A STUDY OF SURGICALLY REMOVED SPECIMENS OF … · A. T. SANDISON FIG. 1.-Low-power view of sclerosing adenosis (florid phase) in a portion of the right breast ofa 27-year-old woman

J. clin. Path. (1958), 11, 101.

A STUDY OF SURGICALLY REMOVED SPECIMENS OFBREAST, WITH SPECIAL REFERENCE TO

SCLEROSING ADENOSISBY

A. T. SANDISONFrom the Departments of Pathology, the University and Western Infirmary, Glasgow

(RECEIVED FOR PUBLICATION JULY 13, 1957)

It is now generally accepted that carcinoma ofthe breast is not restricted to the middle-aged orelderly woman and that a mass in the breast in awoman of any age must be regarded as malignantuntil it is proved to be benign. This recognition,which has recently been re-emphasized elsewhere(Sandison, 1955), has led to a considerable increasein the demand by surgeons for immediateexamination of frozen sections in the theatre incases of a mass in the breast of younger women.In many instances such examinations will quicklyshow whether or not a lesion is malignant. Theappearance known as sclerosing or fibrosingadenosis may present, especially to the less ex-perienced pathologist, a puzzling picture, and onewhich may erroneously be diagnosed as car-cinoma. In sections prepared by the paraffinembedding method the appearance is less likelyto be misinterpreted as carcinoma, but even heredifficulty in interpretation has been known. Thisdifficulty is especially important, since sclerosingadenosis is most characteristically seen in youngerwomen in whom mastectomy leads to greatermental distress than in older women. It there-fore seems worth while to indicate the frequencywith which this picture of sclerosing adenosis hasbeen encountered in the examination of surgicallyremoved breasts or portions of breasts in a five-year period in this laboratory during which justover 1,000 breast specimens were received.The salient features of sclerosing adenosis may

be outlined as follows. It produces a firm, mobilenodular or discoid lump in the breast, mostfrequently in younger women, and is thought tobe due possibly to some temporary hormonal im-balance (Dawson, 1954). The naked-eye appear-ance is that of a greyish-white nodular mass withhyperplastic lobular areas sometimes associatedwith cysts. Histological examination confirms thelobular nature of the lesion-a most importantdiagnostic point. The cytological character varies

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with the phase at which the condition is seen.There is an early florid phase (Fig. 1) whichregresses and goes on to an actively sclerosingstage and a final fibrosed lesion (Fig. 2). In theflorid phase epithelial and myoepithelial hyper-plasia in the lobules dominates the picture withthe formation of narrow tubules or solid cords ofcells. The stroma is delicate, the cells active, andmitotic figures may be present (Figs. 3-5). Later,as the lesion regresses, there is proliferation ofconnective tissue stroma till finally the epithelialcords are attenuated and compressed by fairlydense hyaline connective tissue. This appearanceis one readily mistaken for scirrhous spheroidalcell carcinoma of the breast, especially if viewedonly under the high power of the microscope. Itcannot be too strongly emphasized that in thestudy of breast tissue, especially in frozen sections,very great weight must be given to the impressionobtained under very low magnification with ascanning objective (e.g., x 4) and preferably awide-angle eye-piece, which gives a well-illumin-ated large field.

MethodIn all instances the original reports of the

naked-eye and microscopic findings were consultedand the sections were re-examined, but the caseswere allocated to groups according to the diag-nosis made on re-examination of the sections.These groups consisted of:

(a) True neoplasm, i.e., carcinoma, fibro-adenoma, and papilloma.

(b) The mastopathies subdivided into hyper-plastic cystic disease, characterized by intraductalor intra-acinar hyperplasia (epitheliosis), andsimple fibrocystic disease in which there was noepithelial hyperplasia but which might show somedegree of lobular hyperplasia (adenosis), and tothis group sclerosing adenosis is probably related.

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A. T. SANDISON

FIG. 1.-Low-power view of sclerosing adenosis (florid phase) in aportion of the right breast of a 27-year-old woman who com-plained of a lump in the breast for three weeks. Haemalum andeosin, x 65.

(c) The infective mastitides, lipophagic reaction,lactation effects, and a small miscellaneous group.

Sclerosing adenosis was also regarded as a

primary group where it appeared probable that itwas the condition for which surgery had beenundertaken. A further note was made also of allcases in which sclerosing adenosis was an inci-dental finding. In this way the minimal incidencehas been established. The occurrence of scleros-ing adenosis as a secondary feature in breastpathology is much higher than as a primary condi-tion presenting as a palpable mass. It is thereforepossible that frozen sections of breast in otherconditions may show foci of sclerosing adenosis,the recognition of which is important to avoidmistakes in diagnosis.

MaterialThe survey comprised a review of the sections

of all breast or portions of breast received in thisdepartment over a four-year period from 1950 to1954. The total number of specimens examinedwas 1,029, of which 1,010 were female.

' 4 A1Le

FIG. 2.-Low-power view of sclerosing adenosis (sclerosed phase) inportion of right breast of a 40-year-old woman who complainedof a lump in the breast after pregnancy two years previously.Haemalum and eosin, x65.

The major findings in the male breasts areclassified in Table I, and those in the femalebreasts in Table II. Sclerosing adenosis does notoccur in the male because of the absence oflobular formation.

Included in the miscellaneous group were twolipomata, one large simple adenoma, one epithelialtumour of low-grade malignancy, one angio-endo-thelioma, one secondary melanoma, two cases oftuberculosis, eight mammary duct ectasias, andone simple mammary hypertrophy.The age distribution of the lesions is shown in

Table III, from which some facts of interestemerge. It will be seen that fewer specimens werereceived from women in the second decade of lifethan in any other until the ninth decade. Underthe age of 20 fibro-adenoma was the commonlesion while the only other seen was intraductpapilloma. Two of the fibro-adenomata were offoetal type. In the third decade occasional casesof carcinoma appeared, although fibro-adenomawas much the commonest lesion, with occasionalcases of infective mastitis and lactation effect. In

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FIG. 3.-Sclerosing adz48-year-old womaone year. Haemal

'.EROSING ADENOSIS IN SURGICALLY REMOVED BREASTS 103

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IL ~4 7inosisinthefloridphaseinthe left breast of a FIG. 4.-Higher power view of florid phase scierosing adenosis inthe~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~4.nwhocomplainedofa lump in the breast for same case as Fig. 3 to show great cellularity. Haemalumand~)uradosn,x 0 osn,x 50

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A. T. SANDISON

TABLE IFINDINGS IN MALE BREASTS

Diagnosis oNumber

Carcinoma... 3Physiological hypertrophy or gynaecomastia 15Infective mastitis...

Total .. 19

TABLE I IFINDINGS IN FEMALE BREASTS

Diagnosis Numberof Cases

Carcinoma .. . 524Fibro-adenoma...110Giant fibro-adenoma... 6Papilloma of ducts...37Hyperplastic cystic disease .. 98Simple fibrocystic disease...155Pure sclerosing adenosis...12Infective mastitis .. .27Lipophagic reaction .. 11Lactation effect 4Miscellaneous 26

1,010

the fourth decade carcinoma was as frequent asfibro-adenoma. Infection and lactation effectswere still seen, but now hyperplastic cystic disease(epitheliosis) was fairly common. In the fifthdecade the maximum incidence of breast speci-mens was attained. Carcinoma was by far themost frequent lesion with hyperplastic cysticdisease and fibrocystic disease each much lesscommon. Fibro-adenoma was now relatively in-frequent, but papillomata were at their maximumincidence. Occasional cases of infection stilloccurred. In the sixth decade the frequency of

carcinoma was unchanged, but hyperplastic cysticdisease, simple fibrocystic disease, and fibro-adenoma were relatively rare. Infective mastitisstill occurred in the seventh decade; the frequencyof carcinoma was again relatively unchanged, butall other conditions were relatively rare. In theeighth decade the number of cases of carcinomawas only half of that seen in each of the previousthree decades, while over the age of 80 carcinoma,although uncommon, was the sole lesion for whichsurgery was attempted.Of 524 carcinomas, 40 occurred in women

under the age of 40, while in the next threedecades the incidence remained remarkably stableat about 130, falling off to about half that numberin the eighth decade. Simple fibrocystic disease,hyperplastic cystic disease, and duct papillomatalead most frequently to operation in the fifthdecade. It may be that these are in fact mostcommon at about the time of the menopause orthat in this period of life surgery is morefrequently advised.Fibro-adenoma occurred from the second to the

eighth decade but is commonest in the third andfourth. Giant fibro-adenoma was only about one-eighteenth as common and occurred mostfrequently in the seventh decade. Duct papillo-mata were twice noted in young girls, but wereseen most often in the fifth decade. Infectivemastitis was largely a disease of the third andfourth decades, i.e., the reproductive period, whilefat necrosis occurred in the same group and alsorarely affected older women.Of the male breasts examined all three car-

cinomas were seen after the age of 50, but of thecases of gynaecomastia or hyperplasia almost as

TABLE IIlAGE DISTRIBUTION OF MALE AND FEMALE CASES

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many were seen before this age as after it. Theseincluded three instances in boys in the seconddecade, which are best regarded as adolescenthyperplasias.

Sclerosing AdenosisSclerosing adenosis was present in breast speci-

mens from 12 women as a relatively pure primarylesion. The age distribution may be seen in TableIII. In three of those women in whom mastec-tomy had been done because of an associatedpapillomatosis with nipple discharge, sclerosingadenosis was present both in the original biopsyand in the breast when removed. In the remain-ing nine women biopsies were done in fourinstances and primary local mastectomies in theremaining five.Of these women, 10 were married and only two

single, and the history of a lump varied from threeweeks to 13 years. In one unmarried woman aged44 the lump had been present for 13 years andwas said to have followed a non-puerperal abscess.In another, a married woman aged 39 years, thelump was thought to have followed a puerperalabscess eight years before. In the majority ofcases there was no history of gross menstrual up-set. One 24-year-old woman had, however, noteda mass during the fifth month of her only preg-nancy two years previously; the child was notbreast-fed, and for seven months before operationthere had been severe menorrhagia. Anotherwoman, aged 44, also complained of menorrhagiafor three months before operation. In one in-stance a woman aged 29 had had, three weeksbefore mammary biopsy, an abdominal operationat which the pelvic organs were seen to beentirely normal.

In the majority of instances the clinical impres-sion was one of mobile, firm nodularity of breastsubstance although occasionally a discoid mass wasfelt. In only one woman, aged 48, had the nippledischarged; the discharge was purulent in appear-ance and when examined cytologically (Sandisonand Walker, in preparation) contained histiocytesor " colostrum corpuscles," some red blood cells,and epithelial cells. This appearance is charac-teristic of papillomatosis and was due, not to thesclerosing adenosis, but to a concurrent multi-radiculate papillomatosis. It may be of import-ance to note that this woman had had, shortlybefore mastectomy, a course of oestrin formenopausal symptoms.

Microscopically all of the cases showed a lobularhyperplasia with myoepithelial and epithelialparticipation. In six cases, of which two occurredin the second decade, one in the third, and three in

.j,~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~~~~~~.

FIG. 6.-Mitosis in florid sclerosing adenosis in a biopsy from the rightbreast of a 31-year-old woman who had complained of a lumpfor five years, becoming larger more recently. Haemalum andeosin, x 1,000.

FIG. 7.-High-power view of sclerosing adenosis in sclerosed phaseshowing cords of involuting cells which may be mistaken forscirrhous carcinoma. Haemalum and eosin, x 160.



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A. T. SANDISON

a central fibrous core (Fig. 8). This is consideredto be a change in several lobules arranged at thetermination of a single duct.

Sclerosing adenosis as a complicating lesion waspresent as a secondary lesion in 73 breasts; 28 ofthese were carcinomatous, six contained largepapillomata, and two fibro-adenoma, 23 wereassociated with only simple fibrocystic disease, 13with hyperplastic cystic disease, and one with in-fective mastitis. The age distribution of thesecases is shown in Table IV with that of primarysclerosing adenosis.

TABLE 1VSCLEROSING ADENOSIS AS COMPLICATING LESION

0~~~~~~

Age . e D__ 0 g 0s co a I

20-29.. 4 - 1 - 1 - 1 730-39.. 3 1 1 - 5 5 - 1540-49.. 5 10 4 2 11 5 - 3750-59.. - 10 - - 3 2 - 1560-69.. - 3 - - 2 1 - 670-79 - 4 - - 1 - - 5

Total 12 28 6 2 23 13 1 8

FIG. 8.-Rosette of lobules around a terminal duct; all of these showsclerosing adenosis. Haemalum and eosin, x 10.

the fourth, the appearances were largely of theflorid type. In the instance occurring in the thirddecade mitotic activity was especially marked(Fig. 6). In the remaining cases the florid phasewas less obvious, more or less fibrosis hadoccurred, and the appearances tended to mimicthose of scirrhous infiltrative carcinoma (Figs. 2,7). In 10 cases there was some degree of micro-cystic formation and in seven there were also cystslined by metaplastic "pink" epithelium of so-

called apocrine type. In only two instances was

there associated epitheliosis of ducts, but in ninethere were minute papillomata in ducts. Thisassociation appears to be significant.

In three cases where both biopsy and latermastectomy specimens were available the condi-tion was seen to be present in both. In cases whereprimary mastectomy was carried out, the condi-tion, although most obvious in the focal lesion forwhich the operation was done, was also present toa similar or lesser extent in other regions of thebreast.

In one woman, who was aged 44 and unmarried,there was a peculiar rosetted arrangement around

Of these 28 women with carcinoma, six weresingle and 22 were married. One woman, aged 49,had undergone a course of oestrin therapy formenopausal symptoms shortly before mastectomy.Another, aged 50, had a further mastectomy about18 months later and the second breast also showedwell-marked sclerosing adenosis as the primarycondition. In this case the condition was there-fore bilateral. Yet another woman, aged 64, diedseveral days after mastectomy, and it was possibleto examine the remaining breast at necropsy. Thisshowed epitheliosis, papillomatosis, cyst forma-tion, and sclerosing adenosis in both the florid andfibrosing stages. In the breast removed for car-cinoma the condition was largely in the moreflorid stage. The ovaries at necropsy showed afairly cellular stroma according to the criteria ofSommers and Teloh (1952) and the endometriumwas rather hyperplastic. This case is of especialinterest because the appearance of the endo-metrium suggested some degree of continuingoestrogen activity. In two instances it was of in-terest to note areas of incomplete involution oflactation effect, in view of the belief that perver-sion of lactation may play a part in the aetiologyof the lesion.

In some instances it may be difficult to dif-ferentiate between sclerosing adenosis andscirrhous carcinoma when both are present in the

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SCLEROSING ADENOSIS IN SURGICALLY REMOVED BREASTS

same section. The lobular distribution of thechanges in sclerosing adenosis provided a usefulbasis for differentiation, and detailed comparativecytological examination may reveal considerabledifferences. It is, in fact, a salutary exercise toattempt this differentiation in cases where the twotypes of lesion are closely intermingled. In oneinstance, in a woman aged 48, a carcinoma oflargely intraductal and intra-acinar type was com-plicated by the presence of sclerosing adenosis ofrather florid degree and in which the componentelements were difficult to distinguish. This is notsurprising, since both intra-acinar carcinoma andthe proliferative phase of adenosis are essentiallylobular, highly cellular, and both may show activegrowth with mitotic figures. It is also interestingthat in this case a part of the area of active adenosisshowed some degree of apocrine metaplasia.

Six women showed sclerosing adenosis as asecondary lesion to papillomatosis of the breast.This association of papillomatosis and sclerosingadenosis is of considerable interest since it will berecalled that in nine women who were consideredto show sclerosing adenosis as the primary breastcondition there were also associated microscopicpapillomatosis. In a total of 85 women whoshowed either primary or incidental sclerosingadenosis in some degree, some 15 also showedpapillomatosis in some degree, i.e., just over 17%.On the other hand, of 37 women who showedpapillomatosis as a primary condition only, sixshowed sclerosing adenosis, a proportion of 16%.Of these six women showing an association ofsclerosing adenosis with primary papillomatosis,only one was unmarried. One of the women, aged25, complained of menstrual irregularity. Of twowomen who showed sclerosing adenosis in associa-tion with fibro-adenoma, both were married, in thefifth decade of life, and no history of menstrualirregularity was obtained. One fibro-adenomawas intracanalicular and the other of mixed type.

Simple fibrocystic disease of the breast was thecommonest primary condition to be associatedwith sclerosing adenosis. Twenty-four cases in allwere noted. Of these, five women were known tobe unmarried. In none of these cases wasepitheliosis or intraduct hyperplasia a feature. Inthe majority there was some degree of apocrinemetaplasia in the cysts and also frequently a vary-ing degree of simple adenosis of physiologicaltype. One breast from a 35-year-old womanshowed evidence of incomplete involution oflactation.

Sclerosing adenosis complicated hyperplasticcystic disease, in which there was some degree ofepitheliosis or intraduct hyperplasia, in 13 cases

(13 %). Of these women three were unmarried.In only one instance was there a definite historyof menorrhagia. Three of the cases showed quitemarked epitheliosis; in the remainder the hyper-plasia was of only moderate degree.The one instance of sclerosing adenosis as a

secondary feature in chronic infection occurred ina 27-year-old married woman who showed a non-specific chronic infection of six years' duration.In this instance only one small focus of sclerosedadenosis was seen.When all cases showing sclerosing adenosis in

some degree are considered together the incidencewas 28 instances in 524 cancerous breasts (5.3 %)and 57 instances in 486 non-cancerous breasts(12.2%).

DiscussionSclerosing adenosis although recognized was not

named by the older authorities, e.g., Muir (1941)or Cheatle and Cutler (1931). A brief descriptionof this condition is given by Ewing (1940), whopoints out that more than any other condition inthe breast it is likely to be mistaken for carcinoma.Since then this warning has been reiterated byBoyd (1947), while Foot (1945) mentions "diffusefibrosing adenomatosis" but contents himself withstating that its presence does not alter the prog-nosis of fibrocystic disease. Saner (1950) regardsthe condition as a form of hyperplastic cysticdisease which may give rise to difficulty in diag-nosis on immediate examination in the theatre.

Mulligan (1951) gives a useful summary of hisviews on sclerosing adenosis. It is much morecommonly seen as an incidental microscopic find-ing than as a presenting discrete mass which is inany case rarely large. The lesion is most com-monly found between the ages of 20 and 40 years;it begins within the lobules or terminal ductulesand in the early stage there is considerable proli-ferative activity. Throughout the evolution of thelesion a distinct lobular pattern persists. In thelater phase connective tissue tends to compressirregularly the attenuated cords of epithelial cellsand a bizarre pattern may thus be produced dis-tinctly reminiscent of scirrhous carcinoma.

Willis (1953) also emphasizes this collapse,atrophy, and distortion of the epithelial elementswith stromal fibrosis, and states that there is asuperficial resemblance to infiltrating scirrhouscarcinoma. He states that mistaken diagnosesmay be made, especially in frozen sections, andthat the only safeguard is experience in the recog-nition of fibrosing adenosis at the different evolu-tionary stages and insistence on paraffin sectionsto confirm all frozen section diagnoses.

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Ackerman (1953) has also summarized hisviews in an addendum to his remarks on chroniccystic mastopathy. He considers sclerosing aden-osis to be a highly proliferative form of simplecystic disease of rather uncommon type, and givesthe incidence as 1% of benign breast lesions.

Stewart (1950) gives a detailed consideration offibrosing adenosis in the section on lesions simu-lating carcinoma in his atlas of breast tumours.Stewart points out that the fibrosing phase is thatmost commonly recognized, but that it is alsoimportant to recognize the florid phase of epi-thelial proliferation. The age incidence given issimilar to the experience of Mulligan (1951).Stewart also emphasizes that this lesion is especiallyliable to bz over-diagnosed by pathologists whoonly encounter small numbers of breast specimens.He describes instances where not only mastectomy

but post-operative radiotherapy and castrationhad been recommended, and deprecates the un-

necessary " single-breasted " state of not a fewyoung women in the third decade of life becauseof this diagnostic failure.He gives detailed accounts of the morbid

anatomy and histology of the lesion, which is dis-crete, often coarsely nodular, less firm than car-

cinoma, and usually distinctly lobulated. Stewartconcedes that sclerosing adenosis may occur also

in microscopic foci and that the only real differ-ence between this form and that detected as a

palpable mass is that the former occurs in minia-ture.

Ingleby and Gershon-Cohen (1954) haverecently reviewed the problem of adenosis gener-

ally. They state that in the normal breast in thepost-menstrual phase ductules bud to form new

lobules with deeply staining cells. As the cycleprogresses both epithelial and basal cells becomepaler and larger and myo-epithelial cells are

formed by formation of blunt processes. Somefew days before menstruation begins some

secretion appears in the ducts, while the epithelialand basal cells vacuolate. During the period thebasal cells break up and the epithelium is shedinto the lumen. In the premenstrual phase alsothe intraductal stroma is loose and oedematous,with scattered mononuclear cells, while after theperiod this stroma is dense and fibrous.

Ingleby and Gershon-Cohen classify adenosisinto four types. Type A consists of lobularhyperplasia with very large lobules or numbers ofsmaller lobules close together, while in type B,which is the commonest form, the lobules consistof a few more or less dilated ductules with incom-plete lobular development. They state that typeC occurs near the tumour in most carcinomas of

young women, that epithelial and basal prolifera-tion may be noted, and that duct epitheliosis mayalso be present. Type D is sclerosing adenosis,and Ingleby and Gershon-Cohen think this isoften formed entirely of myo-epithelial cells andtherefore prefer to entitle this lesion " myoidsclerosis." The validity of this concept of scler-osing adenosis as well as that of possible pre-cancerous potentiality in their type C adenosisremains uncertain.

Valuable papers on sclerosing adenosis havecome from Urban and Adair (1949) and Foote anJStewart (1945). The latter authors noted that thelesion was present in some degree in 12.5% of200 non-cancerous and 7% of 300 cancerousbreasts studied, and these figures do not differgreatly from mine, i.e., 12.2% and 5.3%.

Da'wson (1954) has published a comprehensivedescriptive article on fibrosing adenosis empha-sizing the fact that it is often unrecognized. Shepoints out not only the possibility of overdiagnosisand the subjection of the patient to unnecessaryoperative risk, but also of vitiation of statisticalfigures for cancer survival rates. She points outthat in itself the term " adenosis " carries no patho-logical implication, and that, especially in olderwomen, involution after pregnaPcy without lacta-tion may be slow. Studies of post-mortem breastsin this department, to be published later, confirmthis observation (Sandison, 1958).

Post-menopausal adenosis may be due to con-tinued hormone secretion by the adrenal cortexor from other sites. Novak (1952) has speculatedon a similar basis for the noted occurrence ofpost-menopausal endometrial hyperplasia seen inwomen without functional ovarian tumours. It isof interest to note at this point that Geschickter(1945) illustrates a case of mastodynia in a patientwho received over one million i.u. of oestradiolbenzoate over a period of 20 months, and thephotomicrograph shows apparent sclerosing aden-Osis.Dawson emphasizes that recognition of the

phases of normal growth with possible irregularityor perversion is necessary for an understanding offibrosing adenosis. She has also found fibrosingadenosis to be commonest in younger marriedwomen and frequently associated with some per-version of mammary function. It does, however,occur in younger unmarried subjects and in olderpatients. Fibrosing adenosis as a localizedtumour-like condition she has found to be rare.

It is, however, not uncommon as a focal changein the breast as seen in surgically removed speci-mens or at necropsy.

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With regard to histological studies, Dawson,who publishes a large number of photographs,agrees that it is essential to recognize the patternof growth. Dawson's description of the micro-scopic appearances corresponds closely with thoseof Mulligan (1951) and Stewart (1950), and withall of these the present study also correspondsclosely. Dawson rightly points out that stainingby silver methods or by phosphotungstic-acid-haematoxylin shows an intact basement membraneround the distorted glands or cell groups with noevidence of invasion, and that mitoses may occurin epithelial cells in the florid phase and in fibro-blasts in the actively sclerosing phase. Dawsonsuggests that epitheliosis is largely absent in theducts in sclerosing adenosis, but with this state-ment the present study is not in full agreement.Epitheliosis may be present although it is oftenmild. Dawson concedes that epitheliosis may beseen in association with sclerosing adenosis inolder women and thinks that the two are notrelated. It seems possible, however, that dis-ordered hormonal balance may lead to papillaryepitheliosis as well as adenosis and the two maynot be mutually exclusive. Since it is generallybelieved that epitheliosis of duct sometimes pre-cedes the development of intraduct neoplasia, theoccasional association of sclerosing adenosis andcarcinoma is not surprising. Nevertheless itshould be emphasized that there is no causalrelationship between sclerosing adenosis andmammary neoplasia. It is generally accepted thatthe sclerosing phase represents an involutionaryprocess which becomes to all intents and purposesquiescent.There do not appear to be any reports concern-

ing the incidence of sclerosing adenosis in breastsexamined at necropsy, but in this department acomplete study of the breasts in 800 consecutivefemale necropsies (Sandison) showed uncompli-cated sclerosing adenosis in 3.1% of all cases, thestaging of the lesions being 36% in the florid,

36% in the sclerosing, and 28% in the sclerosedphase. A further 3.9% of all cases showedsclerosing adenosis as well as other changes. Adetailed report of the findings in this study will bepublished in due course.

SummaryThe minimal incidence of sclerosing adenosis in

surgical specimens of breast, both as a primarycondition and complicating other lesions, has beenestablished.

In just over 1,000 female breasts there were 12primary and 73 secondary instances of the con-dition. The result of a simple analysis of thetotal number of specimens examined is also pre-sented.The significance of sclerosing adenosis is dis-

cussed, and the importance of its recognition bythe practising surgical pathologist is emphasized.

I am grateful to Messrs. G. Kerr and W. Mason forthe photographs illustrating the paper.

REFERENCES

Ackerman, L. V. (1953). Surgical Pathology. Mosby, St. Louis.Boyd, W. (1947). A Text-book ofPathology, 5th ed. London.Cheatle, G. L., and Cutler, M. (1931). Tumours ofthe Breast. Arnold,

London.Dawson, E. K. (1954). Edinb. med. J., 61, 391.Ewing, J. (1940). Neoplastic Diseases, 4th ed. Saunders, Philadelphia

and London.Foot, N. C. (1945). Pathology in Surgery. Lippincott, Philadelphia.Foote, F. W., and Stewart, F. W. (1945). Ann. Surg.,121, 6.Geschickter, C. F. (1945). Diseases oftheBreast,2nd ed. Lippincott,

Philadelphia.Ingleby, H., and Gershon-Cohen, J. (1954). Surg. Gynec. Obstet., 99,

199.Muir, R. (1941). Text-book ofPathology, 5th ed. London.Mulligan, R. M. (1951). Syllabus ofHuman Neoplasms. London.Novak, E. (1952). Gynecologic and Obstetric Pathology, 3rd ed.

Saunders, Philadelphia and London.Sandison, A. T. (1955). Glasg. med. J., 36, 398.

(1958). A Post-mortem Survey of the Adult Breast in Endo-crine Aspects of Breast Cancer. Livingstone, Edinburgh.

- and Walker, J. C. (1958). The Cytological Examination ofNVipple Discharge as a Diagnostic Aid. In preparation.

Saner, F. D. (1950). The Breast Structure: Function: Disease. Wright,Bristol.

Sommers, S. C., and Teloh, H. A. (1952). A.M.A. Arch. Path., 53, 160.Stewart, F. W. (1950). Atlas of Tumour Pathology, Sect. 9. Fasc. 34:

Tuinours of the Breast. Armed Forces Institute of Pathology,Washington, D.C.

Urban, J. A., and Adair, F. E. (1949). Cancer, 2, 625.Willis, R. A. (1953). Pathology of Tumours, 2nd ed. Butterworth,

London.

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A STUDY OF SURGICALLY REMOVED SPECIMENS OF … · A. T. SANDISON FIG. 1.-Low-power view of sclerosing adenosis (florid phase) in a portion of the right breast ofa 27-year-old woman