Track: Case Reports

Abstract:

Syringocystadenoma papilliferum (SCAP) is a benign cutaneous adnexal neoplasm of apocrine or eccrine origin. These lesions most commonly occur on the head and neck, but have been reported on the lower extremities, trunk, and rarely the mammary region. Most cases occur in children or adolescents, but have been reported in a wide age range, and may occur as a solitary lesion or in association with nevus sebaceous of Judassohn. We present an unusual case of an incidentally discovered SCAP occurring in the nipple of a 49 year-old female who underwent bilateral mastectomies for previously diagnosed ductal carcinoma in situ (DCIS) of the contralateral breast. Sections of the nipple show a 0.9 cm cystic lesion with epidermal connection and broad papillary fronds extending into the cystic space. The lesion is lined by a double cell layer epithelium. The inner cell layer is composed of columnar cells with focal decapitation secretion and the outer cell layer is cuboidal. The stroma of the papillary fronds are rich with plasma cells. The histologic differential diagnosis includes nipple adenoma, intraductal papilloma, and hidradenoma papilliferum which can be differentiated by morphology and anatomic location. To our knowledge, this is the fourth reported case of SCAP involving the nipple (3 female, 1 male; mean age 29.8 years). The incidental discovery in this case suggests these lesions may occur more frequently at this site than currently reported in the literature. Therefore, this case aims to improve diagnosis and classification of this entity when it occurs in atypical locations.

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Mohan Narasimhamurthy