Sclerosing adenosis (SA) is a benign proliferative condition of the terminal duct lobular units characterized by an increased number of acini and their glands. It manifests as multiple small, firm, tender nodules, fibrous tissue, and variable microcysts within the breast. It is sometimes placed under the category of borderline breast disease.

Clinical Presentation

Many women with sclerosing adenosis experience recurring pain that tends to be linked to the menstrual cycle.

In most cases, sclerosing adenosis is detected during routine mammograms or following breast surgery. A biopsy is required to confirm the diagnosis, because the condition may be difficult to distinguish from breast cancer by imaging.

Sclerosing adenosis can appear as a focal or diffuse lesion. It is not physically palpable in 80% of the cases, although in some cases may cause skin retraction.

Pathology

Sclerosing adenosis is a type of adenosis in which enlarged acini become slightly distorted by surrounded stromal fibrosis ("sclerosis"). The normal lobular architecture of the breast is maintained but becomes exaggerated and distorted.

Associations

Sclerosing adenosis can be seen as a component of other proliferative lesions:

• intraductal and/or sclerosing papilloma
• complex sclerosing lesion
• fibroadenoma
• breast cancer, both invasive and in situ 

Radiographic features

Mammography

Sclerosing adenosis has a wide range of mammographic presentations, and can be difficult to distinguish from an infiltrating carcinoma:

• mass, with irregular to well-defined contours
• architectural distortion
• microcalcifications
  • present in 40-55% of cases 5,6
  • may be amorphous, pleomorphic, or punctate 3,5
  • more commonly clustered, although may present in diffuse scattered distribution 3,5

Diagnosis

If many enlarged lobules are close to one another, they may be large enough to be felt as a breast lump. In cases like this, a breast exam may not be enough to tell if the lump is adenosis or a breast cancer.

Calcifications (mineral deposits) can form in adenosis (including sclerosing adenosis) and in breast cancers. These can show up on mammograms, which can make it hard to tell these conditions apart.

Because of these uncertainties, a biopsy is usually needed to know if the breast change is caused by adenosis or cancer. (In a biopsy, small piece of breast tissue are removed and checked under a microscope.)

Treatment

Adenosis does not usually need to be treated, unless it is causing bothersome symptoms.

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Eliza Grace

Journal Manager

Journal of Surgical Pathology and Diagnosis