Mammary adenosis: Difference between revisions

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Latest revision as of 14:55, 8 September 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [3]

Synonyms and keywords: Adenofibrosis; Fibrosing adenosis; Adenosis tumor; Nodular adenosis; Sclerosing adenosis of breast; SA; Sclerosing adenosis

Overview

Sclerosing adenosis is a benign proliferative condition of the terminal duct lobular units characterized by an increased number of the acini and their glands. In women with mammary adenosis, multiple small, firm, tender lumps; fibrous tissue; and sometimes small cysts form in the breast. Mammary adenosis is a proliferative breast lesion in which various elements have become hardened, damaged, or otherwise distorted. Mammary adenosis is a lobular lesion with increased fibrous tissue and interspersed glandular cells.^[1]^[2]^[3]

Historical Perspective

The term "adenosis" means "increased in number", and "sclerosis" means "hardening".

Classification

Mammary adenosis may be classified into seven subtypes:
Adenomyoepithelial adenosis
Apocrine adenosis
Microglandular adenosis
Sclerosing adenosis
Simple adenosis
Tubular adenosis
Blunt duct adenosis

Pathophysiology

On microscopic histopathological analysis, slit-like, smaller acini that are in lobular arrangements and fibrosis which surround the acini are characteristic findings of mammary adenosis.
In mammary adenosis, enlarged acini become slightly distorted by surrounded stromal fibrosis. However, adenosis and sclerosing adenosis retain the lobular architecture, but it becomes exaggerated and distorted. Fibrosis can mimic a desmoplastic reaction.^[4]

Immunohistochemistry

Fibrosis is pink on H&E stain.

Associated Conditions

Mammary adenosis can be seen as a component of other proliferative lesions, such as:
Intraductal and/or sclerosing papilloma and complex sclerosing lesion, and can be present within fibroadenomas
Invasive and in situ cancers

Causes

There are no established causes for mammary adenosis.

Differentiating Mammary adenosis from other Diseases

Mammary adenosis must be differentiated from other diseases, such as:^[4]

Low-grade ductal carcinoma
Tubular adenoma of the breast
Adenomyoepithelioma

Epidemiology and Demographics

Mammary adenosis accounts for approximately 12% of breast biopsy specimens.

Age

Mammary adenosis is more commonly observed among patients aged 30-45 years. However, patients of all age groups may develop mammary adenosis.

Gender

Females are more commonly affected with mammary adenosis than males.

Race

There is no racial predilection for mammary adenosis.

Risk Factors

There are no established risk factors for mammary adenosis.

Natural History, Complications and Prognosis

The majority of patients with mammary adenosis remain asymptomatic.
Mammary adenosis increases the risk of subsequent breast cancer development, approximately 1.5 to 2 times the risk of women with no breast changes. This does not mean that the sclerosing lesion brings about increased risk; it means that the same genetic predispositions which have brought about the mammary adenosis, will also give a woman an increased predisposition towards possible breast carcinoma development. Mammary adenosis is not "pre-cancerous". However, malignant lesions can sometimes develop within them.^[1]

Diagnosis

Symptoms

Symptoms of mammary adenosis may include the following:

Recurring pain that tends to be linked to the menstrual cycle.

Physical Examination

Physical examination may be remarkable for:

Multiple small, firm, tender lumps.
Mammary adenosis is not palpable in approximately 80% of the cases, however in some cases, it might cause skin retraction.
A palpable lump may be felt and may be painful.

Laboratory Findings

There are no specific laboratory findings associated with mammary adenosis.

Imaging Findings

Ultrasound may be helpful in the diagnosis of mammary adenosis.
Mammography is the imaging modality of choice for mammary adenosis.
- On mammograms, mammary adenosis is characterized by bilateral appearance of mammary adenosis, and often with diffuse and scattered microcalcifications, asymmetric density with microcalcifications, a solitary cluster of microcalcifications, or as a non-calcified mass.
- On mammography, mammary adenosis may consist of architectural distortion, amorphous microcalcifications, or both. At times a mass lesion or asymmetrical density may be present. It can be therefore very difficult to mammographically distinguish from an infiltrating carcinoma.
- Mammary adenosis can appear as focal or diffuse.
When the rarer, unusual presentations occur, it is recommended to have the findings verified with a biopsy. When mammary adenosis presents as a mass it is referred to as either "adenosis tumor" or "nodular adenosis", although it is not a tumor and is not cancerous.^[1]

Ultrasound showing microcalcifications in mammary adenosis^[5]

Palpable abnormality of left breast on mammogram in mammary adenosis^[5]

Other Diagnostic Studies

Mammary adenosis may also be diagnosed using biopsy.
Findings on biopsy includes a proliferation of elongated, obliterated, or distorted glands and tubules, in addition to hardening of surrounding collagen and stromal tissue.
In majority of cases, mammary adenosis is detected during routine mammograms or following breast surgery. Usually, a biopsy is required to confirm the diagnosis, because the condition is otherwise difficult to distinguish from breast cancer.

Treatment

Women with mammary adenosis do not need treatment. Once a diagnosis has been confirmed as mammary adenosis, no further treatment is needed, even if the area of concern has not been surgically removed.

Prevention

There are no primary preventive measures available for mammary adenosis. However, patients with mammary adenosis might be watched closely as clinical research suggests that women with sclerosing adenosis may have approximately 1.5-2 times as high a risk of developing breast cancer.

References

↑ ^1.0 ^1.1 ^1.2 mammary adenosis. Radiopedia(2015) http://radiopaedia.org/articles/sclerosing-adenosis-of-the-breast Accessed on April 25, 2016
↑ Wang J, Costantino JP, Tan-Chiu E, Wickerham DL, Paik S, Wolmark N (2004). "Lower-category benign breast disease and the risk of invasive breast cancer". J Natl Cancer Inst. 96 (8): 616–20. PMID 15100339.
↑ Jensen RA, Page DL, Dupont WD, Rogers LW (1989). "Invasive breast cancer risk in women with sclerosing adenosis". Cancer. 64 (10): 1977–83. PMID 2804888.
↑ ^4.0 ^4.1 sclerosing adenosis. Libre pathology(2015) https://librepathology.org/w/index.php?title=Breast_pathology&redirect=no#Sclerosing_adenosis Accessed on April 26, 2016
↑ ^5.0 ^5.1 Image courtesy of Dr. Garth Kruger. Radiopaedia (original file [1]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC

Template:WS Template:WH

[radio-1] 1.0 ^1.1 ^1.2 mammary adenosis. Radiopedia(2015) http://radiopaedia.org/articles/sclerosing-adenosis-of-the-breast Accessed on April 25, 2016

[pmid15100339-2] Wang J, Costantino JP, Tan-Chiu E, Wickerham DL, Paik S, Wolmark N (2004). "Lower-category benign breast disease and the risk of invasive breast cancer". J Natl Cancer Inst. 96 (8): 616–20. PMID 15100339.

[pmid2804888-3] Jensen RA, Page DL, Dupont WD, Rogers LW (1989). "Invasive breast cancer risk in women with sclerosing adenosis". Cancer. 64 (10): 1977–83. PMID 2804888.

[librepathology-4] 4.0 ^4.1 sclerosing adenosis. Libre pathology(2015) https://librepathology.org/w/index.php?title=Breast_pathology&redirect=no#Sclerosing_adenosis Accessed on April 26, 2016

[radio1-5] 5.0 ^5.1 Image courtesy of Dr. Garth Kruger. Radiopaedia (original file [1]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC

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[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{SI}}
-{{CMG}} {{AE}} Your Name
+{{CMG}}; {{AE}} {{Simrat}}
+{{SK}} Adenofibrosis; Fibrosing adenosis; Adenosis tumor; Nodular adenosis; Sclerosing adenosis of breast; SA; Sclerosing adenosis
-{{SK}} Synonym 1; Synonym 2; Synonym 3
+==Overview==
+Sclerosing adenosis is a benign proliferative condition of the terminal duct lobular units characterized by an increased number of the [[acini]] and their glands.
+In women with mammary adenosis, multiple small, firm, tender lumps; fibrous tissue; and sometimes small cysts form in the breast. Mammary adenosis is a proliferative breast lesion in which various elements have become hardened, damaged, or otherwise distorted. Mammary adenosis is a lobular lesion with increased fibrous tissue and interspersed glandular cells.<ref name="radio">mammary adenosis. Radiopedia(2015) http://radiopaedia.org/articles/sclerosing-adenosis-of-the-breast Accessed on April 25, 2016</ref><ref name="pmid15100339">{{cite journal| author=Wang J, Costantino JP, Tan-Chiu E, Wickerham DL, Paik S, Wolmark N| title=Lower-category benign breast disease and the risk of invasive breast cancer. | journal=J Natl Cancer Inst | year= 2004 | volume= 96 | issue= 8 | pages= 616-20 | pmid=15100339 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15100339  }} </ref><ref name="pmid2804888">{{cite journal| author=Jensen RA, Page DL, Dupont WD, Rogers LW| title=Invasive breast cancer risk in women with sclerosing adenosis. | journal=Cancer | year= 1989 | volume= 64 | issue= 10 | pages= 1977-83 | pmid=2804888 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2804888  }} </ref>
-==Overview==
+==Historical Perspective==
+*The term "adenosis" means "increased in number", and "sclerosis" means "hardening".
+==Classification==
+*Mammary adenosis  may be classified into seven subtypes:
+*Adenomyoepithelial adenosis
+*Apocrine adenosis
+*Microglandular adenosis
+*[[Sclerosing adenosis of breast|Sclerosing adenosis]]
+*Simple adenosis
+*Tubular adenosis
+*Blunt duct adenosis
-==Historical Perspective==
-*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
-*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
-*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
-==Classification==
-*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
-:*[group1]
-:*[group2]
-:*[group3]
-*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
 ==Pathophysiology==
-*On microscopic histopathological analysis, slit-like, smaller acini that are in lobular arrangements and fibrosis which surround the acini are characteristic findings of mammary adenosis.
+*On microscopic histopathological analysis, slit-like, smaller [[acini]] that are in lobular arrangements and fibrosis which surround the acini are characteristic findings of mammary adenosis.
-*In mammary adenosis enlarged acini become slightly distorted by surrounded stromal fibrosis. However, adenosis and sclerosing adenosis retain the lobular architecture, but it becomes exaggerated and distorted. Fibrosis can mimic a desmoplastic reaction.
+*In mammary adenosis, enlarged [[acini]] become slightly distorted by surrounded stromal fibrosis. However, adenosis and sclerosing adenosis retain the lobular architecture, but it becomes exaggerated and distorted. Fibrosis can mimic a [[desmoplastic]] reaction.<ref name="librepathology">sclerosing adenosis. Libre pathology(2015) https://librepathology.org/w/index.php?title=Breast_pathology&redirect=no#Sclerosing_adenosis Accessed on April 26, 2016</ref>
 ===Immunohistochemistry===
 *Fibrosis is pink on H&E stain.
 ===Associated Conditions===
 *Mammary adenosis can be seen as a component of other proliferative lesions, such as:
 *Intraductal and/or sclerosing papilloma and complex sclerosing lesion, and can be present within fibroadenomas
 *Invasive and in situ cancers
 ==Causes==
-* [Disease name] may be caused by either [cause1], [cause2], or [cause3].
+*There are no established causes for mammary adenosis.
-* [Disease name] is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
-* There are no established causes for [disease name].
+==Differentiating Mammary adenosis from other Diseases==
+*Mammary adenosis must be differentiated from other diseases, such as:<ref name="librepathology">sclerosing adenosis. Libre pathology(2015) https://librepathology.org/w/index.php?title=Breast_pathology&redirect=no#Sclerosing_adenosis Accessed on April 26, 2016</ref>
-==Differentiating [disease name] from other Diseases==
-*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
+:*Low-grade [[ductal carcinoma]]
-:*[Differential dx1]
+:*[[Tubular adenoma]] of the breast
-:*[Differential dx2]
+:*Adenomyoepithelioma
-:*[Differential dx3]
 ==Epidemiology and Demographics==
-* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
+Mammary adenosis accounts for approximately 12% of breast biopsy specimens.
-* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
 ===Age===
-*Patients of all age groups may develop [disease name].
+*Mammary adenosis is more commonly observed among patients aged 30-45 years. However, patients of all age groups may develop mammary adenosis.
-*[Disease name] is more commonly observed among patients aged [age range] years old.
-*[Disease name] is more commonly observed among [elderly patients/young patients/children].
 ===Gender===
-*[Disease name] affects men and women equally.
+*Females are more commonly affected with mammary adenosis than males.
-*[Gender 1] are more commonly affected with [disease name] than [gender 2].
-* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
 ===Race===
-*There is no racial predilection for [disease name].
+*There is no racial predilection for mammary adenosis.
-*[Disease name] usually affects individuals of the [race 1] race.
-*[Race 2] individuals are less likely to develop [disease name].
 ==Risk Factors==
-*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
+*There are no established risk factors for mammary adenosis.
 == Natural History, Complications and Prognosis==
-*The majority of patients with [disease name] remain asymptomatic for [duration/years].
+*The majority of patients with mammary adenosis remain asymptomatic.
-*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
+*Mammary adenosis increases the risk of subsequent [[breast cancer]] development, approximately 1.5 to 2 times the risk of women with no breast changes. This does not mean that the sclerosing lesion brings about increased risk; it means that the same genetic predispositions which have brought about the mammary adenosis, will also give a woman an increased predisposition towards possible breast carcinoma development. Mammary adenosis is not "pre-cancerous". However, malignant lesions can sometimes develop within them.<ref name="radio">mammary adenosis. Radiopedia(2015) http://radiopaedia.org/articles/sclerosing-adenosis-of-the-breast Accessed on April 25, 2016</ref>
-*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
-*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
-*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
 == Diagnosis ==
-===Diagnostic Criteria===
-*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
-:*[criterion 1]
-:*[criterion 2]
-:*[criterion 3]
-:*[criterion 4]
 === Symptoms ===
-*[Disease name] is usually asymptomatic.
+*Symptoms of mammary adenosis may include the following:
-*Symptoms of [disease name] may include the following:
+:*Recurring [[pain]] that tends to be linked to the [[menstrual cycle]].
-:*[symptom 1]
-:*[symptom 2]
-:*[symptom 3]
-:*[symptom 4]
-:*[symptom 5]
-:*[symptom 6]
 === Physical Examination ===
-*Patients with [disease name] usually appear [general appearance].
 *Physical examination may be remarkable for:
-:*[finding 1]
+:*Multiple small, firm, tender lumps.
-:*[finding 2]
+:*Mammary adenosis is not palpable in approximately 80% of the cases, however in some cases, it might cause skin retraction.
-:*[finding 3]
+:*A palpable lump may be felt and may be painful.
-:*[finding 4]
-:*[finding 5]
-:*[finding 6]
 === Laboratory Findings ===
-*There are no specific laboratory findings associated with [disease name].
+*There are no specific laboratory findings associated with mammary adenosis.
-*A  [positive/negative] [test name] is diagnostic of [disease name].
-*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
-*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 ===Imaging Findings===
-*There are no [imaging study] findings associated with [disease name].
+*Ultrasound may be helpful in the diagnosis of mammary adenosis.
+*Mammography is the imaging modality of choice for mammary adenosis.
-*[Imaging study 1] is the imaging modality of choice for [disease name].
+**On mammograms, mammary adenosis is characterized by bilateral appearance of mammary adenosis, and often with diffuse and scattered microcalcifications, asymmetric density with microcalcifications, a solitary cluster of microcalcifications, or as a non-calcified mass.
-*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
+**On mammography, mammary adenosis may consist of architectural distortion, amorphous microcalcifications, or both. At times a mass lesion or asymmetrical density may be present. It can be therefore very difficult to mammographically distinguish from an infiltrating carcinoma.
-*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
+**Mammary adenosis can appear as focal or diffuse.
+*When the rarer, unusual presentations occur, it is recommended to have the findings verified with a biopsy. When mammary adenosis presents as a mass it is referred to as either "adenosis tumor" or "nodular adenosis", although it is not a tumor and is not cancerous.<ref name="radio">mammary adenosis. Radiopedia(2015) http://radiopaedia.org/articles/sclerosing-adenosis-of-the-breast Accessed on April 25, 2016</ref>
+[[File:Ultrasound.jpg|thumb|none|200px|Ultrasound showing microcalcifications in mammary adenosis<ref name="radio1">Image courtesy of Dr. Garth Kruger. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/sclerosing-adenosis]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>]]
+[[File:Mammo.jpg|thumb|none|200px|Palpable abnormality of left breast on mammogram in mammary adenosis<ref name="radio1">Image courtesy of Dr. Garth Kruger. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/sclerosing-adenosis]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC</ref>]]
 === Other Diagnostic Studies ===
-*[Disease name] may also be diagnosed using [diagnostic study name].
+*Mammary adenosis may also be diagnosed using biopsy.
-*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
+*Findings on biopsy includes a proliferation of elongated, obliterated, or distorted glands and tubules, in addition to hardening of surrounding collagen and stromal tissue.
+*In majority of cases, mammary adenosis is detected during routine mammograms or following breast surgery. Usually, a biopsy is required to confirm the diagnosis, because the condition is otherwise difficult to distinguish from breast cancer.
 == Treatment ==
-=== Medical Therapy ===
+Women with mammary adenosis do not need treatment. Once a diagnosis has been confirmed as mammary adenosis, no further treatment is needed, even if the area of concern has not been surgically removed.
-*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
-*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
-*[Medical therapy 1] acts by [mechanism of action1].
-*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
-=== Surgery ===
-*Surgery is the mainstay of therapy for [disease name].
-*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
-*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
 === Prevention ===
-*There are no primary preventive measures available for [disease name].
+*There are no primary preventive measures available for mammary adenosis. However, patients with mammary adenosis might be watched closely as clinical research suggests that women with sclerosing adenosis may have approximately 1.5-2 times as high a risk of developing breast cancer.
-*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
-*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
 ==References==
 {{Reflist|2}}
-[[Category:Pick One of 28 Approved]]
+[[Category:Oncology]]
+{{WS}}
+{{WH}}