Mammary adenosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

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

Overview

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

  • Mammary adenoss may be classified into two 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.
  • 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.[1]

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].
  • [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:[1]
  • 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.

Gender

  • Females are more commonly affected with mammary adenosis than males.

Race

  • There is no racial predilection for mammary adenosis.

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].

Natural History, Complications and Prognosis

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • 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

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 lump may be felt and may be painful.

Laboratory Findings

  • There are no specific laboratory findings associated with mammary adenosis.

Imaging Findings

  • 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.
  • 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.[2]

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

Medical Therapy

  • 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].
  • 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

  1. 1.0 1.1 sclerosing adenosis. Libre pathology(2015) https://librepathology.org/w/index.php?title=Breast_pathology&redirect=no#Sclerosing_adenosis Accessed on April 26, 2016
  2. mammary adenosis. Radiopedia(2015) http://radiopaedia.org/articles/sclerosing-adenosis-of-the-breast Accessed on April 25, 2016