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Bingxin Ma,1 Gang Wu,1 Haohui Zhu,1 Yifei Liu,1 Wenjia Hu,1 Jing Zhao,1 Yinlong Liu,1 Qiuyu Liu2 1Department of Ultrasound, Henan Provincial People’s Hospital, Zhengzhou, 450000, People’s Republic of China; 2Department of Pathology, Henan Provincial People’s Hospital, Zhengzhou, 450000, People’s Republic of ChinaCorrespondence: Gang Wu, Email drwugang325@126.com; Haohui Zhu, Email zhh761126@163.comObjective: The study aimed to apply an artificial intelligence (AI)-assisted scoring system, and improve the diagnostic efficiency of Sclerosing adenosis and early breast cancer.Methods: This study retrospectively collected adenopathy patients (156 cases) and early breast cancer patients (150 cases) in Henan Provincial People’s Hospital from August 2020 to April 2023.Results: The area under the curve of the model constructed by clinical ultrasound features and combined AI features to predict and identify the two in the training group was 0.89 and 0.94, respectively. The combined AI model with the best performance (training AUC, 0.94, 95% CI, 0.91– 0.97 and validation AUC, 0.95, 95% CI, 0.90– 0.99) was superior to the clinical ultrasound feature model, and the decision curve also showed that the clinical ultrasound combined with AI Nomogram had good clinical practicability. In the training group, the AUC of the sonographer and AI in differential diagnosis was 0.67(95% CI, 0.62– 0.71) and 0.89(95% CI, 0.84– 0.93), respectively, and the sonographer’s assessment showed better sensitivity (1.00 VS 0.73), but AI showed a higher accuracy rate (0.66 VS 0.80).Conclusion: Age, lesion size, burr, blood flow, and AI risk score are independent predictors of sclerosing adenosis and early breast cancer. The combined clinical ultrasound feature and AI model are correlated with AI risk score, US routine features, and clinical data, superior to the clinical ultrasound model and BI-RADS grading, and have good diagnostic performance, which can provide clinicians with a more effective diagnostic tool.Keywords: sclerosing adenosis, breast tumor, ultrasound, AI, computer-aided diagnosis

Sclerosing adenosis (SA) is a subtype of adenosis characterized by proliferative adenosis and stromal sclerosis with distortion of the terminal ductal lobular unit. Although SA is the most prevalent benign breast condition among middle‐aged women, it may be associated with a two‐fold increase in breast cancer risk. Microscopic findings of ductal carcinoma in situ (DCIS) in a SA (SA‐DCIS) may mimic microinvasive carcinoma or even invasive carcinoma, which may result in overtreatment by a breast surgeon. Therefore, pathological evaluation must be performed carefully in such cases to establish a definitive diagnosis. Herein, we present a rare case of SA‐DCIS that mimicked microinvasive ductal carcinoma. A 51‐year‐old woman was diagnosed with high‐grade DCIS of the left breast, highly suspicious for microinvasion, based on core biopsy. She underwent mastectomy of the left breast and prophylactic mastectomy of the right breast for personal reasons after imaging evaluation, including mammography and ultrasonography. However, the final diagnosis was bilateral intermediate‐grade DCIS, characterized by the presence of intraductal carcinoma cells exhibiting enlarged hyperchromatic nuclei and a high nuclear‐to‐cytoplasmic ratio within the mammary ducts. However, the diagnosis was incompatible with the initial pathological results. A‐DCIS has pathological features similar to those of microinvasive or invasive carcinomas. Thoroughly evaluating biopsy findings of lesions to distinguish between SA‐DCIS and invasive carcinoma is crucial to prevent overdiagnosis and unnecessary management in patients with DCIS. Patients diagnosed with SA‐DCIS are at a higher risk of developing bilateral breast cancer than those without SA‐DCIS. [ABSTRACT FROM AUTHOR]

Sclerosing lesions of the breast encompass a spectrum of benign and malignant entities and often pose a diagnostic challenge. Awareness of key morphologic features and pitfalls in the assessment of morphology and immunophenotype is essential to avoid over‐ or underdiagnosis and ensure optimal clinical management. This review summarizes nonneoplastic sclerosing lesions such as radial scar/complex sclerosing lesion, sclerosing adenosis, sclerosing intraductal papilloma, sclerosing variants of ductal adenoma and nipple adenoma, and fibroadenoma with extensive sclerosis, including their clinical presentation, characteristic morphology, differential diagnostic considerations, appropriate immunohistochemical work‐up, when needed, and the clinical significance. In addition, atypical or neoplastic entities (such as atypical ductal hyperplasia, ductal carcinoma in situ, low‐grade adenosquamous carcinoma, and fibromatosis‐like metaplastic carcinoma) that can involve these sclerosing lesions are also briefly discussed. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical and ultrasonic characteristics of breast sclerosing adenosis (SA) and invasive ductal carcinoma (IDC), and construct a predictive nomogram for SA. Materials and methods: A total of 865 patients were recruited at the Second Hospital of Shandong University from January 2016 to November 2022. All patients underwent routine breast ultrasound examinations before surgery, and the diagnosis was confirmed by histopathological examination following the operation. Ultrasonic features were recorded using the Breast Imaging Data and Reporting System (BI-RADS). Of the 865 patients, 203 (252 nodules) were diagnosed as SA and 662 (731 nodules) as IDC. They were randomly divided into a training set and a validation set at a ratio of 6:4. Lastly, the difference in clinical characteristics and ultrasonic features were comparatively analyzed. Result: There was a statistically significant difference in multiple clinical and ultrasonic features between SA and IDC (P<0.05). As age and lesion size increased, the probability of SA significantly decreased, with a cut-off value of 36 years old and 10 mm, respectively. In the logistic regression analysis of the training set, age, nodule size, menopausal status, clinical symptoms, palpability of lesions, margins, internal echo, color Doppler flow imaging (CDFI) grading, and resistance index (RI) were statistically significant (P<0.05). These indicators were included in the static and dynamic nomogram model, which showed high predictive performance, calibration and clinical value in both the training and validation sets. Conclusion: SA should be suspected in asymptomatic young women, especially those younger than 36 years of age, who present with small-size lesions (especially less than 10 mm) with distinct margins, homogeneous internal echo, and lack of blood supply. The nomogram model can provide a more convenient tool for clinicians. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to develop an ultrasound-based radiomics model to distinguish between sclerosing adenosis (SA) and invasive ductal carcinoma (IDC) to avoid misdiagnosis and unnecessary biopsies. Methods: From January 2020 to March 2022, 345 cases of SA or IDC that were pathologically confirmed were included in the study. All participants underwent pre-surgical ultrasound (US), from which clinical information and ultrasound images were collected. The patients from the study population were randomly divided into a training cohort (n = 208) and a validation cohort (n = 137). The US images were imported into MaZda software (Version 4.2.6.0) to delineate the region of interest (ROI) and extract features. Intragroup correlation coefficient (ICC) was used to evaluate the consistency of the extracted features. The least absolute shrinkage and selection operator (LASSO) logistic regression and crossvalidation were performed to obtain the radiomics score of the features. Based on univariate and multivariate logistic regression analyses, a model was developed. 56 cases from April 2022 to December 2022 were included for independent validation of the model. The diagnostic performance of the model and the radiomics scores were evaluated by performing the receiver operating characteristic (ROC) analysis. The calibration curve and decision curve analysis (DCA) were used for calibration and evaluation. Leave-One-Out Cross-Validation (LOOCV) was used for the stability of the model. Results: Three predictors were selected to develop the model, including radiomics score, palpable mass and BI-RADS. In the training cohort, validation cohort and independent validation cohort, AUC of the model and radiomics score were 0.978 and 0.907, 0.946 and 0.886, 0.951 and 0.779, respectively. The model showed a statistically significant difference compared with the radiomics score (p<0.05). The Kappa value of the model was 0.79 based on LOOCV. The Brier score, calibration curve, and DCA showed the model had a good calibration and clinical usefulness. Conclusions: The model based on radiomics, ultrasonic features, and clinical manifestations can be used to distinguish SA from IDC, which showed good stability and diagnostic performance. The model can be considered a potential candidate diagnostic tool for breast lesions and can contribute to effective clinical diagnosis. [ABSTRACT FROM AUTHOR]

Aim: To explore the diagnostic value of multimodal imaging techniques, including automatic breast volume scanner (ABVS), mammography (MG), and magnetic resonance (MRI) in breast sclerosing adenosis (SA) associated with malignant lesions. Methods: From January 2018 to October 2020, 76 patients (88 lesions) with pathologically confirmed as SA associated with malignant or benign lesions were retrospective analyzed. All patients completed ABVS examination, 58 patients (67 lesions) with MG and 50 patients (62 lesions) with MRI were also completed before biopsy or surgical excision, of which, six patients (eight lesions) diagnosed as Breast Imaging Reporting and Data System (BI‐RADS) category 3 by all imaging examinations underwent surgical excision without biopsy, other 70 patients (80 lesions) with BI‐RADS category 4 or above by any imaging examination completed biopsy, including 65 patients (75 lesions) were further surgical excised and the other five patients (five lesions) were just followed up. All lesions were retrospectively described and classified, and were divided into benign group and malignant group according to their pathological results. Image features of different examination methods between the two groups were compared and analyzed. A ROC curve was established using the sensitivity of BI‐RADS categories to predict malignant lesions in different imaging techniques as the ordinate and 1‐specificity as the abscissa. Results: 88 lesions including 26 purely SA and 45 SA associated with benign lesions were classified as benign group, and the remaining 17 SA associated with malignant lesions were classified as malignant group. On ABVS, 40 mass lesions, their heterogeneous echo, not circumscribed margin and coronal convergence signs were statistically significant for malignant lesions (p <.05), but the remain 48 nonmass lesions lack specific sonographic features. On MG, 12 showed negative results, 55 showed with microcalcification, mass, structural distortion, and asymmetric density shadow, of which 11 lesions had the above two signs at the same time, but only microcalcification had statistical difference between the two groups. 35 mass enhanced lesions and 27 nonmass enhanced lesions on MRI, but there were no significant difference between their pathological results. Time signal intensity curves showed no differences, but ADC value <1.10 × 10−3 mm2/s is more significant in malignant lesions (p <.05). The area under the ROC curve (AUC) of BI‐RADS classification of ABVS, MG, and MRI in the diagnosis of malignant lesions were 0.611, 0.474, and 0.751, respectively, and the AUC of the combined diagnosis of the three was 0.761. Conclusion: Mass lesions with heterogeneous echo, not circumscribed margin and coronal convergence sign on ABVS, microcalcification on MG and the ADC value <1.10 × 10−3 mm2/s on MRI are significant signs for SA associated with malignant lesions. The combined diagnosis of the three methods was the highest, and the following were MRI, ABVS, and MG. Therefore, be cognizant of significant characteristics in SA associated with malignancy showed in different imaging examinations can improve the preoperative evaluation of SA and better provide basis for subsequent clinical decision‐making. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of our study is to present a method combining radiomics with deep learning and clinical data for improved differential diagnosis of sclerosing adenosis (SA)and breast cancer (BC). METHODS: A total of 97 patients with SA and 100 patients with BC were included in this study. The best model for classification was selected from among four different convolutional neural network (CNN) models, including Vgg16, Resnet18, Resnet50, and Desenet121. The intra-/inter-class correlation coefficient and least absolute shrinkage and selection operator method were used for radiomics feature selection. The clinical features selected were patient age and nodule size. The overall accuracy, sensitivity, specificity, Youden index, positive predictive value, negative predictive value, and area under curve (AUC) value were calculated for comparison of diagnostic efficacy. RESULTS: All the CNN models combined with radiomics and clinical data were significantly superior to CNN models only. The Desenet121+radiomics+clinical data model showed the best classification performance with an accuracy of 86.80%, sensitivity of 87.60%, specificity of 86.20% and AUC of 0.915, which was better than that of the CNN model only, which had an accuracy of 85.23%, sensitivity of 85.48%, specificity of 85.02%, and AUC of 0.870. In comparison, the diagnostic accuracy, sensitivity, specificity, and AUC value for breast radiologists were 72.08%, 100%, 43.30%, and 0.716, respectively. CONCLUSIONS: A combination of the CNN-radiomics model and clinical data could be a helpful auxiliary diagnostic tool for distinguishing between SA and BC. [ABSTRACT FROM AUTHOR]

Sclerosing adenosis of the prostate (SAP) is a rare benign non-neoplastic small acinar hyperplasia. Like sclerosing adenosis of the breast, which is confused with breast cancer, SAP is a trap in the pathological differential diagnosis of benign and malignant lesions of the prostate. We report such a case to help colleagues better distinguish and diagnose such diseases. A 75-year-old patient with SAP had a prostate specific antigen (PSA) level of 11.0 ng/mL, and he had been suffering from progressive dysuria for 3 years. The central glandular area and the right periphery of the prostate were found to have nodular low signals on magnetic resonance imaging (MRI). Prostate biopsy showed that basal cells were positive for P63 and P504s, few basal cells were positive for S-100, and the positive rate of Ki67 was approximately 2%. We consider that the possibility of SAP is high. The patient was treated conservatively and was discharged in good health, free of dysuria and other problems. SAP is a rare benign lesion that is easily misdiagnosed as prostate cancer. The prostatic gland tube has a complete basal cell layer surrounding it, as well as myoepithelial cell metaplasia of basal cells, which is a key trait in distinguishing it from prostate cancer. Although the latest research indicates that SAP does not require treatment, the question of whether it is a risk factor for prostate cancer remains unanswered. [ABSTRACT FROM AUTHOR]

Purpose: Sclerosing adenosis (SA) is a benign lesion that could mimic breast carcinoma and be evaluated as malignancy by Breast Imaging-Reporting and Data System (BI-RADS) analysis. We aimed to construct and validate the performance of radiomic model based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) compared to BI-RADS analysis to identify SA. Methods: Sixty-seven patients with invasive ductal carcinoma (IDC) and 58 patients with SA were included in this retrospective study from two institutions. The 125 patients were divided into a training cohort (n= 88) from institution I and a validation cohort from institution II (n=37). Dynamic contrast-enhanced sequences including one pre-contrast and five dynamic post-contrast series were obtained for all cases with different 3T scanners. Single-phase enhancement, multi-phase enhancement, and dynamic radiomic features were extracted from DCE-MRI. The least absolute shrinkage and selection operator (LASSO) logistic regression and cross-validation was performed to build the radscore of each single-phase enhancement and the final model combined multi-phase and dynamic radiomic features. The diagnostic performance of radiomics was evaluated by receiver operating characteristic (ROC) analysis and compared to the performance of BI-RADS analysis. The classification performance was tested using external validation. Results: In the training cohort, the AUCs of BI-RADS analysis were 0.71 (95%CI [0.60, 0.80]), 0.78 (95%CI [0.67, 0.86]), and 0.80 (95%CI [0.70, 0.88]), respectively. In single-phase analysis, the second enhanced phase radiomic signature achieved the highest AUC of 0.88 (95%CI [0.79, 0.94]) in distinguishing SA from IDC. Nine multi-phase radiomic features and two dynamic radiomic features showed the best predictive ability for final model building. The final model improved the AUC to 0.92 (95%CI [0.84, 0.97]), and showed statistically significant differences with BI-RADS analysis (p <0.05 for all). In the validation cohort, the AUC of the final model was 0.90 (95%CI [0.75, 0.97]), which was higher than all BI-RADS analyses and showed statistically significant differences with one of the BI-RADS analysis observers (p = 0.03). Conclusions: Radiomics based on DCE-MRI could show better diagnostic performance compared to BI-RADS analysis in differentiating SA from IDC, which may contribute to clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

PurposeSclerosing adenosis (SA) is a benign lesion that could mimic breast carcinoma and be evaluated as malignancy by Breast Imaging-Reporting and Data System (BI-RADS) analysis. We aimed to construct and validate the performance of radiomic model based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) compared to BI-RADS analysis to identify SA.MethodsSixty-seven patients with invasive ductal carcinoma (IDC) and 58 patients with SA were included in this retrospective study from two institutions. The 125 patients were divided into a training cohort (n= 88) from institution I and a validation cohort from institution II (n=37). Dynamic contrast-enhanced sequences including one pre-contrast and five dynamic post-contrast series were obtained for all cases with different 3T scanners. Single-phase enhancement, multi-phase enhancement, and dynamic radiomic features were extracted from DCE-MRI. The least absolute shrinkage and selection operator (LASSO) logistic regression and cross-validation was performed to build the radscore of each single-phase enhancement and the final model combined multi-phase and dynamic radiomic features. The diagnostic performance of radiomics was evaluated by receiver operating characteristic (ROC) analysis and compared to the performance of BI-RADS analysis. The classification performance was tested using external validation.ResultsIn the training cohort, the AUCs of BI-RADS analysis were 0.71 (95%CI [0.60, 0.80]), 0.78 (95%CI [0.67, 0.86]), and 0.80 (95%CI [0.70, 0.88]), respectively. In single-phase analysis, the second enhanced phase radiomic signature achieved the highest AUC of 0.88 (95%CI [0.79, 0.94]) in distinguishing SA from IDC. Nine multi-phase radiomic features and two dynamic radiomic features showed the best predictive ability for final model building. The final model improved the AUC to 0.92 (95%CI [0.84, 0.97]), and showed statistically significant differences with BI-RADS analysis (p

Background: Sclerosing adenosis (SA) is a benign lesion with complicated pathological components and could mimic breast carcinoma in both clinical palpation and medical imaging findings. The present study was conducted to assess the value of ultrasound (US) characteristics in diagnosing SA and their differentiation from breast carcinoma. Methods: We retrospectively reviewed the medical records of 305 women (347 lesions) with invasive ductal carcinoma (IDC) and 54 women with single SA lesion, who had breast excision between April 2016 and July 2018. US BI-RADS atlas and elastography were applied and their associated characteristics were compared between SA and IDC. Results: The mean age of SA was younger than that of IDC (43.6 ± 7.4 vs 53.2 ± 10.3, P < 0.001). Compared to IDC, SA had more frequency of parallel orientation (94.44% vs 71.76%, P < 0.001) and circumscribed margin (48.15% vs 4.90%, P < 0.001), less frequency of irregular shape (64.81% vs 95.97%, P < 0.001), hypoechoic echotexture (88.89% vs 98.27%, P = 0.002), calcification (12.96% vs 55.04%, P < 0.001), and posterior acoustic changes (3.70% vs 53.89%, P < 0.001) or associated features (architectural distortion, 3.70% vs 59.65%, P < 0.001; duct changes, 18.52% vs 63.40%, P < 0.001). Vascularity absence was more common in SA compared to IDC (35.19% vs 6.63%, P < 0.001). And the elasticity score was lower in SA (2.38 ± 0.60 vs 3.91 ± 0.81, P < 0.001). After adjusting for age, we found spiculated margin, posterior shadowing, calcification, architectural distortion, and vascularity could independently identify the differences between these two entities. After involving elasticity score, the calcification and vascularity could still be independent indicators for differential diagnosis. Conclusion: Understanding SA imaging features will enable radiologists to communicate results to the referring physician consistently, which could benefit a reliable assessment and specific management recommendations. A systematic evaluation of the US BI-RADS atlas together with breast elastography may be a powerful tool to identify SA and differentiate it from breast cancer. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Granular cell tumor is a rare neoplasm that has been reported in a variety of organs, including the tongue, oral cavity, and subcutaneous tissue. However, breast is an unusual location for this tumor. Most granular cell tumors present as solitary lesions in the breast. There are a few cases of granular cell tumor of the breast, that have been reported, associated with other breast tumors, such as invasive or in situ ductal carcinoma. Because these tumors can mimic invasive breast cancer both with their clinical and radiological findings, they should always be kept in mind in order to avoid misdiagnosis, and prevent unnecessary treatment modalities. Herein, we present a rare case of granular cell tumor of the breast with associated hyalinized fibroadenoma, florid ductal epithelial hyperplasia and sclerosing adenosis, in a 58 year-old female.

Objetivo: revisar las bases histológicas y los criterios diagnósticos diferenciales de la aplicación de la inmunohistoquímica en la patología mamaria. Caso clínico: se presenta el caso de una paciente con lesión mamaria esclerosante compleja, tipo adenosis microglandular (MGA), que requirió el uso de inmunohistoquímica como técnica auxiliar para diferenciar la lesión de un adenocarcinoma de mama in situ, y definir así el tratamiento. Materiales y métodos: se realizó una búsqueda de la información en las bases de datos Medline vía PubMed, SciELO y en libros de la especialidad. Se reportaron 25 títulos, 12 correspondían con el tema: 4 reportes de caso, 1 con revisión de la literatura, una carta al editor y 7 artículos relacionados de forma más general con el tema. Conclusión: la inmunohistoquímica permite hacer el diagnóstico diferencial de las lesiones mamarias complejas, como la adenosis esclerosante y el cáncer de mama in situ o microinvasor.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.

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. [ABSTRACT FROM AUTHOR]

Sclerosing Adenosis (SA) is a lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast suggesting benignity. The disease has an increased incidence among reproductive-age and perimenopausal women, especially between 35 and 50 years of age. The clinical, radiological, and histopathological properties of sclerosing adenosis may resemble malignancy, which is the factor responsible for the clinical significance of the disease. Early diagnosis of sclerosing adenosis (SA) is very important as it is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be controversial and unclear. The main histopathological alterations of the terminal ductal lobular unit (TDLU) present as a widening and distortion of lobules with an increased number of acini and stromal fibrosis. The lesion is also called an "adenosis tumor of the breast" or "nodular sclerosing adenosis" if it presents as a palpable mass. Sclerosing adenosis is present in 12% of benign proliferative lesions and 20-25% of malignant lesions on histopathological examination. On mammography (MG), it can present as opacity, focal asymmetry, architectural distortion, or micro calcifications, mimicking a carcinoma. We have presented a case of 42 year old female who was diagnosed as carcinoma breast clinically and on radiology. Mammography showed a fibrosed lesion of size 4.5x3 cm with focal specks of microcalcification and irregular borders. But repeated fine needle aspiration cytology (FNAC) smears revealed small and large clusters of ductal epithelial cells with minimal anisonucleosis with background showing amorphous crystalline material and stromal fragments. Basing on FNAC, plan of surgery changed and a wide local excision with 2 cm normal margins was done and the specimen sent for histopathological examination (HPE), which revealed the lesion as sclerosing adenosis (SA). [ABSTRACT FROM AUTHOR]

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 < 0.001) increase in frequency of harboring bilateral and multicentric cancers [17 of 63 (27 %) and 15 of 63 (24 %), respectively] when compared to breast cancer patients without SA, regardless of topographical type. Breast cancers with SA were less invasive ( P < 0.001), of lower histological grade ( P = 0.034), and had similar frequency of estrogen receptor-positive ( P = 0.21) and HER2-positive ( P = 0.74) tumors. In conclusion, contralateral and ipsilateral multicentric breast cancers occurred at a higher frequency in those with SA. Our data suggest that SA is, in addition to lobular neoplasia, a predictor of multicentric breast cancers. [ABSTRACT FROM AUTHOR]

Sclerosing adenosis (SA) increases risk for invasive breast cancer (BC) 2.1 times relative to that in the general population. Here, we sought to evaluate whether the proliferation marker Ki-67 stratifies risk among women with SA. A nested case-control sample of patients with SA was obtained from the Mayo Clinic Benign Breast Disease Cohort. Ki-67 expression was evaluated in SA lesions and in the adjacent normal terminal duct lobular units (TDLU) in women who did (cases, n = 133) or did not (controls, n = 239) develop BC. Ki-67 was scored by intensity and number of positively stained cells per one high-power field (magnification, ×40) (40× HPF) for both SA and normal TDLU. Associations of Ki-67 expression with case-control status were assessed using conditional logistic regression. Higher Ki-67 expression was significantly associated with case-control status in both SA ( P = 0.03) and normal background TDLU ( P = 0.006 ). For the SA lesion, >2 average positively stained cells/40× HPF showed an adjusted odds ratio (OR) of 1.9 (95 % CI, 1.1-3.4) compared to samples with an average of ≤2 positively stained cells. For background TDLU, lobules with >2 but ≤6 average positively stained cells showed an adjusted OR of 1.3-1.5, whereas those with an average of >6 positively stained cells had an OR of 2.4 (95 % CI, 1.1-5.3) compared to those with an average of <2 positively stained cells. Among women with SA, increased Ki-67 expression in either the SA lesion or the normal background TDLU carried an approximately twofold increased odds of subsequent BC as compared to lower Ki-67 expression. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Benign breast disease (BBD) accounts for the majority (90%) of referrals to a breast clinic. It therefore represents a significant part of a breast surgeon''s workload. With a solid understanding of the causes for BBD and the use of triple assessment to exclude breast cancer, a great deal can be done to accurately diagnose the condition and provide adequate explanation and treatment options. These patients are very anxious about their condition and need to be managed in the setting of a multidisciplinary team. With an increase in patient awareness and expectations the number of such referrals is expected to increase. For simplicity BBD is sub-divided into three categories – congenital, aberrations of normal breast development and involution (ANDI) and non-ANDI. This article will discuss each category separately and discuss the current methods of assessment and management of these conditions. [Copyright &y& Elsevier]

We retrospectively reviewed 25 fine-needle aspiration cases of sclerosing adenosis of the breast in conjunction with histologic features of the paired coreneedle biopsy and radiologic findings. The original cytologic diagnoses were benign (n = 19), focally atypical (n = 3), and suspicious for carcinoma (n = 3). The frequent features, although not specific, were low-to-moderate cellularity, bland epithelial cells that focally formed cohesive groups/tubules or occasionally discohesive clusters or individual cells, and fragments of dense fibrous stroma. Some tubules had an angulated configuration. Myoepithelial cells were present in all cases but were scant or absent in small epithelial groups. These cytologic features closely reflected the histologic appearances (ie, compressed and attenuated tubules and sclerotic stroma), but may cause overinterpretation on cytologic smears, especially when angulated tubules, discohesive or individual epithelial cells, scanty myoepithelial cells, and nuclear atypia are noted concurrently. Familiarity with its cytologic features may prevent false-positive diagnosis. Histologic confirmation is recommended for difficult cases. [ABSTRACT FROM AUTHOR]

Granular cell tumor is a rare neoplasm that has been reported in a variety of organs, including the tongue, oral cavity, and subcutaneous tissue. However, breast is an unusual location for this tumor. Most granular cell tumors present as solitary lesions in the breast. There are a few cases of granular cell tumor of the breast, that have been reported, associated with other breast tumors, such as invasive or in situ ductal carcinoma. Because these tumors can mimic invasive breast cancer both with their clinical and radiological findings, they should always be kept in mind in order to avoid misdiagnosis, and prevent unnecessary treatment modalities. Herein, we present a rare case of granular cell tumor of the breast with associated hyalinized fibroadenoma, florid ductal epithelial hyperplasia and sclerosing adenosis, in a 58 year-old female. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Moritani S, Ichihara S, Hasegawa M, Endo T, Oiwa M, Shiraiwa M, Nishida C, Morita T, Sato Y, Hayashi T, Kato A, Aoyama H & Yoshikawa K (2011) Histopathology , 835-846 To examine the histopathological features of 24 surgically resected carcinoma in situ (CIS) involving sclerosing adenosis (SA), with special reference to the topographical relationship between CIS and SA. In 13 (54%) lesions, CIS was entirely surrounded by SA (type A) and in 11 (46%), CIS involved SA at least focally but was not confined to the SA area (type B). The mean size of CIS in type B (30.45 mm) was significantly larger than in type A (18.00 mm). The mean size of SA in type A (39.46 mm) was significantly larger than in type B (19.54 mm). Most type A CIS were non-high-grade, and the oestrogen receptor (ER)(+)/progesterone receptor (PgR)(+)/HER2(−) immunophenotype predominated. Most type B CIS were high-grade and six (54%) were ER(−)/PgR(−). Most type A were bcl-2(+)/p53(−) in both SA and CIS areas, but two (18%) apocrine ductal CIS of type B were bcl-2(−)/p53(+) in both SA and CIS areas. Expression of ER and cyclin D1 in SA was not different from that of SA unassociated with cancer. Most CIS involving SA arises within SA and high-grade DCIS tends to grow beyond SA. Occasional CIS may arise outside SA and secondarily involve SA. [ABSTRACT FROM AUTHOR]

Hybrid sclerosing adenosis and basal cell hyperplasia of the prostate is a rare lesion. Here we report the seventh case of such lesions. Histological examination of the transurethral resection of the prostate of a 83-year-old Japanese man showed a small lesion consisted of sclerosing adenosis and basal cell hyperplasia, in addition to the diffuse glandular and fibromuscular hyperplasia. Immunohistochemically, many basal cells in sclerosing adenosis and basal cell hyperplasia areas showed a positive reaction for p63, cytokeratin 5, and D2-40. Additionally, many basal cells in the sclerosing adenosis area and some basal cells in the basal cell hyperplasia area were positive for S-100 protein and alpha-smooth muscle actin, which are myoepithelial cell markers. Finally, we suggest that hybrid sclerosing adenosis and basal cell hyperplasia may be actually a special form of hyperplastic lesion of all components of prostatic tissue, reflecting the unbalanced distribution of glandular, stromal (sclerosing adenosis), and basal cell hyperplasia with the differentiation toward myoepithelial cells predominantly occurring in a sclerosing adenosis area. Additionally, this case showed that D2-40 is a useful marker of basal cells. [ABSTRACT FROM AUTHOR]