sklerosierende Adenose der Mamma

Mimickers of
breast malignancy: imaging findings, pathologic concordance and clinical management. Sclerosing adenosis. A 35-year-old woman presented with a palpable breast mass. Mediolateral, craniocaudal, and spot tangential mammographic views do not reveal an abnormality (a–c, respectively). Grayscale and color Doppler ultrasound images (d, e) reveal a vascular, mixed cystic, and solid mass correlating with the area of palpable abnormality. Core needle biopsy showed sclerosing adenosis in a background of dense fibrosis without atypia or carcinoma. A 6-month follow-up ultrasound was rcommended and demonstrated stability
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Sclerosing adenosis (SA) is a benign proliferative condition of the terminal duct lobular units characterized by an increased number of acini and their glands. It manifests as multiple small, firm, tender nodules, fibrous tissue, and variable microcysts within the breast. It is sometimes placed under the category of borderline breast disease.

Clinical presentation

Many women with sclerosing adenosis experience recurring pain that tends to be linked to the menstrual cycle.

In most cases, sclerosing adenosis is detected during routine mammograms or following breast surgery. A biopsy is required to confirm the diagnosis, because the condition may be difficult to distinguish from breast cancer by imaging.

Sclerosing adenosis can appear as a focal or diffuse lesion. It is not physically palpable in 80% of the cases, although in some cases may cause skin retraction.

Pathology

Sclerosing adenosis is a type of adenosis in which enlarged acini become slightly distorted by surrounded stromal fibrosis ("sclerosis"). The normal lobular architecture of the breast is maintained but becomes exaggerated and distorted.

Associations

Sclerosing adenosis can be seen as a component of other proliferative lesions:

Radiographic features

Mammography

Sclerosing adenosis has a wide range of mammographic presentations, and can be difficult to distinguish from an infiltrating carcinoma:

  • mass, with irregular to well-defined contours
  • architectural distortion
  • microcalcifications
    • present in 40-55% of cases
    • may be amorphous, pleomorphic, or punctate
    • more commonly clustered, although may present in diffuse scattered distribution

Treatment and prognosis

Although not considered a pre-malignant lesion, sclerosing adenosis is considered an independent risk factor for the development of subsequent breast cancer . Studies suggest that women with sclerosing adenosis may have approximately 1.5-2 times as high a risk of developing breast cancer.

Siehe auch:
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Assoziationen und Differentialdiagnosen zu sklerosierende Adenose der Mamma:
Mammakarzinom
 
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Fibroadenom
 
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