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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 95-96

Subareolar sclerosing duct hyperplasia of the breast: An encounter with a rare entity


1 Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication16-Jun-2017

Correspondence Address:
Anchana Gulati
“Prabhu Anugreh”, Chhota Shimla, Shimla - 171 002, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_35_17

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  Abstract 


Subareolar sclerosing duct hyperplasia of the breast is a rare entity. Patients present with lump located beneath the nipple and areola, with/without nipple retraction and nonspecific mammographic findings, hence closely mimicking carcinoma clinically. Cytology reveals only a benign papillary lesion, therefore creating a diagnostic dilemma for the clinician and the pathologist alike. We report a case of this entity in a 70-year-old female who presented with a lump in the right breast with nipple retraction and nipple discharge of 6-month duration.

Keywords: Breast, sclerosing lesion, subareolar


How to cite this article:
Gulati A, Kaushal V, Jaswal K S, Kaushik R. Subareolar sclerosing duct hyperplasia of the breast: An encounter with a rare entity. Arch Med Health Sci 2017;5:95-6

How to cite this URL:
Gulati A, Kaushal V, Jaswal K S, Kaushik R. Subareolar sclerosing duct hyperplasia of the breast: An encounter with a rare entity. Arch Med Health Sci [serial online] 2017 [cited 2021 Nov 30];5:95-6. Available from: https://www.amhsjournal.org/text.asp?2017/5/1/95/208195




  Introduction Top


Subareolar sclerosing duct hyperplasia (SSDH) is a less often encountered entity. It is a form of sclerosing papilloma of central and subareolar breast parenchyma, sparing the nipple, which can occur in young to elderly females.[1] Patients present with lump located beneath the nipple and areola, with/without nipple retraction, and nonspecific mammographic findings, hence closely mimicking carcinoma.


  Case Report Top


A 70-year-old female presented to the surgery outpatient department with a lump in the right breast and serous nipple discharge of 6-month duration. On examination, lump was 3 cm × 2 cm, well-defined, immobile, nontender, firm and located posterior to the right nipple-areola complex. There was presence of nipple retraction. There was no axillary lymphadenopathy. Clinically, a diagnosis of malignancy was suggested [Figure 1].
Figure 1: Retracted nipple, right breast

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Ultrasonography revealed a 1.7 cm × 1.6 cm hypoechoic mass with well-defined outline. No calcification was seen. Mammography showed a zone of radiopacity in the right retroareolar region with ill-defined margins. It was reported as Breast Imaging-Reporting and Data System III (probably benign).

Fine-needle aspiration (FNA) was done. FNA smears revealed cohesive monolayered sheets, aggregates, finger-like papillae, complex folded groups, rows of palisaded cells, benign ductular epithelial cells, epithelial cells with reactive atypia, and foamy change in cytoplasm. In addition, stromal cells, proteinaceous material, red blood cells, and foamy macrophages were seen in the background. Possibility of a benign papillary lesion was suggested.

Tru-cut biopsy and subsequent lumpectomy showed:

  • Nodule in subepithelial tissue covered over by stratified squamous epithelium revealing mild acanthosis, mild hyperkeratosis, and subepithelial lymphoplasmacytic infiltrate
  • Well-circumscribed nodule showing sclerosis and elastosis in center
  • Duct hyperplasia at periphery, variable-sized ducts lined by benign cuboidal to columnar epithelium, forming cribriform pattern, small solid nests, micropapillary hyperplasia with focal apocrine, and cystic change
  • Surrounding sclerotic stroma [Figure 2].
Figure 2: Section revealing stratified squamous epithelium of nipple with underlying variable sized ducts lined by benign cuboidal to columnar epithelium, forming cribriform pattern, small solid nests, micropapillary hyperplasia (H and E, ×40) inset reveals duct hyperplasia with elastosis and sclerosis in the center of the lesion (H and E, ×100)

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These histopathological features were suggestive of SSDH, breast.


  Discussion Top


Sclerosing papillary duct hyperplasia occurs in various locations in the breast. In the nipple, the process produces a distinct clinicopathological entity referred to as nipple adenoma or florid papillomatosis (FP). Peripheral lesions have been termed radial scar and nonencapsulated sclerosing lesions. When patients present with lump in the subareolar portion of the breast, the term SSDH is used.[2]

The age range of the patients at presentation is 26–73 years with the mean being 46 years. Size ranges from 0.6 cm to 2.0 cm, with sparing of the nipple. Lump is beneath the nipple and/or areola or in the breast close to the areola. Some women can have bloody nipple discharge, but nipple erosion or other signs suggestive of Paget's disease are not seen.

Differential diagnosis of SSDH is with FP and complex sclerosing lesion (radial scar). The clinical presentation of SSDH differs from other conditions making it a separate, distinct process. SSDH forms a discrete tumor near or beneath the nipple-areolar complex. It may be associated with nipple discharge or retraction. The tumor, however, does not grow within the substance of the nipple. Erosion of the nipple surface, typical of FP, is not seen with SSDH.

When examined histologically, SSDH has some features in common with FP of the nipple and radial scar lesions.[3] Differences include the tendency of SSDH to have a circumscribed, or nodular, rather than stellate configuration, the scarcity of cysts, absence of squamous metaplasia, and the relatively prominent papilloma component in SSDH. Elastosis is not a conspicuous feature of SSDH.

Local excision appears adequate to control the lesion in most cases. Excisional biopsy of SSDH has been accomplished without removal of the nipple or areola. Centrally placed tumors and those close to the areolar surface, however, present technical problems and may require excision of the nipple as was in our case. Local recurrence can occur, probably reflecting incomplete excision at the initial operation.

Our case report highlights this lesser known entity which must be kept as a differential diagnosis when a patient presents with a subareolar nodule.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rosen PP, editor. Papilloma and related benign tumors. In: Rosen's Breast Pathology. 3rd ed. Lippincott Williams & Wilkins, 2009. p. 107-8.  Back to cited text no. 1
    
2.
Rosen PP. Subareolar sclerosing duct hyperplasia of the breast. Cancer 1987;59:1927-30.  Back to cited text no. 2
    
3.
Rosen PP, Caicco JA. Florid papillomatosis of the nipple. A study of 51 patients, including nine with mammary carcinoma. Am J Surg Pathol 1986;10:87-101.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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