Introduction
Nipple Adenoma (NA), also referred to as erosive adenoma or florid
papillomatosis of the breast [1], is a rare benign breast disease
affecting the nipple; it is considered a generally under-recognized
condition and it usually affects middle-aged women with an average age
of 43-45 years [2]. Exact incidence rate is not yet known due to its
rarity, however certain studies estimated that the pathology was present
in one out of every 8,000-8,500 skin biopsies or surgical specimens
[3], implying a greater incidence in the general population . Male
and adolescent patients have been reported, however they are the
exception, accounting for under 5% of recorded cases [3].
NA presents clinically with nipple enlargement, nipple discharge (serous
or hematic) and the presence of palpable lesion or erosion of the nipple
[4, 5]. Female patients in particular have usually already
self-diagnosed an anomaly of the nipple area months, or even years,
prior to seeking medical assistance. NA cases may present benign
developmental variations, inversion, retraction, or enlargement of the
nipple, which may be of either a benign or a malignant nature; a
palpable mass, nipple discharge, skin changes in and around the nipple,
infection with resultant nipple changes or a the presence of subareolar
mass [6].
Several diagnostic and other examination tools are being used to assess
NA, including mammography, breast ultrasonography, galactography,
magnetic resonance imaging, cytology examination and core biopsy and
histo-pathology examination [3]. Accurate clinical evaluation and
management of NA usually requires a multi-disciplinary approach,
involving primary care physicians, dermatologists, breast specialists
and histopathologists [7]. This thorough diagnostic approach is
necessary, as NA may clinically mimic malignant conditions such as
Paget’s disease, carcinoma of the breast or nipple eczema [8] and
adequate histological assessment is vital in the differentiation of the
pseudo invasive pattern that often characterizes NA, a benign tumor,
from breast cancer precursors and aggressive carcinoma [9-11].
Treatment of NA is surgical, with various techniques having been
described, however no single approach has, yet, been proposed as the
gold standard; owing to both the scarcity of NA, as well as the
possibility of the presence of aggressive patterns that could alter the
therapeutic approach. This report presents the case of NA in the nipple
areolar complex (NAC) area and evaluates the effectiveness of a novel
surgical excision technique which maintains “nipple” projection. The
following case is presented in accordance with the CARE reporting
checklist.