Description, Causes and Risk Factors:
Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue. Sclerosing adenosis is a benign condition in which extra tissue grows within the breast lobules. It can cause recurring pain or result in a small, firm lump in the breast.
Sclerosing adenosis is defined as a benign lobulocentric lesion of disordered acinar, myoepithelial, and connective tissue elements, which can mimic infiltrating carcinoma both grossly and microscopically. Sclerosing adenosis can manifest as a palpable mass or as a suspicious finding at mammography. It is strongly associated with various proliferative lesions, including epithelial hyperplasias, intraductal or sclerosing papilloma, complex sclerosing lesion, calcification, and apocrine changes. It can coexist with both invasive and in situ cancers. Studies found sclerosing adenosis to be a risk factor for invasive breast cancer apart from its association with other proliferative lesions of the breast.
Sclerosing adenosis arises as a result of proliferation of the terminal duct-lobular units in a disordered manner caused by an increase in acinar and myoepithelial cells and stromal elements. It is commonly seen as part of the normal aging process, especially in women in their 30s and 40s, but can occur at any age. Most women will not notice any symptoms and it is often only diagnosed during a routine mammogram (breast x-ray) or following investigation of an unrelated breast condition.
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.
Patients may present with either a breast lump or breast pain, or may be noted to have an area of increased density or clustered microcalcification.
Sclerosing adenosis can be difficult to diagnose as on a mammogram it can sometimes look like breast cancer. Because of this, a biopsy may be needed to make a firm diagnosis. This may be done in a few ways:
It may be a stereotactic biopsy if the area isvery small and difficult to target. A mammogrammachine linked to a computer may be used tolocate the exact position of the area, to helpguide the biopsy needle with greater accuracy.This procedure may be done in a sitting positionor 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 theequipment used. After an injection of localanesthetic, a small cut is made in the skin.A hollow probe connected to a vacuum deviceis placed through this. Using ultrasound ormammography as a guide, breast tissue is suckedthrough the probe by the vacuum into a collectingchamber. This enables removal of several tissuesamples without having to remove the probe.These samples are sent to the laboratory wherethey are examined under a microscope toestablish a diagnosis.
This may be a core biopsy, where small samplesof breast tissue are removed, sent to a laboratoryand examined under a microscope to establisha diagnosis.
Although sclerosing adenosis can often be diagnosed with a core biopsy, occasionally a small operation (excision biopsy) may be needed to remove the affected area and confirm that it is not breast cancer.
If core biopsy is conclusive, no further treatment or follow-up is required. Where there is an area of doubt, excision biopsy is recommended. Impalpable lesions will require preoperative mammographic localization. There is a mildly elevated risk for the subsequent development of breast cancer. This risk is slightly higher in women with a positive family history.
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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