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Adenosis, Sclerosing Adenosis, Microglandular Adenosis
Nicole S. Winkler, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Nodular adenosis = tumoral adenosis
            • Definitions

              • Adenosis: Benign proliferation of lobular glandular elements with increased number of acini/ductules relative to surrounding tissue
                • Nodular subtypes form solid masses (nodular adenosis, adenosis tumor)
                • Part of spectrum of fibrocystic change, together with fibrosis and cysts
              • Sclerosing adenosis (SA): Adenosis + intervening stromal fibrosis compressing and distorting acini
              • Microglandular adenosis (MGA): Extremely rare variant of adenosis
                • Proliferation of ductules with single epithelial cell layer infiltrative pattern
                • Only benign epithelial lesion that lacks myoepithelial cell layer but retains basement membrane
                • May represent nonobligate precursor to triple-negative breast cancer

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Image-Guided Biopsy

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Bahl M et al: Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol. 209(5):1162-1167, 2017
                                            2. Hicks and Lester: Diagnostic Pathology: Breast 2nd Edition. Philadelphia: Elsevier. 126-133, 2016
                                            3. Visscher DW et al: Sclerosing adenosis and risk of breast cancer. Breast Cancer Res Treat. 144(1):205-12, 2014
                                            4. Eusebi V et al. Tumours of the nipple. In: Lakhani SR et al. WHO Classification of Tumours of the Breast. 4th Edition Lyon, France: IARC; 2012
                                            5. Wen YH et al: Microglandular adenosis: a non-obligate precursor of triple-negative breast cancer? Histol Histopathol. Epub ahead of print, 2013
                                            6. Shin SJ et al: Molecular evidence for progression of microglandular adenosis (MGA) to invasive carcinoma. Am J Surg Pathol. 33(4):496-504, 2009
                                            7. Khalifeh IM et al: Clinical, histopathologic, and immunohistochemical features of microglandular adenosis and transition into in situ and invasive carcinoma. Am J Surg Pathol. 32(4):544-52, 2008
                                            8. Salarieh A et al: Breast carcinoma arising in microglandular adenosis: a review of the literature. Arch Pathol Lab Med. 131(9):1397-9, 2007
                                            9. Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: Elsevier Saunders. 439-42, 2005
                                            10. Guinebretière JM et al: Normal and pathological breast, the histological basis. Eur J Radiol. 54(1):6-14, 2005
                                            11. Markopoulos C et al: Adenosis tumor of the breast. Breast J. 9(3):255-6, 2003
                                            12. Gill HK et al: When is a diagnosis of sclerosing adenosis acceptable at core biopsy? Radiology. 228(1):50-7, 2003
                                            13. Resetkova E et al: Ten-year follow-up of mammary carcinoma arising in microglandular adenosis treated with breast conservation. Arch Pathol Lab Med. 127(1):77-80, 2003
                                            14. Günhan-Bilgen I et al: Sclerosing adenosis: mammographic and ultrasonographic findings with clinical and histopathological correlation. Eur J Radiol. 44(3):232-8, 2002
                                            15. Sabaté JM et al: Microglandular adenosis of the breast in a BRCA1 mutation carrier: radiological features. Eur Radiol. 12(6):1479-82, 2002
                                            16. Rosen PP: Rosen's Breast Pathology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins. 139-51, 2001
                                            17. DiPiro PJ et al: Mammographic and sonographic appearances of nodular adenosis. AJR Am J Roentgenol. 175(1):31-4, 2000
                                            18. Cyrlak D et al: Breast imaging case of the day. Florid sclerosing adenosis. Radiographics. 19(1):245-7, 1999
                                            19. Jensen RA et al: Invasive breast cancer risk in women with sclerosing adenosis. Cancer. 64(10):1977-83, 1989
                                            20. Rosen PP: Microglandular adenosis. A benign lesion simulating invasive mammary carcinoma. Am J Surg Pathol. 7(2):137-44, 1983
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Nodular adenosis = tumoral adenosis
                                                      • Definitions

                                                        • Adenosis: Benign proliferation of lobular glandular elements with increased number of acini/ductules relative to surrounding tissue
                                                          • Nodular subtypes form solid masses (nodular adenosis, adenosis tumor)
                                                          • Part of spectrum of fibrocystic change, together with fibrosis and cysts
                                                        • Sclerosing adenosis (SA): Adenosis + intervening stromal fibrosis compressing and distorting acini
                                                        • Microglandular adenosis (MGA): Extremely rare variant of adenosis
                                                          • Proliferation of ductules with single epithelial cell layer infiltrative pattern
                                                          • Only benign epithelial lesion that lacks myoepithelial cell layer but retains basement membrane
                                                          • May represent nonobligate precursor to triple-negative breast cancer

                                                      IMAGING

                                                      • General Features

                                                        • Mammographic Findings

                                                          • Ultrasonographic Findings

                                                            • MR Findings

                                                              • Image-Guided Biopsy

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Bahl M et al: Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol. 209(5):1162-1167, 2017
                                                                                      2. Hicks and Lester: Diagnostic Pathology: Breast 2nd Edition. Philadelphia: Elsevier. 126-133, 2016
                                                                                      3. Visscher DW et al: Sclerosing adenosis and risk of breast cancer. Breast Cancer Res Treat. 144(1):205-12, 2014
                                                                                      4. Eusebi V et al. Tumours of the nipple. In: Lakhani SR et al. WHO Classification of Tumours of the Breast. 4th Edition Lyon, France: IARC; 2012
                                                                                      5. Wen YH et al: Microglandular adenosis: a non-obligate precursor of triple-negative breast cancer? Histol Histopathol. Epub ahead of print, 2013
                                                                                      6. Shin SJ et al: Molecular evidence for progression of microglandular adenosis (MGA) to invasive carcinoma. Am J Surg Pathol. 33(4):496-504, 2009
                                                                                      7. Khalifeh IM et al: Clinical, histopathologic, and immunohistochemical features of microglandular adenosis and transition into in situ and invasive carcinoma. Am J Surg Pathol. 32(4):544-52, 2008
                                                                                      8. Salarieh A et al: Breast carcinoma arising in microglandular adenosis: a review of the literature. Arch Pathol Lab Med. 131(9):1397-9, 2007
                                                                                      9. Bassett LW et al: Diagnosis of Diseases of the Breast. 2nd ed. Philadelphia: Elsevier Saunders. 439-42, 2005
                                                                                      10. Guinebretière JM et al: Normal and pathological breast, the histological basis. Eur J Radiol. 54(1):6-14, 2005
                                                                                      11. Markopoulos C et al: Adenosis tumor of the breast. Breast J. 9(3):255-6, 2003
                                                                                      12. Gill HK et al: When is a diagnosis of sclerosing adenosis acceptable at core biopsy? Radiology. 228(1):50-7, 2003
                                                                                      13. Resetkova E et al: Ten-year follow-up of mammary carcinoma arising in microglandular adenosis treated with breast conservation. Arch Pathol Lab Med. 127(1):77-80, 2003
                                                                                      14. Günhan-Bilgen I et al: Sclerosing adenosis: mammographic and ultrasonographic findings with clinical and histopathological correlation. Eur J Radiol. 44(3):232-8, 2002
                                                                                      15. Sabaté JM et al: Microglandular adenosis of the breast in a BRCA1 mutation carrier: radiological features. Eur Radiol. 12(6):1479-82, 2002
                                                                                      16. Rosen PP: Rosen's Breast Pathology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins. 139-51, 2001
                                                                                      17. DiPiro PJ et al: Mammographic and sonographic appearances of nodular adenosis. AJR Am J Roentgenol. 175(1):31-4, 2000
                                                                                      18. Cyrlak D et al: Breast imaging case of the day. Florid sclerosing adenosis. Radiographics. 19(1):245-7, 1999
                                                                                      19. Jensen RA et al: Invasive breast cancer risk in women with sclerosing adenosis. Cancer. 64(10):1977-83, 1989
                                                                                      20. Rosen PP: Microglandular adenosis. A benign lesion simulating invasive mammary carcinoma. Am J Surg Pathol. 7(2):137-44, 1983