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.