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Squamous metaplasia of the breast is a rare and unusual finding. A number of benign and malignant differential entities exist when squamous cells are present in a breast lesion. Our patient was found to have pronounced squamous metaplasia and keratin cysts arising in a complex fibroadenoma. The rare nature of squamous metaplasia arising in such a lesion poses some diagnostic challenges, as squamous epithelium and squamous metaplasia in the breast may raise suspicion for malignancy. Herein we present a unique case and discussion of benign and malignant differential entities. We also retrospectively reviewed a series of complex fibroadenomas in our institution, including the demographic and histologic features, and more importantly the associated breast cancer risk.

We report a case of nodular sclerosing adenosis presenting as false-positive uptake on molecular breast imaging (MBI). A 51-year-old woman with elevated lifetime risk of breast cancer underwent supplemental MBI which showed focal uptake in the right breast. A corresponding mass was found on ultrasound with subsequent biopsy yielding nodular sclerosing adenosis. After the biopsy results were reviewed, a problem solving breast MR was recommended. Breast MR showed a solitary enhancing right breast mass containing a marker clip, and the sonographic biopsy was then deemed concordant with pathology. While adenosis lesions are known mimickers of malignancy on other breast imaging modalities, their appearance on MBI has not been previously published.

Sclerosing adenosis is a common benign proliferative disorder of the breast. We describe FDG PET/CT findings in a case of sclerosing adenosis showing focal intense FDG uptake mimicking malignancy. This case indicates that sclerosing adenosis should be included in the differential diagnosis of focal breast FDG accumulation along with malignant and nonmalignant conditions.

Atypical apocrine adenosis (AAA) is a benign lesion of the breast that is identified more frequently today than in the past when it was considered a rare diagnosis and commonly misdiagnosed as other malignant lesions of the breast. AAA is defined as the presence of apocrine cytology in a recognisable lobular unit associated with sclerosing adenosis. We present a case of an incidental finding of AAA and discuss diagnostic challenges and their implications on clinical management.

Purpose Sclerosing adenosis (SA), found in ¼ of benign breast disease (BBD) biopsies, is a histological feature characterized by lobulocentric proliferation of acini and stromal fibrosis and confers a two-fold increase in breast cancer risk compared to women in the general population. We evaluated a NanoString-based gene expression assay to model breast cancer risk using RNA derived from formalin-fixed, paraffin-embedded (FFPE) biopsies with SA. Methods The study group consisted of 151 women diagnosed with SA between 1967 and 2001 within the Mayo BBD cohort, of which 37 subsequently developed cancer within 10 years (cases) and 114 did not (controls). RNA was isolated from benign breast biopsies, and NanoString-based methods were used to assess expression levels of 61 genes, including 35 identified by previous array-based profiling experiments and 26 from biological insight. Diagonal linear discriminant analysis of these data was used to predict cancer within 10 years. Predictive performance was assessed with receiver operating characteristic area under the curve (ROC-AUC) values estimated from 5-fold cross-validation. Results Gene expression prediction models achieved cross-validated ROC-AUC estimates ranging from 0.66 to 0.70. Performing univariate associations within each of the five folds consistently identified genes DLK2, EXOC6, KIT, RGS12, and SORBS2 as significant; a model with only these five genes showed cross-validated ROC-AUC of 0.75, which compared favorably to risk prediction using established clinical models (Gail/BCRAT: 0.57; BBD-BC: 0.67). Conclusions Our results demonstrate that biomarkers of breast cancer risk can be detected in benign breast tissue years prior to cancer development in women with SA. These markers can be assessed using assay methods optimized for RNA derived from FFPE biopsy tissues which are commonly available. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4441-z) contains supplementary material, which is available to authorized users.

Benign sclerosing lesions of the breast comprise primarily sclerosing adenosis and radial scar/complex sclerosing lesions (RS/CSL). Other benign lesions which may become fibrosed and malignant tumours frequently associated with a sclerotic stromal reaction, may enter their differential diagnosis either radiologically or on pathological examination. This updated review focuses on the core biopsy diagnosis and operative pathology of these lesions with particular reference to their prognosis and recent trends in their management.

BACKGROUND: Deep learning-based computer-aided diagnosis (CAD) is an important method in aiding diagnosis for radiologists. We investigated the accuracy of a deep learning-based CAD in classifying breast lesions with different histological types. METHODS: A total of 448 breast lesions were detected on ultrasound (US) and classified by an experienced radiologist, a resident and deep learning-based CAD respectively. The pathological results of the lesions were chosen as the golden standard. The diagnostic performances of the three raters in different pathological types were analyzed. RESULTS: For the overall diagnostic performance, deep learning-based CAD presented a significantly higher specificity (76.96%) compared with the two radiologists. The area under ROC of CAD was almost equal with the experienced radiologist (0.81 vs. 0.81), while significantly higher than the resident (0.81 vs. 0.70, P

Most breast core biopsies are benign and the majority of the detected lesions will not need any further medical intervention. These are the ones that are given a histological score of B2. This chapter deals with these lesions, including fibroadenoma and fibrocystic and columnar cell change, sclerosing adenosis, apocrine adenosis, duct ectasis, granulomatous mastitis and other less common lesions. The lesions are illustrated and a discussion is given of how to differentiate them from closely related B3 lesions that might need clinical intervention.

Pubmed'de indekslenmektedir This work investigates the in vivo dielectric properties of healthy and benign rat mammary tissues in an attempt to expand the dielectric property knowledge of animal models. The outcomes of this study can enable testing of microwave medical technologies on animal models and interpretation of tissue alteration-dependent in vivo dielectric properties of mammary tissues. Towards this end, in vivo dielectric properties of healthy rat mammary tissues and chemically induced benign rat mammary tumors including low-grade adenosis, sclerosing adenosis, and adenosis were collected with open-ended coaxial probes from 500 MHz to 18 GHz. The in vivo measurements revealed that the dielectric properties of benign rat mammary tumors are higher than the healthy rat mammary tissues by 9.3% to 35.5% and 19.6% to 48.7% for relative permittivity and conductivity, respectively. Furthermore, to our surprise, we found that the grade of the benign tissue affects the dielectric properties for this study. Finally, a comparison with ex vivo healthy human mammary tissue dielectric properties revealed that the healthy rat mammary tissues best replicate the dielectric properties of healthy medium density human samples.

The purpose of the study is to develop an effective radiological symptom-complex of small-sized breast cancer affected by fibrocystic breast disease by using multivariate statistical methods. Materials and methods. Radiological findings of small-sized breast cancer affected by fibrocystic mastopathy were analyzed in 100 patients with histologically verified diagnosis. Results. It was revealed that the conventional approach to the analysis of mammograms based on the detection of the primary, secondary and indirect mammographic signs of small-sized breast cancer is not effective enough - the sensitivity of mammography is only 62%. Fibrocystic disease and moderate-to-severe sclerosing adenosis make small-sized breast cancer hard to visualize by mammography. The detailed analysis of mammograms allowed us to identify the additional manifestations of small-sized breast cancer affected by mastopathy. The computer program allowing us to evaluate the risk of small-size breast cancer and the diagnostic algorithm for detecting small size breast cancer with sensitivity of 92% were developed.

The present study was conducted to evaluate the radiological findings, particularly the ultrasonographic (US) characteristics of sclerosing adenosis (SA), and their correlation with histopathological results. A retrospective review identified 191 patients with a total of 200 lesions histopathologically confirmed as SA following breast surgery between July 2009 and December 2012. Of the 191 patients, 145 (151 lesions) with SA as the major component were included for US and mammographic (MG) analysis. All 145 patients analyzed were female, with a mean age ± standard deviation of 46.8±7.8 years (range, 25-71 years). All 145 patients underwent US examination and the imaging findings included heterogeneously echogenic areas in 9.3% (14/151), masses in 51.7% (78/151), masses with calcifications in 13.9% (21/151), focal acoustic shadowing in 4.0% (6/151) and were negative in 21.2% (32/151) patients. Among the 119 lesions with visible abnormalities, 87.4% (104/119) were hypoechoic, 58.0% (69/119) were irregular in shape, 52.1% (62/119) had an ill-defined margin, calcifications were found in 17.6% (21/119) and 7.6% (9/119) were hypervascular, while none of the characteristics mentioned above were significantly correlated with histopathology. A total of 136 patients underwent MG at the Fudan University Shanghai Cancer Center, and the imaging findings included microcalcifications in 31.6% (43/136), masses in 23.5% (32/136), asymmetric focal density in 14.7% (20/136), focal architectural distortion in 22.8% (31/136), and were negative in 7.4% (10/136). The mass lesions were fewer on MG compared with US (23.5 vs. 65.6%, respectively). The area under the curve of US distinguishing between benign and malignant lesions was significantly larger compared with that of MG (0.547 vs. 0.497, respectively; P=0.036). In the 60 lesions that were overestimated by Breast Imaging Reporting and Data System US category, one or more characteristics of malignancy were found on US imaging. The most common finding of SA was masses with or without calcifications on US and microcalcifications on MG. The accuracy of US was limited, but higher compared with that of MG; however, SA mimicking the characteristics of malignancy may contribute to misdiagnosis with US.

Juvenile papillomatosis of the breast, also known as Swiss cheese disease, is a rare and benign proliferative disorder affecting young women. These patients tend to have a strong family history of cancer. The lesion typically presents as a localized mass without sharp borders. Clinical presentation resembles that of a precancerous lesion. For this reason, JP is often misdiagnosed in the preoperative period. However postoperative histopathological examination reveals distinct microscopic features, such as duct papillomatosis, cysts and sclerosing adenosis, which confirm the diagnosis of juvenile papillomatosis. We report two cases of juvenile papillomatosis. Both cases were preoperatively diagnosed as benign proliferative lesions with fibrocystic changes. However, after surgical excision, histopathological examination showed juvenile papillomatosis. Interestingly, both patients had a strong family history of breast cancer in both the paternal and maternal line. More research is needed to assess the correlation between a family history of breast cancer and the juvenile papillomatosis. ispartof: European journal of breast health vol:15 issue:2 pages:130-134 ispartof: location:Turkey status: published

Sclerosing polycystic adenosis (SPA) is a recently described, rare, neoplastic or reactive sclerosing inflammatory process of the salivary glands. It is similar to sclerosing adenosis or adenosis tumor of the mammary gland, but pathogenesis is still unclear. The commonest sites of involvement are parotid and submandibular gland, while minor salivary glands are very rare. Here we report an extremely rare case of SPA with intraluminal crystalloids in the buccal mucosa.

Highlights • Ductal Carcinoma in situ in sclerosing adenosis encapsulated by a hamartoma is rare. • The diagnosis is difficult due to the appearance of these combined lesions. • Atypical appearance of a hamartoma may suggest a co-existing malignancy., Introduction Ductal Carcinoma in situ (DCIS) of the breast can develop in areas of sclerosing adenosis. The radiographic finding of sclerosing adenosis is a spiculated mass and can look like invasive ductal carcinoma. We report a patient with DCIS in sclerosing adenosis encapsulated by a hamartoma, with imaging findings quite different from the typical findings of sclerosing adenosis. Presentation of case A 73-year old woman, with no previous mammography, presented with a palpable mass in the left breast. Mammography showed a 36 mm well-defined mass with fat density in the middle outer quadrant of the left breast. Ultrasonography showed a well-defined mass in the same area which was composed of hypoechoic and hyperechoic areas. The histological diagnosis by core needle biopsy was sclerosing adenosis. We considered the patient’s age and tumor size and performed a partial mastectomy for both diagnosis and treatment. Final pathology showed DCIS in sclerosing adenosis in a hamartoma. Discussion This patient had DCIS in an area of sclerosing adenosis, encapsulated by a hamartoma. DCIS can develop in areas of sclerosing adenosis, and can appear similar to invasive ductal carcinoma, so we must avoid misdiagnosis or over-treatment. Malignant transformation of a hamartoma is rare, but can occur since it contains epithelial tissue. Definitive biopsy should be performed due to the possibility of a malignancy inside the hamartoma. Conclusions When diagnosing a hamartoma, the presence of atypical findings on imaging studies, should suggest the possibility of malignancy. Although rare, a malignant tumor may be present inside the hamartoma.

A number of conditions can lead to metaplastic or proliferative changes in the myoepithelial cell layer of the breast, resulting in a variety of benign and malignant myoepithelial cell lesions. Nonneoplastic myoepithelial lesions are common, often observed as an incidental finding in the breast, and include myoepithelial hyperplasia, sclerosing adenosis, and collagenous spherulosis. Myoepithelial neoplasms are uncommon and include adenomyoepithelioma, malignant adenomyoepithelioma, and myoepithelial carcinoma.

Fibroadenomas with a predominant cystic change are called cystic fibroadenomas. These are extremely rare forms of fibroadenomas and only one case has been reported so far. They are classified under the category of complex fibroadenomas. Complex fibroadenomas are a rare variant of fibroadenomas occurring in elderly females. They are characterized by presence of one of the complex features along with the usual patterns of fibroadenoma such as cysts more than 3 mm, papillary apocrine metaplasia, or sclerosing adenosis. Patients with these lesions have higher chances of developing carcinoma of breast. We present a case of 35 years old lady with a freely mobile mass in the left breast diagnosed as cystic fibroadenoma after thorough histopathological examination of the lesion.

Summary Background Sclerosing adenosis is a benign, usually asymptomatic lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast. It is commonly an incidental finding in perimenopausal women undergoing screening mammography. Case Report We reported on two patients with sclerosing adenosis assessed with mammography, ultrasound, and contrast-enhanced magnetic resonance imaging. Case 1 was a 21-year-old woman with a palpable lesion in her right breast that was depicted as an irregular mass on contrast-enhanced magnetic resonance imaging. Case 2 was an asymptomatic 42-year-old woman with suspicious ultrasound findings in her left breast; contrast-enhanced magnetic resonance imaging showed regional non-mass-like enhancement associated with increased vascularity. Both patients underwent ultrasound-guided vacuum-assisted biopsy. Sclerosing adenosis does not have distinctive radiological features and can mimic a malignant growth process, thus requiring a diagnostic biopsy. Conclusions SA is a common, benign, generally asymptomatic proliferative lesion of the breast. It is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be elucidated. It does not exhibit distinctive MG, US or even MRI features. Since it may mimic a carcinoma it requires further investigation with a diagnostic biopsy.

To study the imaging and clinical features of breast sclerosing adenosis (SA), and to enhance the recognition of this disease, as well as to help the clinic to give a correct diagnosis. Imaging findings were retrospectively reviewed in 47 women with SA lesions confirmed by pathology (including 39 cases of mammography, 40 cases of ultrasound [US], and 34 cases magnetic resonance imaging [MRI]). Of 47 patients confirmed with SA, 18 cases were pure SA, and 29 cases coexist with other proliferative lesions and malignancies; the maximum diameter of SA lesions was 0.5 to 3.5 cm with an average of 1.6 cm. On the mammogram of 39 SA cases, the percentage of architectural distortion, calcifications, mass/nodular, asymmetric density, and mass combining with calcifications were 30.8%, 23.1%, 17.9%, 12.8%, and 7.7%, respectively; and 3 cases had no abnormal findings. On the sonogram (excluding 5 normal finding cases), the majority of lesions showed regular shaped (57.1%), well defined margined (60.0%), heterogenous low echoed (71.4%) nodulus. 85.3% lesions showed high signal on T2-weighted images, and all lesions were enhanced markedly, including 82.4% lesions appearing mass-like enhancement (17 star-shaped enhanced masses included); and the percentage of the time-signal intensity curve in type 1, type 2, and type 3 were 52.9%, 41.2%, and 5.9%, respectively. If the category breast imaging-reporting and data system ≥4b was considered to be a suspicious malignant lesion, the misdiagnostic rates of mammography, US, and MRI would be 17.9%, 17.5%, and 35.3%, respectively. The SA lesions are small and can occur with other diseases histologically. The majority of SA lesions showed distortion or calcifications on mammograms, low echo-level nodules with heterogenous echo on US and mass-like lesion with or without star shape on enhanced MRI.

Over one million American women have a benign breast biopsy annually. Sclerosing adenosis (SA) is a common, but poorly understood benign breast lesion demonstrating increased numbers of distorted lobules accompanied by stromal fibrosis. Few studies of its association with breast cancer have been conducted, with contradictory results. We studied SA in the Mayo Benign Breast Disease (BBD) Cohort, which includes women who had benign biopsies at Mayo-Rochester 1967–2001. Breast cancer risk in defined subsets was assessed using standardized incidence ratios (SIRs), relative to the Iowa Surveillance, Epidemiology, and End Results registry. This BBD cohort of 13,434 women was followed for a median of 15.7 years. SA was present in 3,733 women (27.8 %) who demonstrated an SIR for breast cancer of 2.10 (95 % CI 1.91–2.30) versus an SIR of 1.52 (95 % CI 1.42–1.63) for the 9,701 women without SA. SA was present in 62.4 % of biopsies with proliferative disease without atypia and 55.1 % of biopsies with atypical hyperplasia. The presence of SA stratified risk in subsets of women defined by age, involution status, and family history. However, SA does not further stratify risk in women diagnosed with other forms of proliferative breast disease, either with or without atypia. SA is a common proliferative lesion of the breast which, as a single feature, conveys an approximate doubling of breast cancer risk. Its role in breast carcinogenesis remains undefined; its presence may aid in risk prediction for women after a breast biopsy.

The objective of the study is to assess the use of “Intact” Breast lesion excision system as the primary method for histopathological diagnosis of suspicious small and borderline lesions as well as the unclassified microcalcifications. Material and method Eighty cases were included for BLES excision of radiologically high risk lesions. Results Eighty cases were successfully done, age range between 21 and 55 years old. 72.5% (58/80) cases were done under ultrasound guidance and 27.5% (22/80) cases were done under stereotactic guidance. Thirty percent (24/80) lesions were removed by using the 15 mm probe and 70% (56/80) lesions were removed by using the 20 mm probe size. The main indication was complete removal of a small indeterminate mass (30/80) followed by biopsy of unclassified micro calcifications, either without mass (18/80) or associated with a mass (16/80). Asymmetry (6/80) and distortion (4/80) and finally clustered micro cysts (6/80) were observed. (44/80) representing 55% were categorized as BIRADS 3 while (36/80) about 45% were categorized as BIRADS 4.30% (24/80) of lesions were benign (including fibroadenomas, fibrocystic changes and sclerosing adenosis), 52.5% (42/80) were potentially high risk lesions (including ADH, ALH and papillomas) and 17.5% (14/80) of lesions were malignant (including LCIS, DCIS and IDC). Open surgery was done for all the malignant and potentially malignant lesions and there was no underestimation. However there was no enough margin after BLES in (3/6) IDC. Conclusion BLES offers complete lesion removal thus much indicated in borderline lesions.

Anogenital mammary-like glands represent a normal anatomic constituent of the anogenital area and may give rise to many benign and malignant tumors that morphologically mimic similar breast diseases. The literature review is complemented by a description of 286 cases of benign tumors and tumor-like processes in the mammary-like glands. The paper presents the clinical and morphological characteristics of papillary hidradenoma, fibroadenoma, benign phyllodes tumor, lactating adenoma, sclerosing adenosis, pseudoangiomatous stromal hyperplasia, etc.Маммароподобные железы являются нормальным анатомическим компонентом аногенитальной области и могут давать начало многочисленным доброкачественным и злокачественным опухолям, морфологически напоминающим аналогичные заболевания молочной железы. Обзор литературы дополнен описанием 286 случаев доброкачественных опухолей и опухолеподобных процессов маммароподобных желез. В статье представлена клинико-морфологическая характеристика папиллярной гидраденомы, фиброаденомы, доброкачественной филлоидной опухоли, лактирующей аденомы, склерозирующего аденоза, псевдоангиоматозной стромальной гиперплазии и др.

Many different types of both benign and malignant breast lesions can be associated with stromal fibrosis and collagen deposition and can be broadly classified as sclerosing lesions. Recognising the aetiology of the fibrosis on excisional biopsy is usually not very difficult; however, extensive fibrosis and related histologic changes may create major diagnostic challenges on a limited sample such as a core needle biopsy. Sclerosing adenosis and radial scar/complex (radial) sclerosing lesion are two benign entities that will be described in this chapter. The main clinical significance of these lesions is that they may mimic invasive carcinoma clinically and radiographically as well as in gross and microscopic evaluations.

Cancer in sclerosing adenosis includes the following 2 types: cancer genuinely arising from sclerosing adenosis and cancer arising near a sclerosing adenosis lesion and infiltrating into it. This study aimed to elucidate the features of the former by comparing both types.This study included 28 lesions in 27 cases of cancer in sclerosing adenosis for which surgery was performed during a 2-year period from January 2006 at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research. We determined the proportions of cancer in sclerosing adenosis relative to the overall lesion of ductal carcinoma in situ. They were compared for 13 clinico-pathological factors by dividing the lesions into 2 groups: those involving cancer in 50 % or more (cancer in sclerosing adenosis predominant type-inner type) and those involving cancer in less than 50 % (cancer out of sclerosing adenosis predominant type-outer type).There were 20 lesions (71 %) of the inner type and 8 lesions (29 %) of the outer type. The comparison between the 2 types revealed significant differences in the following 3 factors. Bilateral breast cancer was observed in 5 cases (26 %) of the inner type and in none (0 %) of the outer type, indicating that there were significantly more cases of bilateral breast cancer for the inner type (p = 0.04). Regarding the subtypes of ductal carcinoma in situ, there were significantly more cases of the non-comedo type for the inner type (p = 0.002). Significantly fewer cases were positive for human epidermal growth factor receptor type 2 (HER2) for the inner type (p = 0.007).The results of this study suggest that cancer genuinely arising in sclerosing adenosis may often have biological features of bilateral breast cancer, non-comedo type in subtype, and being negative for HER2.

목적 : 본 연구는 침생검을 통해 진단 받은 경화성 선증에 대해 추가적인 수술 없이 경과 관찰했을 때의 잠재적 안정성을 알아보고자 하였다. 방법 : 1996년 1월부터 2010년 5월까지 침생검을 통해 경화성 선증으로 진단된 143명의 환자의 145개 병변을 대상으로 (core-needle biopsies 118례, vacuum-assisted biopsies 27례) 의무기록 검토를 토대로 한 후향적 고찰이다. 결과 : 환자들의 BI-RADS(The American College of Radiology Breast Imaging Reporting and Data System) 분류는 다음과 같다: C3(n=8), C4a(n=123), C4b(n=11), C4c(n=e), C5(n=1). 그 중 14명은 조직검사를 재시행하였고 BI-RADS 분류 C5이면서 영상의학적 소견과 병리학적 소견의 불일치를 보인 1명의 환자가 침윤성 유방암으로 진단되어 수술을 시행하였다. 나머지 환자들은 정기적인 초음파 검사 및 유방촬영술을 통해 경과 관찰하였고, 평균 추적관찰 기간 40개월 동안 144개의 병변의 최종 BI-RADS 분류는 다음과 같다: C1(n=5), C2(n=107), C3(n=32), 경과 관찰기간 동안 142명의 환자에서 악성 유방질환이 발견된 환자는 없었다. 결론 : 침생검을 통해 경화성 선증으로 진단된 환자에 있어서 추가적인 수술 없이 정기적인 검진을 통하여 경과 관찰하는 것은 잠재적 안전성을 가지고 있다. 하지만 조직검사와 영상검사 결과의 불일치 소견을 보이는 경우 수술적 생검을 통한 최종 진단이 필요하다.

Benign sclerosing lesions of the breast comprise primarily sclerosing adenosis and radial scar/complex sclerosing lesions (RS/CSL). Other benign lesions which may become fibrosed and malignant tumours frequently associated with a schirrous reaction, may enter their differential diagnosis either radioloigcally or on pathological examination. This review focuses on the pre-operative diagnosis and operative pathology of these lesions with particular reference to their prognosis and recent trends in their management.

This article discusses the most common small glandular proliferations, namely sclerosing lesions (sclerosing adenosis and radial scar), tubular carcinoma, and epithelial displacement after needle core biopsy, as well as less common entities, such as low-grade adenosquamous carcinoma, microglandular adenosis, and syringomatous adenoma. Due to significant morphologic overlap, these entities are easily mistaken for one another. The similarities and differences among these lesions in their clinicopathologic features, radiologic findings, and immunohistochemical profiles are emphasizesd.

Sclerosing adenosis, sclerosing lesions, microglandular adenosis, and mucocele-like lesions are benign lesions that may mimic invasive carcinoma on routine histology. Adenosis and sclerosing lesions are small glandular proliferations that may resemble well-differentiated invasive ductal or tubular carcinoma, whereas mucocele-like lesions may be confused with mucinous carcinoma. It may be especially difficult to recognize these lesions in the limited core needle biopsy sample, and therefore, it is important to maintain a low threshold for diagnostic work-up. Immunohistochemical studies for myoepithelial cell markers facilitate the correct diagnosis in challenging cases. However, a notable exception, microglandular adenosis, lacks myoepithelial cells, and must be distinguished from well-differentiated invasive carcinoma by its S-100 protein immunoreactivity and triple negative phenotype.

In this chapter, a dose-compatible diagnostic tool for the assessment and risk stratification of breast microcalcifications exploiting the sub-pixel resolution sensitivity of X-ray dark-field is presented. First, the diagnostic importance of breast microcalcification grading and its clinical limitations are illustrated, by which the necessity and potential of additional, refining classification procedures is given credit. Our results indicate that dark-field imaging of microcalcifications may enhance the diagnostic validity of current microcalcification analysis and reduce the number of invasive procedures. Finally, we take a critical look at a recent publication, which suggest a chemically-based assessment of calcifications by means of dark-field mammography. Note that this chapter has been submitted for publication to Scientific Reports as “Scherer, K. et al. Improved mammography diagnostics by assessing the micromorphology of breast calcifications via X-Ray dark-field radiography”.

Apocrine change is seen in a wide spectrum of breast lesions, ranging from microscopic cysts to frankly malignant lesions. This article gives an overview of the non-invasive lesions in which apocrine change occurs, and discusses the available data on the clinical significance of these lesions. While many of these cases do not present any diagnostic difficulty, apocrine proliferations demonstrating cytological atypia can be particularly challenging. The histological criteria that have been proposed to foster reproducibility in categorizing such lesions are reviewed. This review also attempts to clarify the terminology that has been applied to a range of benign lesions, including sclerosing adenosis and complex sclerosing lesions, containing foci of apocrine change.

Fine needle aspiration cytology was performed in a 46-year-old female presenting with a breast lump and mammography suggesting a malignancy. The smears were cellular with cohesive clusters and scattered epithelial cells showing moderate nuclear pleomorphism and focal acinar formation. Stromal fragments, benign epithelial cell clusters and a few naked nuclei were noted in the background. Considering the clinical features, mammography findings as well as cytological features, a diagnosis of ductal carcinoma was suggested. Subsequent histopathological examination revealed it to be nodular sclerosing adenosis. The cytohistological correlation of this uncommon lesion, a potential pitfall in breast fine needle aspiration diagnosis which may lead to a false-positive diagnosis is discussed.

Breast cancer is occasionally complicated by sclerosing adenosis (SA). Although both lesions usually originate in the terminal duct lobular unit, their pathogenetic relationship has not yet been elucidated. The present study analyzed 63 breast cancer patients with SA (involving a total of 75 breasts) to clarify if coexisting SA increased the frequency of multicentric breast cancer or not. Using the topographical classification proposed in our previous study, breast cancers with SA were classified into the following three types: type A (n = 22), cancer area was completely surrounded by the SA; type B (n = 26), cancer area partially overlapped the SA; and type C (n = 27), cancer area was located separate from the SA. Breast cancers with SA had a significant (P

Apocrine proliferations most often are metaplasia as a component offibrocystic change. However, the appearance of apocrine metaplasia within various breast lesions, such as papillomas, ductal adenomas, and sclerosing adenosis, may complicate their diagnosis. Distinguishing benign from malignant apocrine proliferations can be problematic owing to the nuclear characteristics of apocrine cells. In this article, we characterize the spectrum of apocrine proliferations in the breast ranging from benign to malignant and attempt to clarify the difficult lesions that are intermediate between hyperplasia and ductal carcinoma in situ.

The destruction of the epithelial basement membrane is widely regarded as a clear criterion for invasive malignant tumor growth. Since, however, defects in the basement membrane may also occur in non-invasive conditions, such as inflammatory and proliferative lesions, and since it has been shown that particularly in highly differentiated squamous cell carcinomas a continuous basement membrane is mimicked by the presence of isolated components, this criterion seems to be of minor value for the diagnosis of malignancy. Despite these drawbacks, the immunolocalization of basement membrane material may still be of differential diagnostic significance in certain situations. This holds particularly true for invasive (ductal) breast carcinomas, which usually completely lack a basement membrane. Accordingly, sclerosing adenosis can be distinguished from invasive carcinoma, as a distinction can be made between neoplastic (malignant) tubular formations and reactive lesions.

The tubular carcinoma of the breast is an uncommon histological subtype of invasive breast cancer, which is generally associated with an excellent prognosis. Previous studies have demonstrated that this well differentiated variant is linked with a low incidence of lymph node involvement, a low rate of local recurrence and a high overall survival rate when compared to standard invasive ductal carcinoma. Due to its favorable prognosis, some studies have proposed that a diagnosis of tubular carcinoma might warrant less aggressive surgical or adjuvant treatment. Histologically, tubular carcinoma may mimic sclerosing adenoma or bluntduct adenosis. Its ductal nature appears well confirmed by the few ultrastructural studies of this mammary cancer. Tubular carcinoma should also be distinguished from microglandular adenosis, an uncommon form of sclerosing adenosis. The aim of this study is to prove that the ultrastructure results can give the correct diagnosis between tubular carcinoma and sclerosing adenosis.

Objective: reviewing the histological basis and differential diagnostic criteria for applying immunohistochemistry in breast pathology. Clinical case: the case of a patient suffering from complex sclerosing lesion (CSL) of the breast, microglandular adenosis (MGA) pattern is presented; she required immunohistochemistry as an auxiliary technique for differentiating an adenocarcinoma-related breast lesion in situ and thus defining its treatment. Materials and methods: a search was made of the pertinent information in Medline databases via PubMed, SciELO and in books on the specialty; 25 titles were reported, 12 of them corresponding to the immediate topic: 4 were case reports with a literature review and one was a letter to the editor. 7 articles dealt with the topic in a more general way. Conclusion: immunohistochemistry led to the differential diagnosis of complex breast lesions such as sclerosing adenosis, and in situ or microinvase breast cancer.

Sclerosing adenosis recently has been implicated as an indicator of mildly increased risk for invasive mammary carcinoma. This article illustrates the confines of definition and morphologic spectrum for sclerosing adenosis, discusses its association with other histologic findings in the breast, and reviews the recently accumulated evidence for inclusion of sclerosing adenosis as an increased risk lesion.

E-cadherin (EC) is an important glycoprotein cell-adhesion molecule that appears to play a significant role in the progression of breast lesions. The objective of this study was to evaluate EC expression in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma. Samples of breast lesions from 44 women were used in this study, comprising cases of sclerosing adenosis (n = 11), ductal carcinoma in situ (DCIS) (n = 10) and invasive ductal carcinoma (n = 23). Immunohistochemical evaluation of EC expression was assessed semiquantitatively and considered negative (10% of cells with stained cytoplasmic membranes), positive+ (10-50% of cells stained) or positive++ (50% of cells stained). Fisher's exact test was used to compare the distribution of staining intensity in the lesions (P0.05). There was a progressive loss of EC expression from benign to malignant lesions. This difference was statistically significant when sclerosing adenosis was compared with DCIS (P0.0002), when sclerosing adenosis was compared with invasive ductal carcinoma (P0.008) and when DCIS was compared with invasive ductal carcinoma (P0.007). The present findings point to a significant association between reduced EC expression and the progression and aggressivity of breast lesions. Diagn. Cytopathol. 2010. (c) 2009 Wiley-Liss, Inc.

Eleven cases of sclerosing adenosis of the prostate gland, a recently reported uncommon pseudoneoplastic lesion with characteristic histological, histochemical, and immunohistochemical features, are described. The well-circumscribed cellular lesions were composed of variably sized and shaped, often compressed, glands and small clusters of epithelial cells embedded in a cellular, often myxoid stroma. Mild cytologic atypia was occasionally present, and one case had moderate cytologic atypia. A distinct basement membrane often surrounded the glands and clusters. Luminal acid mucin was typically present. Keratin-positive basal cells were present in the glands and as spindle cells in the stroma. The basal cells were also immunoreactive for S-100 and muscle-specific actin, suggesting myoepithelial differentiation. Clinical follow-up has shown no evidence of prostatic carcinoma. The available evidence suggests that sclerosing adenosis of the prostate gland is a benign lesion with distinctive features that should enable it to be distinguished from prostatic adenocarcinoma.