Spectrum of findings of sclerosing adenosis at breast MRI. Poster No.: C-0738 Congress: ECR 2012 Type: Scientific Exhibit Authors: F. Vasselli 1, F. Pediconi 2, M. Telesca 2, M. Luciani 2, V. Casali 2, E. Keywords: DOI: Miglio 2, C. Catalano 3 ; 1 Rome, italia/it, 2 Rome/IT, 3 Roma (RM)/IT Breast, MR, Diagnostic procedure, Neoplasia 10.1594/ecr2012/C-0738 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 7
Purpose Sclerosing adenosis is a benign proliferative disease of the breast that occurs as a part of a spectrum of benign proliferative abnormalities referred to as fibrocystic changes. It may present a broad spectrum of imaging findings, from minimal lobular changes to macroscopic mass lesions. The main histopathological alterations of the terminal ductal lobular unit present as a widening and distortion of lobules, an increased number of acini and stromal fibrosis. The clinical, radiological and histopathological properties of sclerosing adenosis may resemble the masses that are usually associated with malignancy, which is the factor responsible for the clinical significance of the disease. As a matter of fact, sclerosing adenosis, because of hits histological features such elastosis and stromal sclerosis, can be difficult to distinguish from infiltrating carcinoma at mammography, ultrasound and even at MRI. The aim of our study was to describe the spectrum of features of sclerosing adenosis at breast MRI. Methods and Materials we retrospectively selected from our database 21 patients with pathological diagnosis of sclerosing adenosis of the breast. For each patient, an MR scan of the breast was available. MR examinations were performed on a 1.5T scanner, before and after administration of contrast agent. Results We analized the spectrum of findings of the morphological characteristics and the enhancement pattern of all the lesions. In all patients sclerosing adenosis was visible at breast MRI such as enhancing lesion. The mean age was 43,4 (range 24-57 years old). Among the 21 patients, contrast enhanced MRI identified 15 focal mass with irregular or spiculated margins, 3 irregular focal areas of enhancement, 1 regional area of Page 2 of 7
enhancement and 2 intraductal areas of enhancement. The BI-RADS was assessed as 4 in 13 lesions, 5 in 4 lesions and 3 in 3 lesions. Images for this section: Fig. 1: 24 years old woman presenting a mass in the inner upper quadrant of the left breast (fig. d). The lesion shows irregular margins and fast enhancemnt, with wash out (type 3 curve; images a, b, c). DWI shows also hyperintense signal (fig e). ADC was assessed as 1.24 mm/s2. Page 3 of 7
Fig. 2: 42 years old woman presenting a mass in the confluence of external quadrants of the left breast (fig. a). The lesion shows lobulated margins and fast, heterogeneous enhancemnt, with wash out (type 3 curve; images b, c). Page 4 of 7
Fig. 3: 47 years old woman presenting a non mass enhancement in the confluence of external quadrants of the left breast (fig. b). The lesion shows regional heterogeneous enhancement. However, the intensity/time curve shows tipe 1 dynamics (fig a, b). Page 5 of 7
Fig. 4: 37 years old woman presenting a mass in the lower external quadrant of the left breast. The lesion showed smooth shape and regular margins (fig b), the T2 signal was high (fig a), but the enhancement was fast and type curve was borderline (images c, d). Page 6 of 7
Conclusion although MRI has been proved to be very useful in the detection of breast lesions showing a very high sensitivity, it still have in some cases low specificity. Both benign and malignant breast lesions can share common morphological and kinetic features. Furthermore, involvement of sclerosing adenosis by in situ carcinoma can be extremely difficult to distinguish from invasive carcinoma. Because of its histological characteristics such as stromal sclerosis and elastosis, sclerosing adenosis may present a problem for the radiologists as it can present with a contrast enhancement pattern similar to that of malignant process. References Nodular sclerosing adenosis mimicking malignancy in the breast: magnetic resonance imaging findings. Oztekin PS, Tuncbilek I, Kosar P, Gültekin S, Oztürk FK. Breast J. 2011 Jan-Feb;17(1):95-7. doi: 10.1111/j.1524-4741.2010.01022.x. Epub 2010 Dec 6. Fibrocystic change of the breast presenting as a focal lesion mimicking breast cancer in MR imaging. Chen JH, Nalcioglu O, Su MY. J Magn Reson Imaging. 2008 Dec;28(6):1499-505. Eusebi V, Collina G, Bussolati G. Carci- noma in situ in sclerosing adenosis of the breast: an immunocytochemical study. SeminDiagnPathol1989;6:146-152. Fechner RE. Carcinoma in situ involving sclerosing adenosis (letter). Histopathol- ogy 1996; 28:570. Personal Information Page 7 of 7