Chang Yu-Kai, Chen Yuan-Yuei, Hong Zhi-Jie, Liao Guo-Shiou, Yu Jyh-Cherng
Department of Surgery Tri-Service General Hospital, National Defense Medical Center Taipei Taiwan.
Department of Pathology Tri-Service General Hospital, National Defense Medical Center Taipei Taiwan.
Clin Case Rep. 2024 Dec 12;12(12):e9639. doi: 10.1002/ccr3.9639. eCollection 2024 Dec.
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.
硬化性腺病（SA）是腺病的一种亚型，其特征为增生性腺病和间质硬化，伴有终末导管小叶单位的变形。尽管SA是中年女性中最常见的良性乳腺疾病，但它可能使乳腺癌风险增加两倍。SA合并导管原位癌（SA-DCIS）的显微镜下表现可能类似微浸润癌甚至浸润癌，这可能导致乳腺外科医生过度治疗。因此，在此类病例中必须仔细进行病理评估以明确诊断。在此，我们报告一例罕见的SA-DCIS病例，其表现类似微浸润性导管癌。一名51岁女性经粗针活检被诊断为左乳高级别DCIS，高度怀疑有微浸润。在包括乳腺X线摄影和超声检查在内的影像学评估后，她因个人原因接受了左乳乳房切除术和右乳预防性乳房切除术。然而，最终诊断为双侧中级DCIS，其特征是在乳腺导管内存在导管癌细胞，这些癌细胞表现为核增大、核深染且核质比高。然而，该诊断与最初的病理结果不符。SA-DCIS具有与微浸润癌或浸润癌相似的病理特征。彻底评估病变的活检结果以区分SA-DCIS和浸润癌对于防止DCIS患者的过度诊断和不必要的治疗至关重要。诊断为SA-DCIS的患者比未患SA-DCIS的患者发生双侧乳腺癌的风险更高。
