A case of nipple adenoma showing a characteristic hyper vascular echo image

Abstract

A 51-year-old woman was admitted to our department with the complaint of right nipple bleeding. She had bilateral inverted nipples. An easily-bleeding tumor about 1 cm in size was found in the right nipple. A breast ultrasonography (US) revealed a well-defined low-echo tumor measuring 12.7 mm in the concave part of the right nipple. On color Doppler echo imaging (CDI), extremely rich blood flow was observed, and about 10 arterial blood flows running almost parallel from the deep to the shallow part were observed. The blood flow in this case was like the flow of a “broom”. Since the tumor in the right nipple was easily bleeding, Paget’s disease should be ruled out. An incisional biopsy was performed using a trephine needle. Nipple adenoma was diagnosed as a proliferation of ductal epithelium with myoepithelium in a tubular or papillary shape. One month after the initial visit, the right nipple tumor was resected under local anesthesia by our plastic surgeon. The pathological diagnosis of the resected specimen was the same as the biopsy. Abundant vessels were observed in the resected specimen. Nipple adenoma is a rare benign tumor that grows in the nipple. Differential diagnosis from malignant diseases such as Paget’s disease is necessary. Most cases are reported by dermatologists and there are few descriptions of US, but some reports have also noted abundant blood flow by CDI. It is considered that such abundant blood flow findings may be useful for differential diagnosis of nipple adenoma in the future by accumulating case reports.