Infiltrating Syringomatous Adenoma of the Nipple: A Case Report

Abstract

We describe a case of a 46-year-old woman who was treated initially for a presumed non-lactational breast abscess.As symptoms did not subside with conservative management a major duct excision was conducted and histology revealed an infiltrating syringomatous adenoma.She underwent further surgery to achieve clear margins and the tumour is the largest reported to date.These are benign, infiltrating lesions and are rare with less than 40 cases reported in the literature.Patients usually present with a retro-areolar mass and adjacent skin and nipple changes. Radiologically they are difficult to differentiate from breast cancer and diagnosis is largely confirmed through histologic and immunohistochemical analysis.Treatment is with local excision to achieve clear margins as recurrence rates are high with residual tumour. Keywords: Syringomatous adenoma; Nipple; Breast abscess Case Report:Mrs A, a 46-year-old woman was initially admitted acutely to hospital with a presumed non-lactational breast abscess in the central left breast and commenced on intravenous antibiotics.She had been assessed nine years previously by a breast surgeon for left nipple discomfort that was thought to be due to duct ectasia. She was offered a duct excision at this time but declined. She underwent needle aspiration and purulent appearing material was obtained however laboratory analysis did not identify causative bacteria. She experienced clinical improvement and was discharged home.At subsequent outpatient clinic follow up the area of induration around the left nipple remained along with a small sub-areolar collection on ultrasound, which persisted despite antibiotics and serial aspiration.Ultrasound did not suggest features concerning for malignancy. As the nipple changes failed to settle the patient was offered left major duct excision. Histology demonstrated appearances suggestive of infiltrating syringomatous adenoma (ISA) of the nipple.The lesion was 45 × 25 mm, which appears to be the largest case of ISA reported in the literature. As margins were positive, the decision was made for re-excision with complete excision of the left nipple areola complex. Histology confirmed that the residual ISA had been excised with negative margins.