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Nipple adenomas (NAs) are benign neoplasms composed of papillary hyperplasia of the epithelium of the major lactiferous ducts. Patients with NA may report bloody nipple discharge and clinically may resemble Paget disease, raising concern for malignancy. Mammographically, NAs are often occult. US can show a hypervascular circumscribed mass centered within the nipple with varying echogenicity. Diagnosis is usually made on punch biopsy or excision, but breast radiologists should be aware of this entity. Malignancy can be found elsewhere in the ipsilateral or contralateral breast, or very rarely may directly extend to involve an NA, but published experience with concurrent malignancies is small. We describe the radiologic-pathologic correlation of NAs.

A man in his 60s with a history of chronic obstructive pulmonary disease (COPD) and dyspnea presented with right lower quadrant abdominal pain. A noncontrast computed tomographic (CT) scan of the abdomen demonstrated splenomegaly, ascites, and a retroperitoneal mass posterior to the pancreatic head. Fine-needle aspiration from the retroperitoneal mass and ascitic fluid revealed no malignant cells. The patient subsequently developed a left-sided lateral chest wall hematoma, and, in retrospect, it was thought that the retroperitoneal mass was actually a hematoma because multiple follow-up studies demonstrated the mass steadily decreasing in size. Echocardiography showed right atrial and ventricular dilatation and increased thickness of the interventricular septum. Laboratory tests showed elevated results for serum-free λ light chain and proteinuria levels and altered liver function tests but a normal coagulation profile. Routine surveillance noncontrast CT imaging of the neck demonstrated a submucosal soft-tissue mass containing few punctate calcifications centered in the epiglottis with clinically significant narrowing of the oropharyngeal and supraglottic laryngeal airways by the enlarged epiglottis (Figure).