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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 2, left breast. (A) Regional clumped non-mass-like enhancement in the superomedial quadrant in the subtraction image obtained before and after contrast medium administration. (B) Only a few microcysts are depicted at the site of the non-mass-like enhancement in the sagittal T2-weighted image (FSE with fat saturation). (C) At the same site, DW (Diffusion Weighted) sequences (b value 600 s/mm2) show an area of inhomogeneous hyperintensity with diffusion restriction. (D) MIP (maximum intensity projection) image showing non-mass-like enhancement associated with asymmetrically increased vascularity. (E) Histopathology: complex sclerosing adenosis lesion associated with usual ductal hyperplasia (UDH) and florid UDH.
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f2-poljradiol-80-122: Radiological and histopathological features of case 2, left breast. (A) Regional clumped non-mass-like enhancement in the superomedial quadrant in the subtraction image obtained before and after contrast medium administration. (B) Only a few microcysts are depicted at the site of the non-mass-like enhancement in the sagittal T2-weighted image (FSE with fat saturation). (C) At the same site, DW (Diffusion Weighted) sequences (b value 600 s/mm2) show an area of inhomogeneous hyperintensity with diffusion restriction. (D) MIP (maximum intensity projection) image showing non-mass-like enhancement associated with asymmetrically increased vascularity. (E) Histopathology: complex sclerosing adenosis lesion associated with usual ductal hyperplasia (UDH) and florid UDH.

Mentions: In December 2013, a 42-year-old woman with a family history of breast carcinoma underwent CE-MRI at our institution to investigate an asymptomatic non-nodular hypoechoic area associated with some microcysts found by US in the superomedial quadrant of the left breast (image not available) while MG performed at the same time was negative. CE-MRI examination showed regional clumped non-mass-like enhancement in the superomedial quadrant of the breast (maximum axial diameters, 4×16 mm, longitudinal diameter, 18 mm) and time-signal intensity curves type I and II. On T2-weighted images (FSE with fat saturation), only some microcysts whose maximum size was 5 mm could be visualized at the site of the non-mass-like enhancement, whereas DW sequences showed slight diffusion restriction (ADC lesion 1.32×10−3 mm2/s vs. ADC corpus mammae 1.78×10−3 mm2/s). Asymmetrically increased vascularity was also noted in the same area. Histolopathological examination of 6 tissue samples collected in US-guided vacuum-assisted biopsy (Ethicon Endo-Surgery) using an 11-gauge needle at our institution demonstrated a complex SA lesion associated with epithelial proliferation that was reminiscent of usual ductal hyperplasia (UDH) including florid and papillary aspects as well as columnar cell metaplasia/hyperplasia with evidence of flat epithelial atypia (Figure 2A–2E).


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 2, left breast. (A) Regional clumped non-mass-like enhancement in the superomedial quadrant in the subtraction image obtained before and after contrast medium administration. (B) Only a few microcysts are depicted at the site of the non-mass-like enhancement in the sagittal T2-weighted image (FSE with fat saturation). (C) At the same site, DW (Diffusion Weighted) sequences (b value 600 s/mm2) show an area of inhomogeneous hyperintensity with diffusion restriction. (D) MIP (maximum intensity projection) image showing non-mass-like enhancement associated with asymmetrically increased vascularity. (E) Histopathology: complex sclerosing adenosis lesion associated with usual ductal hyperplasia (UDH) and florid UDH.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4356184&req=5

f2-poljradiol-80-122: Radiological and histopathological features of case 2, left breast. (A) Regional clumped non-mass-like enhancement in the superomedial quadrant in the subtraction image obtained before and after contrast medium administration. (B) Only a few microcysts are depicted at the site of the non-mass-like enhancement in the sagittal T2-weighted image (FSE with fat saturation). (C) At the same site, DW (Diffusion Weighted) sequences (b value 600 s/mm2) show an area of inhomogeneous hyperintensity with diffusion restriction. (D) MIP (maximum intensity projection) image showing non-mass-like enhancement associated with asymmetrically increased vascularity. (E) Histopathology: complex sclerosing adenosis lesion associated with usual ductal hyperplasia (UDH) and florid UDH.
Mentions: In December 2013, a 42-year-old woman with a family history of breast carcinoma underwent CE-MRI at our institution to investigate an asymptomatic non-nodular hypoechoic area associated with some microcysts found by US in the superomedial quadrant of the left breast (image not available) while MG performed at the same time was negative. CE-MRI examination showed regional clumped non-mass-like enhancement in the superomedial quadrant of the breast (maximum axial diameters, 4×16 mm, longitudinal diameter, 18 mm) and time-signal intensity curves type I and II. On T2-weighted images (FSE with fat saturation), only some microcysts whose maximum size was 5 mm could be visualized at the site of the non-mass-like enhancement, whereas DW sequences showed slight diffusion restriction (ADC lesion 1.32×10−3 mm2/s vs. ADC corpus mammae 1.78×10−3 mm2/s). Asymmetrically increased vascularity was also noted in the same area. Histolopathological examination of 6 tissue samples collected in US-guided vacuum-assisted biopsy (Ethicon Endo-Surgery) using an 11-gauge needle at our institution demonstrated a complex SA lesion associated with epithelial proliferation that was reminiscent of usual ductal hyperplasia (UDH) including florid and papillary aspects as well as columnar cell metaplasia/hyperplasia with evidence of flat epithelial atypia (Figure 2A–2E).

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