Sclerosing Adenosis

Sclerosing adenosis refers to a proliferative breast lesion in which various elements have become hardened, damaged, or otherwise distorted. Sclerosing adenosis is considered to be a benign lesion, but can sometimes confused with tubular carcinoma, particularly if some lobular neoplasia is evident. A sclerosing adenosis lesion may be completely asymptomatic, or may present as a palpable mass in a clinical exam.

Dr. Halls Dr. Halls
When a biopsy result shows sclerosing adenosis, it’s good news.


Talking Moose
Talking Moose
Especially when you were worrying at first about cancer.


Brittany Brittany
It’s not cancer.



 
 

Sclerosis means ‘hardening’

‘Adenosis’ means ‘increased in number’, and ‘sclerosis’ means ‘hardening‘.

Hector Hector
Is anyone going to make a ‘hardening’ joke? Anyone?



 
 

Histologically, (examined after biopsy) sclerosing adenosis often presents as a proliferation of elongated, obliterated, or distorted glands and tubules, in addition to hardening of surrounding collagen and stroma tissue. The condition is sometimes called fibrosing adenosis, or adenofibrosis, and tends to arise from problems with the terminal duct lobular unit. (TDLU)

Here is a picture of sclerosing adenosis of the breast. Histopathology.
breast sclerosing adenosis

On a mammogram, sclerosing adenosis is rather variable in its presentation. It usually appears bilaterally, and often with diffuse and scattered microcalcifications. It can also present as an asymmetric density with microcalcifications, a solitary cluster of microcalcifications, or as a non-calcified mass. When these rarer, unusual presentations occur, it is best to have the findings verified with a biopsy. When it presents as a mass it is referred to as either ‘nodular adenosis’ or ‘adenosis tumor’, but it is not a tumor and is not cancerous.

Sclerosing adenosis is common,and does not increase risk of developing breast cancer.

Sclerosing adenosis occurs most frequently with women between the ages of 30 and 45. It is quite common, accounting for about 12% of breast biopsy specimens. The development of sclerosing adenosis has no direct link to breast carcinoma. It is not ‘pre-cancerous’. However, as is the case with many common benign breast abnormalities, malignant lesions can sometimes develop within them.

breast sclerosing adenosis

Dr. Halls Dr. Halls
Wow. that mammogram image showing the starburst shape and all those punctate microcalcifications, would worry me into recommending a biopsy.


Talking Moose
Talking Moose
So even if you have an inkling it might be sclerosing adenosis, you kindof have to biopsy it.



 
 

A woman with sclerosing adenosis may be at increased risk of developing breast cancer in the future

Over the long term, it is thought that sclerosing adenosis increases the risk of subsequent breast cancer development approximately two times. But to clarify, this does not mean that the sclerosing lesion brings about increased risk. What it means, is that the same genetic predispositions which have brought about the sclerosing adenosis, will also give a woman an increased predisposition towards possible breast carcinoma development.

 

We have room to take a few questions here.

  • What is nodular sclerosing adenosis? It’s just ordinary, but in a rounded shape that looks like a nodule.
  • What does it feel like? It feels hard, and so you worry it is a lump or nodule.
  • How to treat it? It doesn’t need treatment per-se, but often the pathology report adds more scary words, and people sometimes just want the whole thing surgically removed to stop worrying about it. That’s treatment by excisional biopsy.
  • What causes the calcifications in sclerosing adenosis? The same guesses apply here. Nobody can say exactly, but I think the fibrosis just traps some debris from dying cells, and that stuff slowly turns hard and calcifies.
  • Should I get an ultrasound? Usually yes, because if ultrasound can find a target to biopsy, it’s the easiest, quickest, more painless way to get a biopsy done.
  • How is sclerosing adenosis different vs radial scar? Radial scar is a ‘duct’-related thing, and adenosis is more ‘lobule’-related. But they look VERY SIMILAR on mammograms.

 

References

  1. Jacobs, Timothy. Selected Challenging Breast cases for the practicing Pathologist. Dept. of Pathology, Virginia Mason Medical Center, Seattle. WA. Sept. 2008.
  2. Kinko, Z., Michal, M., Anogenital mammary type sclerosing adenosis–two case reports and the review of literature. Ceska Gynekologie.2004; 69(4):292-7.
  3. Kornguth, P. Bentley, R. Mammographic-Pathologic Correlation: Part 1. Benign Breast Lesions. Journal of Women’s Imaging:Volume 3(1)February 2001pp 29-37
  4. Tavassoli FA: Pathology of the Breast. Second edition. Stamford, CT: Appleton &Lange, 1999.
  5. Krieger N, Hiatt RA. Risk of breast cancer after benign breast diseases: variation by histologic type, degree of atypia, age at biopsy, and length of follow-up. Am J Epidemiol 1992;135:619-631.

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