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Sclerosing adenosis of the breast: report of two cases and review of the literature.

Cucci E, Santoro A, Di Gesù C, Di Cerce R, Sallustio G - Pol J Radiol (2015)

Bottom Line: It is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be elucidated.It does not exhibit distinctive MG, US or even MRI features.Since it may mimic a carcinoma it requires further investigation with a diagnostic biopsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Catholic University of the Sacred Heart-Foundation for Research and Treatment "John Paul II", Campobasso, Italy.

ABSTRACT

Background: Sclerosing adenosis is a benign, usually asymptomatic lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast. It is commonly an incidental finding in perimenopausal women undergoing screening mammography.

Case report: We reported on two patients with sclerosing adenosis assessed with mammography, ultrasound, and contrast-enhanced magnetic resonance imaging. Case 1 was a 21-year-old woman with a palpable lesion in her right breast that was depicted as an irregular mass on contrast-enhanced magnetic resonance imaging. Case 2 was an asymptomatic 42-year-old woman with suspicious ultrasound findings in her left breast; contrast-enhanced magnetic resonance imaging showed regional non-mass-like enhancement associated with increased vascularity. Both patients underwent ultrasound-guided vacuum-assisted biopsy. Sclerosing adenosis does not have distinctive radiological features and can mimic a malignant growth process, thus requiring a diagnostic biopsy.

Conclusions: SA is a common, benign, generally asymptomatic proliferative lesion of the breast. It is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be elucidated. It does not exhibit distinctive MG, US or even MRI features. Since it may mimic a carcinoma it requires further investigation with a diagnostic biopsy.

No MeSH data available.


Related in: MedlinePlus

Radiological and histopathological features of case 1, right breast. (A) Right mediolateral oblique view: distortion of breast parenchyma between the upper quadrants showing inhomogeneous density and star-like appearance, but no radio-opaque nucleus. (B, C) Irregular mass between the upper quadrants exhibiting heterogeneous hyperintensity in sagittal T2-weighted images (FSE with fat saturation) (B) and hyperintensity on DW (Diffusion Weighted) sequences (b value 600 s/mm2) without diffusion restriction (C). (D) Irregular mass with spiculated margins showing rim enhancement and persistent enhancement in the sagittal subtraction images obtained before and after contrast medium administration. (E) Histopathological examination: fibrocystic breast tissue with a sclerosing adenosis lesion and columnar cell metaplasia/hyperplasia.
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f1-poljradiol-80-122: Radiological and histopathological features of case 1, right breast. (A) Right mediolateral oblique view: distortion of breast parenchyma between the upper quadrants showing inhomogeneous density and star-like appearance, but no radio-opaque nucleus. (B, C) Irregular mass between the upper quadrants exhibiting heterogeneous hyperintensity in sagittal T2-weighted images (FSE with fat saturation) (B) and hyperintensity on DW (Diffusion Weighted) sequences (b value 600 s/mm2) without diffusion restriction (C). (D) Irregular mass with spiculated margins showing rim enhancement and persistent enhancement in the sagittal subtraction images obtained before and after contrast medium administration. (E) Histopathological examination: fibrocystic breast tissue with a sclerosing adenosis lesion and columnar cell metaplasia/hyperplasia.

Mentions: A 21-year-old woman with a family history of breast carcinoma underwent lumpectomy for tubular adenoma (maximum lesion size, 30 mm) in her left breast in 2012. In October 2013, a self-examination revealed a nodule in the right breast. US scanning performed at another institution depicted a hypoechoic area with ill-defined margins between the upper quadrants of the right breast, whose maximum size was 40 mm (image not available). She underwent CE-MRI examination at our institution with a 1.5 T scanner (Signa Excite HD; GE Healthcare, Milwaukee, WI, USA) and a dedicated breast coil (GE 4-channel breast array coil). MRI examination disclosed an irregular mass with spiculated borders between the upper quadrants of the right breast, measuring 23 mm (antero-posterior diameter) ×20 mm (longitudinal diameter) ×23 mm (transverse diameter). The mass exhibited rim enhancement and predominant type II curves except for some SA foci which showed early washout (type III curve). The mass demonstrated intermediate intensity on T1-weighted images and inhomogeneous hyperintensity on T2-weighted images (FSE with fat saturation). Diffusion-weighted imaging (DWI) showed a hyperintense mass without diffusion restriction (Apparent Diffusion Coefficient [ADC] mass 1.53×10−3 mm2/s vs. ADC corpus mammae 1.45×10−3 mm2/s). MG examination showed a distortion of breast parenchyma with inhomogeneous density and star-like appearance, without a radio-opaque nucleus. The latter finding was best depicted in the mediolateral oblique view. Six tissue samples were collected in US-guided vacuum-assisted biopsy (Ethicon Endo-Surgery, Hamburg) using an 11-gauge needle. Histolopathological examination demonstrated fibrocystic breast tissue where an SA lesion was associated with columnar cell metaplasia/hyperplasia and subacute-chronic inflammation at both intra- and extraductal sites also involving histiocytes (Figure 1A–1E).


Sclerosing adenosis of the breast: report of two cases and review of the literature.

Cucci E, Santoro A, Di Gesù C, Di Cerce R, Sallustio G - Pol J Radiol (2015)

Radiological and histopathological features of case 1, right breast. (A) Right mediolateral oblique view: distortion of breast parenchyma between the upper quadrants showing inhomogeneous density and star-like appearance, but no radio-opaque nucleus. (B, C) Irregular mass between the upper quadrants exhibiting heterogeneous hyperintensity in sagittal T2-weighted images (FSE with fat saturation) (B) and hyperintensity on DW (Diffusion Weighted) sequences (b value 600 s/mm2) without diffusion restriction (C). (D) Irregular mass with spiculated margins showing rim enhancement and persistent enhancement in the sagittal subtraction images obtained before and after contrast medium administration. (E) Histopathological examination: fibrocystic breast tissue with a sclerosing adenosis lesion and columnar cell metaplasia/hyperplasia.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4356184&req=5

f1-poljradiol-80-122: Radiological and histopathological features of case 1, right breast. (A) Right mediolateral oblique view: distortion of breast parenchyma between the upper quadrants showing inhomogeneous density and star-like appearance, but no radio-opaque nucleus. (B, C) Irregular mass between the upper quadrants exhibiting heterogeneous hyperintensity in sagittal T2-weighted images (FSE with fat saturation) (B) and hyperintensity on DW (Diffusion Weighted) sequences (b value 600 s/mm2) without diffusion restriction (C). (D) Irregular mass with spiculated margins showing rim enhancement and persistent enhancement in the sagittal subtraction images obtained before and after contrast medium administration. (E) Histopathological examination: fibrocystic breast tissue with a sclerosing adenosis lesion and columnar cell metaplasia/hyperplasia.
Mentions: A 21-year-old woman with a family history of breast carcinoma underwent lumpectomy for tubular adenoma (maximum lesion size, 30 mm) in her left breast in 2012. In October 2013, a self-examination revealed a nodule in the right breast. US scanning performed at another institution depicted a hypoechoic area with ill-defined margins between the upper quadrants of the right breast, whose maximum size was 40 mm (image not available). She underwent CE-MRI examination at our institution with a 1.5 T scanner (Signa Excite HD; GE Healthcare, Milwaukee, WI, USA) and a dedicated breast coil (GE 4-channel breast array coil). MRI examination disclosed an irregular mass with spiculated borders between the upper quadrants of the right breast, measuring 23 mm (antero-posterior diameter) ×20 mm (longitudinal diameter) ×23 mm (transverse diameter). The mass exhibited rim enhancement and predominant type II curves except for some SA foci which showed early washout (type III curve). The mass demonstrated intermediate intensity on T1-weighted images and inhomogeneous hyperintensity on T2-weighted images (FSE with fat saturation). Diffusion-weighted imaging (DWI) showed a hyperintense mass without diffusion restriction (Apparent Diffusion Coefficient [ADC] mass 1.53×10−3 mm2/s vs. ADC corpus mammae 1.45×10−3 mm2/s). MG examination showed a distortion of breast parenchyma with inhomogeneous density and star-like appearance, without a radio-opaque nucleus. The latter finding was best depicted in the mediolateral oblique view. Six tissue samples were collected in US-guided vacuum-assisted biopsy (Ethicon Endo-Surgery, Hamburg) using an 11-gauge needle. Histolopathological examination demonstrated fibrocystic breast tissue where an SA lesion was associated with columnar cell metaplasia/hyperplasia and subacute-chronic inflammation at both intra- and extraductal sites also involving histiocytes (Figure 1A–1E).

Bottom Line: It is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be elucidated.It does not exhibit distinctive MG, US or even MRI features.Since it may mimic a carcinoma it requires further investigation with a diagnostic biopsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Catholic University of the Sacred Heart-Foundation for Research and Treatment "John Paul II", Campobasso, Italy.

ABSTRACT

Background: Sclerosing adenosis is a benign, usually asymptomatic lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast. It is commonly an incidental finding in perimenopausal women undergoing screening mammography.

Case report: We reported on two patients with sclerosing adenosis assessed with mammography, ultrasound, and contrast-enhanced magnetic resonance imaging. Case 1 was a 21-year-old woman with a palpable lesion in her right breast that was depicted as an irregular mass on contrast-enhanced magnetic resonance imaging. Case 2 was an asymptomatic 42-year-old woman with suspicious ultrasound findings in her left breast; contrast-enhanced magnetic resonance imaging showed regional non-mass-like enhancement associated with increased vascularity. Both patients underwent ultrasound-guided vacuum-assisted biopsy. Sclerosing adenosis does not have distinctive radiological features and can mimic a malignant growth process, thus requiring a diagnostic biopsy.

Conclusions: SA is a common, benign, generally asymptomatic proliferative lesion of the breast. It is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be elucidated. It does not exhibit distinctive MG, US or even MRI features. Since it may mimic a carcinoma it requires further investigation with a diagnostic biopsy.

No MeSH data available.


Related in: MedlinePlus