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

Sclerosing adenosis is a benign proliferative condition of the terminal duct lobular units characterised by an increased number of the acini and their glands. In women with mammary adenosis, multiple small, firm, tender lumps; fibrous tissue; and sometimes small cysts form in the breast. Mammary adenosis is a proliferative breast lesion in which various elements have become hardened, damaged, or otherwise distorted. It is a lobular lesion with increased fibrous tissue and interspersed glandular cells.

Historical Perspective

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

Classification

• Mammary adenosis may be classified into seven subtypes:
• Adenomyoepithelial adenosis
• Apocrine adenosis
• Microglandular adenosis
• Sclerosing adenosis
• Simple adenosis
• Tubular adenosis
• Blunt duct adenosis

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.

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:

• 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. However, patients of all age groups may develop mammary adenosis.

Gender

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

Race

• There is no racial predilection for mammary adenosis.

Risk Factors

• There are no established risk factors for mammary adenosis.

Natural History, Complications and Prognosis

• The majority of patients with mammary adenosis remain asymptomatic.
• Mammary adenosis increases the risk of subsequent breast cancer development, approximately 1.5 to 2 times the risk of women with no breast changes. This does not mean that the sclerosing lesion brings about increased risk; it means that the same genetic predispositions which have brought about the mammary adenosis, will also give a woman an increased predisposition towards possible breast carcinoma development. Mammary adenosis is not ‘pre-cancerous’. However, malignant lesions can sometimes develop within them.

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 palpable lump may be felt and may be painful.

Laboratory Findings

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

Imaging Findings

• Ultrasound may be helpful in the diagnosis of mammary adenosis.
• 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.
• Mammary adenosis can appear as focal or diffuse.
• 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.

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

Women with mammary adenosis do not need treatment. Once a diagnosis has been confirmed as mammary adenosis, no further treatment is needed, even if the area of concern has not been surgically removed.

Prevention

• There are no primary preventive measures available for mammary adenosis. However, patients with mammary adenosis might be watched closely as clinical research suggests that women with sclerosing adenosis may have approximately 1.5-2 times as high a risk of developing breast cancer.