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Swellings in the axilla especially in women are always viewed with suspicion owing to a large number of these being associated with breast carcinoma presenting as nodal metastasis. In a country like India, tuberculous lymphadenopathy is also amongst the first differentials. We present a case of a woman with left sided axillary swelling which on Fine Needle Aspiration Cytology (FNAC) turned out to be sclerosing adenosis of the accessory axillary breast. Accessory breasts may present as asymptomatic masses or cause symptoms such as pain or restriction of arm movements. Both benign and malignant tumors can arise in accessory breasts. So far cases of fibroadenoma and carcinoma breast have been reported but sclerosing adenosis has never been reported. Accessory breasts as mass in the axilla may prove to be a diagnostic challenge for surgeon. FNAC being an easy and accurate technique can be very helpful in differentiating such lesions.
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Objective To evaluate the value of M RI in the diagnosis of breast sclerosing adenosis.Methods 20 cases of breast sclerosing adenosis were analyzed retrospectively.MRI(T1WI,T2WI fat suppression),diffusion-weighted imaging(DWI)and dynamic contrast-enhanced scan were examined.The images were processed by ADW workstation.Apparent diffusion coefficient (ADC),time-signal intensity curve(TIC),maximum intensity projection(MIP)and plain MR features of the breast sclerosing adenosis were analyzed.Results All 20 cases showed iso-or low-intensity on T1WI and heterogeneous high-intensity on T2WI fat suppression.Among 20 cases,the ADC value were between(1.45-1.60)×10-3mm2/s in 12 cases,(1.25-1.45)×10-3mm2/s in 7 cases,(1.00-1.25)× 10-3mm2/s in 1 case.TIC curves were type Ⅰ in 18 cases,type Ⅱ in 2 cases and no case was type Ⅲ.Mass-like lesions were showed in 18 cases which displayed clearly on MIP image.Conclusion Combination of MRI,DWI,dynamic contrast-enhanced can greatly improve the diagnosis accuracy of breast sclerosing adenosis,to provide a reliable basis for clinical treatment.
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Sclerosing Adenosis (SA) is a lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast suggesting benignity. The disease has an increased incidence among reproductive-age and perimenopausal women, especially between 35 and 50 years of age. The clinical, radiological, and histopathological properties of sclerosing adenosis may resemble malignancy, which is the factor responsible for the clinical significance of the disease. Early diagnosis of sclerosing adenosis (SA) is very important as it is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be controversial and unclear. The main histopathological alterations of the terminal ductal lobular unit (TDLU) present as a widening and distortion of lobules with an increased number of acini and stromal fibrosis. The lesion is also called an “adenosis tumor of the breast” or “nodular sclerosing adenosis” if it presents as a palpable mass. Sclerosing adenosis is present in 12% of benign proliferative lesions and 20-25% of malignant lesions on histopathological examination. On mammography (MG), it can present as opacity, focal asymmetry, architectural distortion, or micro calcifications, mimicking a carcinoma. We have presented a case of 42 year old female who was diagnosed as carcinoma breast clinically and on radiology. Mammography showed a fibrosed lesion of size 4.5x3 cm with focal specks of microcalcification and irregular borders. But repeated fine needle aspiration cytology (FNAC) smears revealed small and large clusters of ductal epithelial cells with minimal anisonucleosis with background showing amorphous crystalline material and stromal fragments. Basing on FNAC, plan of surgery changed and a wide local excision with 2 cm normal margins was done and the specimen sent for histopathological examination (HPE), which revealed the lesion as sclerosing adenosis (SA).
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Objective To analyze the clinical and X-ray manifestations of sclerosing adenosis of the breast,and to evaluate the val-ue of preoperative differential diagnosis between the sclerosing adenosis and the breast cancer combined with pathology.Methods X-ray manifestations and clinical features of 25 patients with the sclerosing adenosis of the breast confirm by surgical pathology were analyzed retrospectively.Then the X-ray manifestations and clinical features were compared with the pathological results.Results Total 25 patients suffered from the sclerosing adenosis of the breast.Among them,2 cases were bilateral sclerosing adenosis,23 ca-ses were unilateral sclerosing adenosis,6 cases with epithelial atypical hyperplasia,4 cases with intraductal papilloma,7 cases with fibroadenoma nodule formation,and the rest with the pure sclerosing adenosis.X-ray manifestations:7 cases presented the medium density nodular shadows with blurred and irregular edges,1 6 cases showed the star-shaped shadows of which 6 cases were the“black stars”,3 cases of“white stars”.One in 7 cases can only see a star shadow,another was unclear or the form was varied.1 3 patients showed the calcification among 4 cases presented the small clusters of distribution with needlepoint-like calcification,2 cases of bulky curved calcification,and the rest with scattered and regional distribution of dot,needlepoint-like calcification.Conclusion Combined with clinical manifestations,the breast X-ray plays an important role in the differential diagnosis of sclerosing adenosis and the breast cancer.
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Objetivo: revisar las bases histológicas y los criterios diagnósticos diferenciales de la aplicación de la inmunohistoquímica en la patología mamaria. Caso clínico : se presenta el caso de una paciente con lesión mamaria esclerosante compleja, tipo adenosis microglandular (MGA), que requirió el uso de inmunohistoquímica como técnica auxiliar para diferenciar la lesión de un adenocarcinoma de mama in situ, y definir así el tratamiento. Materiales y métodos: se realizó una búsqueda de la información en las bases de datos Medline vía PubMed, SciELO y en libros de la especialidad. Se reportaron 25 títulos, 12 correspondían con el tema: 4 reportes de caso, 1 con revisión de la literatura, una carta al editor y 7 artículos relacionados de forma más general con el tema. Conclusión: la inmunohistoquímica permite hacer el diagnóstico diferencial de las lesiones mamarias complejas, como la adenosis esclerosante y el cáncer de mama in situ o microinvasor.
Objective: reviewing the histological basis and differential diagnostic criteria for applying immunohistochemistry in breast pathology. Clinical case: the case of a patient suffering from complex sclerosing lesion (CSL) of the breast, microglandular adenosis (MGA) pattern is presented; she required immunohistochemistry as an auxiliary technique for differentiating an adenocarcinoma-related breast lesion in situ and thus defining its treatment. Materials and methods: a search was made of the pertinent information in Medline databases via PubMed, SciELO and in books on the specialty; 25 titles were reported, 12 of them corresponding to the immediate topic: 4 were case reports with a literature review and one was a letter to the editor. 7 articles dealt with the topic in a more general way. Conclusion: immunohistochemistry led to the differential diagnosis of complex breast lesions such as sclerosing adenosis, and in situ or microinvase breast cancer.
Subject(s)
Adult , Female , Breast , PathologyABSTRACT
Objective To improve the knowledge of mammographic signs of sclerosing adenosis.Methods The X-ray and pathological features of sclerosing adenosis of 17 focuses in 15 cases proved by histology were reviewed in comparison with that of breast cancer.The study was put emphasis upon the difference between sclerosing adenosis and breast cancer on clinic and radiographs.Results On mammography,the lesions appeared as asymmetric and disseminated density in 5/17(29.4%),dense nodules in 10/17(58.8%),calcifications inside the lesions in 3 and focal architectural disorder combined with stellate constriction in 2/17(11.8%).Conclusion The sclerosing adenosis is easily confused with breast carcinoma on radiographic signs,the diagnosis would be combined with clinical history and palpation examination.
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The initial presentation of breast malignancy as noninvasive carcinoma in an area of sclerosing adenosis is unusual. Especially, lobular carcinoma in situ in sclerosing adenosis sometimes can be a potential source of confusion with invasive lobular carcinoma. We report a case of lobular carcinoma in situ presenting in adenosis exhibiting patterns akin to invasive lobular carcinoma, thus leading to potential misdiagnosis. Overall architecture of the lesion as seen at lower power and immunohistochemistry can be useful to distinguish between sclerosing adenosis with lobular carcinoma in situ and infiltrating lobular carcinoma.