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. 2023 Oct:71:99-105.
doi: 10.1016/j.breast.2023.08.002. Epub 2023 Aug 7.

Adenosquamous proliferation in radial sclerosing lesions: Histologic spectrum and key features in systematic review of 247 lesions

S Emily Bachert  1 , Virgilius Cornea  2 , Thérèse Bocklage  2
Affiliations

Adenosquamous proliferation in radial sclerosing lesions: Histologic spectrum and key features in systematic review of 247 lesions

S Emily Bachert et al. Breast. 2023 Oct.

Abstract

Adenosquamous proliferation (ASP) is known to occur in the central nidus of radial sclerosing lesions (RSL) of the breast. However, their significance is debated and remains largely unknown. In addition, there is a histologic overlap between ASP and low-grade adenosquamous carcinomas (LGASC). We conducted a large retrospective review of 247 RSLs to evaluate the prevalence of ASP and quantitatively analyze associated histologic features of RSLs including size, stromal cellularity, and presence of chronic inflammation. The central nidus of RSLs were classified as hyalinized in 121 cases (49%), cellular in 37 cases (15%), and equally mixed hyalinized and cellular in 89 (36%). ASP occurred in 92 of 247 RSLs (37.2%). Cases with ASP were significantly associated with a cellular stroma; 78.4% of RSLS with cellular stroma had ASP versus just 11.6% of hyalinized RSLs. In our large cohort, inflammation is commonly found in RSLs with ASP (p= <0.001). In conclusion, we confirm that ASP is statistically more likely to be found in RSLs with a cellular stroma. In addition, ASP is commonly associated with chronic inflammation. The finding challenges the notion that prominent lymphocytes are a diagnostic clue to LGASC on limited biopsy material.

Keywords: Adenosquamous proliferation; Breast; Sclerosing lesions.

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Figures

Fig. 1
Fig. 1
Low power magnification of radial scar involved by usual ductal hyperplasia.
Fig. 2
Fig. 2
Flow chart of specimen selection and demographics.
Fig. 3
Fig. 3
A: Low power magnification of lymphoid aggregates surrounding central nidus in radial sclerosing lesion with stroma classified as mixed-hyalinized predominant. B: Additional representative lymphoid aggregate abutting central nidus.
Fig. 3
Fig. 3
A: Low power magnification of lymphoid aggregates surrounding central nidus in radial sclerosing lesion with stroma classified as mixed-hyalinized predominant. B: Additional representative lymphoid aggregate abutting central nidus.
Fig. 4
Fig. 4
A: Cellular stroma (100x magnification) B: Hyalinized stroma (40× magnification). C: Mixed stroma. Cellular component of stroma through center of picture with hyalinized stroma in bottom left and top right corners. (100x magnification).
Fig. 4
Fig. 4
A: Cellular stroma (100x magnification) B: Hyalinized stroma (40× magnification). C: Mixed stroma. Cellular component of stroma through center of picture with hyalinized stroma in bottom left and top right corners. (100x magnification).
Fig. 4
Fig. 4
A: Cellular stroma (100x magnification) B: Hyalinized stroma (40× magnification). C: Mixed stroma. Cellular component of stroma through center of picture with hyalinized stroma in bottom left and top right corners. (100x magnification).
Fig. 5
Fig. 5
A: ASP with features visible at 100x magnification.B: ASP with focal squamoid features.C: ASP with squamoid features which appear to spin off adjacent benign gland.D: ASP with squamoid cells located variably distant from glandular component.
Fig. 5
Fig. 5
A: ASP with features visible at 100x magnification.B: ASP with focal squamoid features.C: ASP with squamoid features which appear to spin off adjacent benign gland.D: ASP with squamoid cells located variably distant from glandular component.
Fig. 5
Fig. 5
A: ASP with features visible at 100x magnification.B: ASP with focal squamoid features.C: ASP with squamoid features which appear to spin off adjacent benign gland.D: ASP with squamoid cells located variably distant from glandular component.
Fig. 5
Fig. 5
A: ASP with features visible at 100x magnification.B: ASP with focal squamoid features.C: ASP with squamoid features which appear to spin off adjacent benign gland.D: ASP with squamoid cells located variably distant from glandular component.
Fig. 6
Fig. 6
RSL on core needle biopsies with other associated diagnoses and follow-up excisions. There were 43 RSLs on biopsy with ASP. Four RSLs showed ASP present on excision that were not present on the CNB.
Fig. 7
Fig. 7
RSL in resections specimens and other associated diagnoses within or immediately adjacent to the RSL.
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References

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