The paper presents a case of a rare benign lesion of the breast - nipple adenoma. Nipple adenoma is a benign tumor without connective tissue cores composed of small tubules lined by epithelial and myoepithelial cells with or without proliferation of the epithelial component around collecting ducts. In 1955, Jones considered it as a separate clinical pathologic entity. The tumor most often develops in women between 40-50 years of age in the form of erythema, crust or ulceration, and it is therefore often mistaken for Paget\u27s disease. We report a case of a patient referred to our cytology laboratory for clinical suspicion of malignancy, with an erythematous, exulcerated nipple and occasional hemorrhagic discharge. The mammographic finding was normal and sonography indicated a smaller hypoechogenous zone immediately below the nipple. Scraping material for cytologic analysis was stained by the standard MGG staining raising the suspicion of a malignant tumor.
The nipple containing a tumor of a firm consistency underwent PHD analysis. Biposies of standard H&E-stained sections showed the tumor partly covered with multilayered squamous epithelium, with ducts revealing scattered epithelial proliferation and the diagnosis of nipple adenoma was made. Due to its rare occurrence, clinical presentation and cytologic pattern of increased cellularity, dissociation of epithelial cells with occasional signs of atypia, the tumor is often misinterpreted and cytologically classified as carcinoma. For nipple lesions presented as exulcerated changes, and any changes in the nipple\u27s appearance in general, except for Paget\u27s disease, the possibility of a benign tumor ,such as adenoma of the nipple, should always be taken into consideration.
The treatment of choice consists of the removal of the entire nipple since foci of carcinoma can sometimes, although rarely, be found in a nipple adenoma, too.U radu je prikazan slučaj rjeđega benignog tumora dojke – adenoma bradavice. Adenom bradavice je benigni tumor bez vezivne čahure građen od malih tubula obloženih epitelnim i mioepitelnim stanicama sa ili bez proliferacije epitelne komponente oko sabirnih kanalića. Kao zasebni kliničko patološki entitet 1955. ga izdvaja Jones. Tumor se najčešće pojavljuje u žena između 40-50 godine uz simptome često krvavog iscjetka te promjene bradavice u obliku eritema, kruste ili ulceracije zbog čega se klinički često zamijeni s Pagetovom bolesti.
Izvještavamo o pacijentici koja je u citološki laboratorij upućena pod kliničkom sumnjom da se radi o malignoj bolesti, s eritematoznom, egzulceriranom bradavicom uz povremeni krvavi iscjedak. Mamografski nalaz je bio uredan, a UZV nalaz je pokazivao manju hipoehogenu zonu neposredno ispod bradavice. Materijal za citološku analizu dobije se metodom struganja, oboji standardno MGG-om te se citološki postavi sumnja na zloćudni tumor.
Na PHD analizu se zaprimila bradavica s tumorom čvršće konzistencije. Biopsije standardnog H&E bojenja pokazivale su tumor koji je dijelom bio pokriven višeslojnim pločastim epitelom uz kanaliće u kojima se mjestimice vidjela i proliferacija epitela te se postavila dijagnoza adenoma bradavice.
Zbog rijetke pojave ovog tumora, njegove kliničke prezentacije te citološke slike jake celularnosti, disocijacije stanica uz mjestimice izražene znakove atipije, nije neobično da se tumor citološki klasificira kao karcinom. Za lezije bradavice koje se prezentiraju kao egzulcerirane promjene, te općenito promijenjeni izgled bradavice, osim Pagetove bolesti treba svakako razmišljati i o benignim tumorima kao što je adenom bradavice.
Terapija izbora je uklanjanje bradavice u cijelosti zato jer se, iako rijetko, mogu naći i žarišta karcinoma
