Coexistence of nipple duct adenoma and breast carcinoma: a clinicopathologic study of five cases and review of the literature.

The simultaneous occurrence of nipple duct adenoma (NDA) and carcinoma in the same breast is rare and generally considered an incidental finding. Five examples of such concurrent lesions are reported. The patients ranged in age from 48 to 70 y, and they all presented with a palpable mass that was subareolar in three and in the lower inner quadrant in two women. The presence of distorted nipple with discharge in two patients and nipple erosion in another had raised the possibility of Paget's disease clinically. Microscopically, an infiltrating duct carcinoma was present in four women and an intraductal carcinoma in the fifth--all along with a NDA. Two of the invasive carcinomas were adjacent to the NDA and immediately beneath the surface epithelium of the nipple; the NDA in one of these had atypical intraductal hyperplasia. Three women had mastectomy and axillary node dissection, two had excisional biopsy only. Follow-up was available in four women and ranged from 1.5 to 8 y. One of these women developed metastasis and died 8 y postdiagnosis; the remaining three are alive and well. In at least three cases, the invasive carcinoma was not suspected clinically, and the initial procedure was done because of symptomatology secondary to the NDA.