign masses with a well-defined border. The cells are dominated by the proliferation of tubular structures. They arise from the upper outer quadrant of the breast. They are seen as slowly growing new cells as a result of multiplication. These masses of cells are palpable, solitary, painless masses that move freely and are well-defined. In ninety percent of cases, they are seen in women below the age of forty. The proliferation of epithelial and myoepithelial cells dominates it.
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Gross Appearance: The tumor size is 1 to 7.5 cm going up to 3 cm. The giant forms can grow as large as 15 cm. It is seen as smooth, rounded, firm, and solid rubbery tumors. They are yellow to brown in color.
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On Microscopy: These cells are seen as uniformly arranged round and tubular cells with a well-defined border during lab studies. The tubular cells are bi-layered with inner ductal luminal and outer myoepithelial cells. It rarely shows nucleoli and mitosis. The cells also show little blood cells distributed randomly across the stroma. Tubular adenomas rarely develop into a malignant condition.
What Is a Benign Breast Nodule?
These are nodules seen in the breast during pregnancy or breastfeeding. Lactational changes follow it. They are seen as a soft, painless, palpable, solid mobile mass that does not show variation in skin and nipple structures. Normally these nodules measure less than five centimeters but can grow up to twenty-five centimeters. Usually, it heals on its own after breastfeeding stops. This can be observed around the nipple area and in the axilla. It is seen as a single lesion or may occur bilaterally. These cells are sharply separated from the surrounding tissues.
How Do Adenomas of the Breast Develop in Young Females?
Fibroepithelial tumors of the breast are seen commonly among young women. They are known as fibroadenomas and are a common condition. It is seen as a solid, round, palpable breast mass. Mostly they occur as a single mass but can also be seen bilaterally or multifocal. It can also occur as giant fibroadenomas measuring larger than five centimeters or weighing more than five hundred grams.
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Clinical Feature: On clinical examination, they are seen as grayish-white in color, firm to rubbery in consistency, and round to oval in shape. They are well-circumscribed masses with no infiltration to surrounding tissues.
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Microscopic Examination: Upon microscopic examination, the most commonly seen features are changes in cellular rigidity or fibrocystic changes, change in cellular nature or apocrine metaplasia, enlargement of milk-producing lobules or adenosis and increase in duct size or ductal epithelial hyperplasia. Rarely multinucleated giant cells can also be seen.
What Are Apocrine Adenomas?
Apocrine glands are exocrine glands that secrete secretions like sweat. Apocrine adenomas are rare lesions seen as a uniform mass demarcated from their surrounding breast tissue. It is made of benign breast ducts with apocrine epithelium and surrounding stroma. It rarely develops into cysts.
What Are Cellular Fibroadenomas?
These arise during the second decade of life and can grow rapidly and appear cellular. In myxoid fibroadenomas, the surrounding stroma undergoes changes. Secondary cellular changes are seen as infarction or death of cells with or without calcification. These tumors are fibroepithelial tumors arranged in a leaf-like pattern. They occur rarely and account for less than three percent of fibroepithelial tumors. It is most commonly seen in the fifth and sixth decades of life.
What Are the Tests Done to Rule Out Breast Adenomas?
Many tests are done to understand the nature of the lesion. The most commonly done tests are as follows:
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Mammogram: Images of the breasts are captured to see the extension of borders.
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Immunohistochemistry: The cytokeratin epithelial component is positive, vimentin stromal cells are positive, and CD34 and beta-catenin are positive.
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Blood Count: This shows a high value of hemoglobin and white blood cells.
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USG Guided FNAC: An image is captured of the soft tissue along with the tissue sample collected using fine needle aspiration for a biopsy study.
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CA- 125: For malignant or cancerous conditions, tumor markers are used to stage cancer.
How Can Breast Adenomas Be Treated?
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Surgical Excision: In young girls, surgical procedures are done differently for fibroadenoma and benign phyllodes tumors. A very narrow margin is made. There are chances of recurrence in phyllodes tumors. Hence, wider margins of excision are made.
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Lymph Node Dissection: This procedure is not widely practiced due to its high potential for spreading to surrounding tissues like lungs, pleura, and bones and spreading through the bloodstream. This can give rise to metastasis.
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Radiotherapy: Wider lesions are burned using high radiation beams.
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Chemotherapy: Chemotherapy is done in malignant tumors, where the tumors are treated using chemotherapeutic drugs and radiotherapy.
Conclusion
Breast adenomas are well-defined common lesions that are freely moveable masses. Breast adenomas that are malignant can result in breast distortion by invading axillary lymph nodes present under the armpits. Most adenomas are treatable by surgically excising them.
