探讨超声不典型表现的乳头腺瘤(NA)的临床误诊原因及诊断学特征。

回顾性分析2020年7月17日皖南医学院第一附属医院普外科收治的1例NA患者的临床资料，并进行文献复习。

患者女性，29岁，2个月前因左乳头肿物行"左乳头肿物切除术"，术后病理示左乳头乳头状瘤病，术后因切口反复破溃入院，体格检查发现左侧乳头皮肤破裂，无明显渗出，双侧腋窝未见肿大淋巴结。超声检查显示左侧乳头增大，血流信号丰富，考虑乳腺Paget病。术后病理诊断为NA，病理镜下：肿瘤为腺性结构且位于真皮内，导管上皮呈乳头状或腺瘤样增生。免疫组织化学染色示腺上皮低分子质量细胞角蛋白(CAM 5.2)阳性，p63阳性，基底细胞角蛋白5/6(CK 5/6)阳性，肌上皮平滑肌肌动蛋白(SMA)阳性，Ki-67阳性，人类表皮生长因子受体2(HER-2)阴性，抑癌基因p53阴性。

NA极易被误诊为乳头乳头状瘤病和乳腺Paget病。超声检查可以为诊断NA提供帮助，但在某些情况下，单纯通过超声检查很难做出正确诊断，应通过病理检查和免疫组织化学染色确诊。

To investigate the clinical misdiagnosis causes and diagnostic features of nipple adenoma (NA) with atypical ultrasonographic manifestations.

The clinical data of a NA patient admitted to the Department of General Surgery, the First Affiliated Hospital of Wannan Medical College on July 17, 2020 were analyzed, and the literatures were reviewed.

The 29-year-old female patient underwent " left nipple mass resection" for left nipple mass 2 months ago. Postoperative pathology showed left nipple papillomatosis, and the patient was admitted to the hospital due to repeated incision. Physical examination revealed skin rupture of the left nipple with no obvious exudation, and showed no enlarged lymph nodes in bilateral armpits. Ultrasound examination showed that the left nipple was enlarged with rich blood flow signal, and Paget′s disease of the breast was considered. The postoperative pathological diagnosis was NA. Microscopically, the tumor was a glandular structure, located in the dermis, with papillary or adenomatous hyperplasia of ductal epithelium. Immunohistochemically, in tumor cells, low molecular cytokeratin (CAM 5.2) in glandular epithelium, p63 in myoepithelium, basal cytokeratin 5/6 (CK 5/6) in hyperplastic epithelium, smooth muscle actin (SMA) in myoepithelium and Ki-67 in nuclear were positive, but human epidermal growth factor receptor 2 (HER-2) and tumor suppressor gene (p53) were negative.

NA is easily misdiagnosed as nipple papillomatosis and Paget′s disease of the breast. Ultrasound examination is a helpful method for the assessment of NA. However in some cases, it is pretty difficult to make a correct diagnosis of NA just by ultrasound examination, pathological examination and immunohistochemistry should be used to confirm the diagnosis.