Fukai Shota, Yoshida Atsushi, Akiyama Futoshi, Tsunoda Hiroko, Lefor Alan Kawarai, Kimura Jiro, Sakamoto Takashi, Suzuki Koyu, Mizokami Ken
Department of Surgery, Tokyo Bay Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chu-o-ku, Tokyo, 104-8560, Japan.
Int J Surg Case Rep. 2018;45:9-12. doi: 10.1016/j.ijscr.2018.03.002. Epub 2018 Mar 7.
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.
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.
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.
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.
乳腺导管原位癌（DCIS）可在硬化性腺病区域发生。硬化性腺病的影像学表现为毛刺状肿块，可能类似浸润性导管癌。我们报告一例硬化性腺病合并DCIS被错构瘤包裹的患者，其影像学表现与典型的硬化性腺病表现截然不同。
一名73岁女性，既往未行乳腺钼靶检查，因左侧乳房可触及肿块就诊。乳腺钼靶显示左乳中外象限有一个36毫米边界清晰、密度似脂肪的肿块。超声检查显示同一区域有一个边界清晰的肿块，由低回声和高回声区域组成。粗针活检的组织学诊断为硬化性腺病。考虑到患者年龄和肿瘤大小，我们进行了保乳手术以明确诊断并进行治疗。最终病理显示错构瘤内的硬化性腺病合并DCIS。
该患者的DCIS发生在硬化性腺病区域，被错构瘤包裹。DCIS可在硬化性腺病区域发生，且可能类似浸润性导管癌，因此我们必须避免误诊或过度治疗。错构瘤恶变罕见，但因其含有上皮组织故有可能发生。鉴于错构瘤内存在恶性肿瘤的可能性，应进行确定性活检。
诊断错构瘤时，影像学检查出现非典型表现应提示恶变的可能性。虽然罕见，但错构瘤内可能存在恶性肿瘤。
