Adenosis: Description, Causes and Risk Factors:A rarely used term for a more or less generalized glandular disease.In adenosis, the breast lobules are enlarged, and they contain more glands than usual. Adenosis is often found in biopsies of women with fibrocystic changes. There are many names for this condition, including aggregate adenosis, tumoral adenosis, or adenosis tumor. Even though some of these terms contain the term tumor, this condition is benign and is not a cancer.Sclerosing adenosis is a special type of adenosis in which the enlarged lobules are distorted by scar-like fibrous tissue.If many enlarged lobules are close to one another, they may be large enough to be felt. When this is the case, it may be hard for the doctor to tell these lumps from a breast cancer with only a breast exam. Calcifications (mineral deposits) may form in adenosis, in sclerosing adenosis, and in cancers. These can be confusing on mammograms.Because adenosis can often be confused with cancer based on breast exams or mammograms, a biopsy is usually needed to tell them apart. Fine needle aspiration (FNA) biopsy of these lumps can usually show if they are benign. A core needle biopsy can usually identify the mass as adenosis, but sometimes a surgical biopsy is needed to be sure it is not cancer.Some studies have found that women with sclerosing adenosis have a greater risk of developing breast cancer—about 1 to 2 times the risk of women with no breast changes.Risk Factors:Menopausal hormone use (postmenopausal hormone use).
A family history of breast cancer or benign breast conditions.
Research: So far 27 cases of palpable and/or tumor-forming adenosis in the female breast, called adenosis tumor, have been investigated. It is a rare lesion, which most often presents as a breast mass that clinically and histologically is sometimes misinterpreted as carcinoma. The majority of patients were under the age of 45 years. Grossly, most tumors were firm or elastic and showed a grey or grayish-white cut surface. Furthermore, seven (26%) were granular and nine (34%) were microcystic, whereas none showed chalky streaks. Microscopically, 20 cases were poorly circumscribed and seven cases were well circumscribed. In contradistinction to the often uniform growth pattern of tubular carcinoma, the adenosis tumors characteristically showed adenosis arranged in a mixture of eight different growth patterns. The most frequent and also most extensive growth pattern was classical sclerosing adenosis and the least frequent was tubular adenosis. Another conspicuous feature in adenosis tumors was patchy growth in contrast to the stellate configuration of tubular carcinoma which is the most likely differential diagnosis. Other findings separating adenosis tumors from carcinomas were microcysts (93%), apocrine metaplasia (63%), luminal histiocytes (52%) and pseudo-papillomas, called glomeruloid structures (48%). Epithelial changes that could cause anxiety about malignancy were frequently found and comprised epithelial hyperplasia (44%), epithelial atypia (26%) and fat or nerve infiltration (30%). Three patients were subjected to unnecessary mastectomy because of incorrectly diagnosed adenosis tumors. Adenosis tumors and non-infiltrating carcinoma were found together in five cases, but their association is probably over represented due to selection. None of 18 pure adenosis tumors solely treated by excision had recurred at follow-up 1-9 years later.Symptoms:Symptoms may include:Breast discomfort and general tenderness.
Symptoms may alter during the menstrual cycle - tending to become more pronounced just before or during menses (menstrual bleeding). After the menopause women do not generally have symptoms any more.Women may have very different symptoms, and the same woman may experience varying symptoms on different occasions. For some patients fibroadenosis is a slight nuisance, while for others it is extremely painful. Doctors say fibroadenosis is the female body's normal reaction to changes in hormone levels.Diagnosis:On a mammogram, sclerosing adenosis can look like breast cancer. Because of this, a biopsy is generally needed to make a definitive diagnosis. This may be a core biopsy, where small samples of breast tissue are removed, sent to a laboratory and examined under a microscope to establish a diagnosis.It may be a stereotactic biopsy if the area is very small and difficult to target. A mammogram machine linked to a computer may be used to locate the exact position of the area, to help guide the biopsy needle with greater accuracy. This procedure may be done in a sitting position or lying down on a specialized examination table. You may be offered a vacuum-assisted biopsy. This may be referred to as a `Mammotome' biopsy, which is one of the brand names of the equipment used. After an injection of local anaesthetic, a small cut is made in the skin. A hollow probe connected to a vacuum device is placed through this. Using ultrasound or mammography as a guide, breast tissue is sucked through the probe by the vacuum into a collecting chamber. This enables removal of several tissue samples without having to remove the probe. These samples are sent to the laboratory where they are examined under a microscope to establish a diagnosis.These tests are done in the Breast Clinic or X-Ray Department. For more information about breast biopsies consult your physician/surgeon.Although sclerosing adenosis can often be diagnosed on a core biopsy, a small operation is sometimes needed to remove the affected area and confirm that it is not breast cancer. Once the affected area is removed, the tissue is sent to a laboratory where it is looked at under a microscope to confirm the diagnosis.Treatment:Your doctor will usually suggest a small operation to completely remove the radial scar or complex sclerosing lesion. The removed breast tissue will be sent to a laboratory to confirm that there are no malignant features. Once the area has been completely removed and confirmed as a radial scar or complex sclerosing lesion, no further tests or treatment will be needed. There are differing opinions as to whether having a radial scar or complex sclerosing lesion may be associated with a slightly increased risk of developing breast cancer in the future. Some doctors believe that any increase in risk is determined by what else is found in the excised tissue such as, for example, an area of atypical hyperplasia.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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