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 (SA) is a benign (non-cancerous) proliferative condition of the terminal duct lobular units characterised by an increased number of the acini and their glands. It is sometimes placed under the category of borderline breast disease.

In women with sclerosing adenosis, multiple small, firm, tender lumps (called nodules); fibrous tissue; and sometimes small cysts (i.e. sacs filled with fluid or semi-solid material) form in the breast.

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.

Historical Perspective

• [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
• In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

• Mammary adenoss may be classified into two groups:

• [group1]
• [group2]
• [group3]

• Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

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.

Gender

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

Race

• There is no racial predilection for mammary adenosis.

Risk Factors

• Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

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 lump may be felt and may be painful.

Laboratory Findings

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

Imaging Findings

• 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.
• 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

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].