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Abstract:
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. This report describes 12 women who presented with sclerosing papillary duct hyperplasia in the subareolar portion of the breast. The term subareolar sclerosing duct hyperplasia (SSDH) is proposed for this condition. The average age of the patients was 46 years (26-73 years). None of the lesions, which averaged 1.2 cm (0.6 to 2.0 cm), involved the nipple. All were beneath the nipple and/or areola or in the breast close to the areola. Three women had bloody nipple discharge but none had nipple erosion or other signs suggestive of Paget's disease. Five patients were well 9 months to 3 years, 9 months (average, 2 years, 7 months) after excisional biopsy. Two other patients had persistent SSDH reexcised 2 years, 6 months and 2 years, 10 months, respectively, after diagnosis. Both were well 1 year later. There is no follow up in two patients treated by excision. Three women are well after treatment by mastectomy. In one of those patients, intraductal carcinoma was found arising in SSDH. The clinical presentation of SSDH differs sufficiently from other proliferative duct lesions to warrant considering it a distinct disease process. It does not appear to be associated with a particular proclivity to evolve into carcinoma and short-term follow-up suggests that excisional biopsy is probably adequate therapy.