Coexistence of sclerosing polycystic adenosis and dysgenetic polycystic disease of parotid, Report of a case

Sclerosing polycystic adenosis (SPA) is a rare benign salivary gland lesion. Dysgenetic polycystic disease (DPD), which is a histologically similar lesion, may cause a lattice-like gross appearance with bilateral enlargement of the entire salivary glands. In this report, we present a case of SPA in the right parotid and coexistent DPD involving the both parotid.

Sclerosing polycystic adenosis: A case report with review of the literature

Sclerosing polycystic adenosis (SPA) is primarily a disease of major salivary glands. It was recognized as a distinct morphologic entity by Smith et al. in 1996. To best of our knowledge, 67 cases of SPA are reported in English literature. Here, we describe a case of SPA showing classic histomorphological features, involving the parotid gland of a 17-year-old girl. It was diagnosed as mucoepidermoid carcinoma at a peripheral hospital and was referred to our center. Histologically, it was well circumscribed and composed of lobules, separated by hyalinized stroma. Lobules showed adenosis, foci of acinic cell hyperplasia, and intraductal epithelial proliferation. Immunohistochemistry with p63 highlighted myoepithelial layer around every duct, acinus, and also in foci showing epithelial hyperplasia. There was no evidence of malignancy. Awareness of SPA, a benign rare entity, is essential to avoid misdiagnosing it as other common salivary gland tumors which it may mimic.

Sclerosing Adenosis in Axillary Supernumerary Breast: A Case Report

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.

The diagnostic value of dynamic contrast enhanced magnetic resonance imaging and diffusion weightedimaging in differential diagnosis between adenosis of the breast and breast cancer / 实用放射学杂志

Objective To evaluate the differential diagnostic value of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI) and diffusion weighted imaging(DWI) in adenosis of the breast and breast cancer.Methods 30 cases of adenosis and 45 cases of breast cancer with pathological verification were scanned with DCE-MRI and DWI.The MRI features of the lesions were analyzed, including shape,margin,T2WI singal, features of enhancement, time intensity curve(TIC) type, early enhancement rate(EER),peak time, background enhancement and ADC value.Results The irregular margin with or without spiculation and the heterogeneous enhancement were mostly seen in breast cancer (P=0.002,P=0.009, respectively).The TIC type Ⅲ, EER larger than 100% and peak time within 2 minutes were mostly seen in breast cancer(P0.05).Conclusion DCE-MRI combined with DWI will be helpful to the diagnosis of breast lesions.

Comparison of ultrasonic manifestations among triple-negative breast cancer and BI-RADS 4A atypical fibroadenoma or adenosis / 中国医学影像技术

Objective To compare ultrasonic manifestations of triple-negative breast cancer (TNBC),BI-RADS category 4A atypical fibroadenoma and adenosis.Methods Ultrasonic findings of TNBC group (n=42),BI-RADS 4A atypical fibroadenoma group (n=34) and adenosis group (n =36) were analyzed retrospectively,and statistical analysis was performed.Results There were statistically significant differences of age,tumor size,shape,echo,margin and BI-RADS category between TNBC group and fibroadenoma group (all P＜0.016 7).There were statistically significant differences (all P＜0.016 7) of age,size,margin,peripheral duct changes,and BI-RADS category between TNBC group and adenosis group.There were statistically significant differences of shape between fibroadenoma group and adenosis group (P＜0.016 7).There was no statistically significant difference of boundary,halo,posterior acoustic features,orientation,nor calcification among three groups (all P＞0.05).Conclusion TNBC often occurs in women older than 50 years old,and the lesions usually demonstrate larger than 2 cm,very lower echo,and irregular shape with distinct margin.TNBC is usually associated with harder elastography feature,and is classified as more than BI-RADS 4B.Fibroadenoma classified as BI-RADS 4A is most likely to be a mass with lobulated or irregular shape with distinct margin.Adenosis classified as BI-RADS 4A often appears irregular and vertical orientation,which may be confused with breast cancer.

Clinical value of MRI in the diagnosis of breast sclerosing adenosis / 实用放射学杂志

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.

Mammary Carcinoma Arising in Microglandular Adenosis: A Report of Five Cases

Mammary carcinoma arising in microglandular adenosis (MGA) is extremely rare, and MGA is regarded as a non-obligate precursor of triple-negative breast cancer. We report five cases of carcinoma arising in MGA of the breast. All cases showed a spectrum of proliferative lesions ranging from MGA to atypical MGA, ductal carcinoma in situ or invasive carcinoma. Immunohistochemically, all cases were triple-negative and expression of S-100 protein gradually decreased as the lesions progressed from MGA to atypical MGA and carcinoma. Three cases showed acinic cell differentiation with reactivity to α1-antitrypsin, and one case was metaplastic carcinoma. During clinical follow-up, one patient developed local recurrence. Carcinoma arising in MGA is a rare but distinct subset of triple-negative breast cancer with characteristic histologic and immunohistochemical findings.

Sclerosing adenosis clinically feigning as carcinoma breast: A case report.

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).

Magnetic Resonance Imaging Features of Adenosis in the Breast / 한국유방암학회지

PURPOSE: Adenosis lesions of the breast, including sclerosing adenosis and adenosis tumors, are a group of benign proliferative disorders that may mimic the features of malignancy on imaging. In this study, we aim to describe the features of breast adenosis lesions with suspicious or borderline findings on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS: In our database, we identified 49 pathologically proven breast adenosis lesions for which the final assessment of the breast MRI report was classified as either category 4 (n=45) or category 5 (n=4), according to the Breast Imaging Reporting and Data System (BI-RADS) published by the American College of Radiology (ACR). The lesions had a final diagnosis of either pure adenosis (n=33, 67.3%) or mixed adenosis associated with other benign pathologies (n=16, 32.7%). RESULTS: Of the 49 adenosis lesions detected on DCE-MRI, 32 (65.3%) appeared as enhancing masses, 16 (32.7%) as nonmass enhancements, and one (2.1%) as a tiny enhancing focus. Analysis of the enhancing masses based on the ACR BI-RADS lexicon revealed that among the mass descriptors, the most common features were irregular shape in 12 (37.5%), noncircumscribed margin in 20 (62.5%), heterogeneous internal pattern in 16 (50.0%), rapid initial enhancement in 32 (100.0%), and wash-out delayed en-hancement pattern in 21 (65.6%). Of the 16 nonmass enhancing lesions, the most common descriptors included focal distribution in seven (43.8%), segmental distribution in six (37.5%), clumped internal pattern in nine (56.3%), rapid initial enhancement in 16 (100.0%), and wash-out delayed enhancement pattern in eight (50.0%). CONCLUSION: Adenosis lesions of the breast may appear suspicious on breast MRI. Awareness of these suspi-cious-appearing features would be helpful in obviating unnecessary breast biopsies.

X-ray diagnosis and clinically pathological analysis with sclerosing adenosis of the breast / 实用放射学杂志

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.

A Case of Sclerosing Polycystic Adenosis of Parotid Gland / 대한이비인후과학회지

Sclerosing polycyctic adenosis (SPA) is a rare lesion of unknown etiology morphologically resembling fibrocystic changes of the breast. To our knowledge, 53 cases of SPA have been reported in the literature to date. SPA is well circumscribed, yet not encapsulated. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important in making the correct diagnosis. The differential diagnosis of SPA includes polycystic disease, sclerosing sialadenitis and benign/malignant glandular neoplasias. Although atypia ranging from mild dysplasia to carcinoma in situ can occur in some cases, SPA has a favorable outcome. In this article, we describe a 38-year-old male patient diagnosed with SPA in the parotid gland.

Sclerosing polycystic adenosis of salivary gland:a clinicopathologic analysis of 2 cases and review of literature / 中国基层医药

Objective To investigate the clinicopathologic features of sclerosing polycystic adenosis(SPA)of salivary gland.Methods The clinical and pathologic profiles of 2 SPA cases were evaluated.Immunohistochemical study was performed on fixed tissues.The biologic behavior was analyzed with follow-up data.Results The main clinical manifestation of patients was parotid painless nodules.Histological features were embedded cystic dilatation of ducts and alveoli as hyaline sclerosis collagen tissue background,catheter see apocrine metaplasia,focal areas of ductal epithelial hyperplasia and dysplasia.Immunohistochemical staining for calponin and SMA staining showed that the catheter had a layer of myoepithelial cells.Conclusion Sclerosing polycystic sialadenopathy of parotid is a rare disease,the cause and course of the disease are not very clear,but the literature reports are atypical ductal epithelial remarkable phenomenon,thus strengthen the follow-up to patients.

Inmunohistoquímica en patología de mama: diferenciación de lesiones complejas benignas y malignas de mama: un reporte de caso y revisión de la literatura / Immunohistochemistry in breast pathology: differentiating complex benign and malign breast lesions: a case report and literature review

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.

Microglandular Adenosis / 한국유방암학회지

Microglandular adenosis (MGA) of the breast is a very rare and benign proliferative lesion. Most patients complain of a palpable breast mass that may arouse a clinical suspicion of breast cancer. Histopathologically, it is hard to distinguish MGA from breast cancer because of the lack of a myoepithelial layer and infiltrative proliferation. Several studies have reported a strong relationship between MGA and carcinoma arising in MGA, so the mass should be excised completely in cases of MGA determined from a core needle biopsy rather than observation. A 72-years-old woman presented with a palpable breast mass. On physical examination, a mass was palpable in the right upper outer quadrant area and somewhat fixed to the surrounding tissues and pectoralis major muscle. We could not detect any mass or dense lesion on mammography because of a grade 4 dense breast. Ultrasonographic findings revealed a low echoic lesion with indistinct margins. The result of a core needle biopsy was MGA, which was confirmed by excision. We report one case of MGA, which was believed to breast cancer clinically.

A Case of Vaginal Adenosis / 대한피부과학회지

The mucosa of vagina in normal women is lined with thick nonkeratinizing squamous epithelium. The vaginal adenosis is defined as the abnormal presence of glandular epithelium or columnar epithelium with secretary product in the vagina. The incidence of vaginal adenosis was highly increased when diethylstilbestrol(DES) was in wide use by the mid 1940s. A 44-year-old woman without the previous intrauterine DES-exposure visited our clinic with pain on external genital area and erosive red erythematous patch on the vagina. Histopathologically, the multiple glands consisted of the columnar epithelium existed in the lamina propria of vaginal mucosa. And the lining cells resembled those cells of the fallopian tube and endometrium, namely mucinous columnar cells. We report a case of vaginal adenosis in a 44-year-old woman.

Sclerosing Adenosis:Radiographic Diagnosis and Pathology / 实用放射学杂志

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.

Lobular carcinoma in situ in sclerosing adenosis

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.

Adenomyoepithelioma of the breast: its diagnostic problems and histogenesis

We report three cases of adenomyoepithelioma of the breast that occurred in middle aged women. The tumor is characterized by a balanced proliferation of epithelial tubules and surrounding myoepithelial cells that are spindle shaped or have clear cytoplasms. The first case mimicked tubular adenoma in the initial biopsy. However, on excision it turned out to be an adenomyoepithelioma of the tubular. The other two cases were lobulated types and had fibroadenomatous areas. The morphologic appearance of this tumor varies, making it misleading to other benign or even malignant lesions. The tumor has a potential for local recurrence, therefore, wide excision is recommended for proper diagnosis and treatment.

Adenosis Deaminase (ADA) activity in tuberculous and in carcinomatous lungs.

Determination of ADA activity in BALF was carried out in 12 patients with active pulmonary tuberculosis, 12 patients with bronchogenic carcinoma and 11 healthy volunteers. Pertinent findings were: (1) ADA activity increased significantly only in tuberculous lungs; and (2) ADA activity in diseased lungs was significantly higher than in apparently non-diseased lungs. The latter findings may reflect the difference in local cellular activity and proliferation rate between the diseased and non-diseased lungs.

Benign proliferative disorders of the breast

Fibrocystic disease of the breast has been generally regarded as a disorder due to either excess hormonal stimulation or an exaggerated proliferative response by hypersensitive breast epithelium. The unique lobular lesion-adenosis- and its variants have been regarded as non-neoplastic and non-preneoplastic glandular hypertrophy and hyperplasia, and have different organoid patterns and origins. We have examined a total of 242 cases previously diagnosed as 'fibrocystic disease' at the Department of Pathology with the purpose of clarifying the variants of adenosis in detail and refining the infinitely large 'fibrocystic disease' classification as non-proliferative fibrocystic change and proliferative disorders, such as epitheliosis and atypical hyperplasia. In this study, 224 cases (92.5%) were nonproliferative disease, mostly adenosis (40.1%), and 18 cases (7.5%) were proliferative disease, which consisted of moderate to florid hyperplasia and epitheliosis.