Difference between revisions of "Atypical ductal hyperplasia"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =
| Width      =
| Caption    =
| Synonyms  =
| Micro      = cytologic and architectural features of low-grade DCIS (equal cell spacing, lumina round, variable architecture (classically [[cribriform]] or solid - may be micropapillary or papillary), small nuclei, small indistinct nucleoli); limited extent - either (1) two or less complete ducts, (2) <2 mm
| Subtypes  =
| LMDDx      = [[ductal carcinoma in situ]], [[invasive ductal carcinoma of the breast]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Staging    =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = none
| Prevalence = relatively common
| Bloodwork  =
| Rads      = suspicious calcifications
| Endoscopy  =
| Prognosis  = benign, increased risk of malignancy
| Other      =
| ClinDDx    =
| Tx        = lumpectomy when found on biopsy, follow-up if on extensional specimen
}}
'''Atypical ductal hyperplasia''', abbreviated '''ADH''', a benign [[breast pathology|breast lesion]] associated with an increased risk of [[malignancy]].
'''Atypical ductal hyperplasia''', abbreviated '''ADH''', a benign [[breast pathology|breast lesion]] associated with an increased risk of [[malignancy]].


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==Microscopic==
==Microscopic==
Features:
Features:
*Cytologic and architectural feature of low-grade DCIS.
*Cytologic and architectural features of low-grade DCIS.
**Cell spacing ~ equal.
**Cell spacing ~ equal.
**Lumina round.
**Lumina round.
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DDx:
DDx:
*Low-grade [[DCIS]].
*Low-grade [[ductal carcinoma in situ]] (DCIS).
*[[Florid epithelial hyperplasia of the usual type]] (FEHUT).
*[[Florid epithelial hyperplasia of the usual type]] (FEHUT).


Revision as of 15:36, 28 April 2016

Atypical ductal hyperplasia
Diagnosis in short
LM cytologic and architectural features of low-grade DCIS (equal cell spacing, lumina round, variable architecture (classically cribriform or solid - may be micropapillary or papillary), small nuclei, small indistinct nucleoli); limited extent - either (1) two or less complete ducts, (2) <2 mm
LM DDx ductal carcinoma in situ, invasive ductal carcinoma of the breast
Site breast
Symptoms none
Prevalence relatively common
Radiology suspicious calcifications
Prognosis benign, increased risk of malignancy
Treatment lumpectomy when found on biopsy, follow-up if on extensional specimen

Atypical ductal hyperplasia, abbreviated ADH, a benign breast lesion associated with an increased risk of malignancy.

General

  • Molecular studies have shown it is the same thing as low-grade DCIS; thus, some have called for abolition of the term.[1]
  • ADH is considered an indication for a lumpectomy.[2]
    • Two large studies suggest the conversion of an ADH on core biopsy to breast cancer on surgical excision, known as "up-grading", is approximately 30%.[3][4]

Epidemiology:

  • Relative risk of breast cancer, based on a median follow-up of 8 years, in a case control study of US registered nurses, is 3.7.[5]

Microscopic

Features:

  • Cytologic and architectural features of low-grade DCIS.
    • Cell spacing ~ equal.
    • Lumina round.
    • Architecture - classically cribriform or solid; may be micropapillary or papillary.
    • Small nuclei.
      • Small indistinct nucleoli.
  • Limited extent (diagnostic size cutoffs) - either:[6]
    1. < Two complete ducts.
    2. < 2 mm. ‡

DDx:

Notes:

  • High-grade DCIS is not in the DDx of ADH.
  • ‡ 3 mm is used in papillary lesions.[citation needed]

Images

  • ADH. Very low mag. (WC/Nephron)

  • ADH - low mag. (WC/Nephron)

  • ADH - intermed. mag. (WC/Nephron)

  • ADH - high mag. (WC/Nephron)

  • ADH - very high mag. (WC/Nephron)

IHC

  • CK5 <20% +ve.
  • ER +ve - diffusely.

See also

References

  1. ↑ Ghofrani, M.; Tapia, B.; Tavassoli, FA. (Dec 2006). "Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey.". Virchows Arch 449 (6): 609-16. doi:10.1007/s00428-006-0245-y. PMID 17058097.
  2. ↑ Liberman L, Cohen MA, Dershaw DD, Abramson AF, Hann LE, Rosen PP (May 1995). "Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy". AJR Am J Roentgenol 164 (5): 1111–3. PMID 7717215. http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=7717215.
  3. ↑ Deshaies, I.; Provencher, L.; Jacob, S.; Côté, G.; Robert, J.; Desbiens, C.; Poirier, B.; Hogue, JC. et al. (Feb 2011). "Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy.". Breast 20 (1): 50-5. doi:10.1016/j.breast.2010.06.004. PMID 20619647.
  4. ↑ Margenthaler, JA.; Duke, D.; Monsees, BS.; Barton, PT.; Clark, C.; Dietz, JR. (Oct 2006). "Correlation between core biopsy and excisional biopsy in breast high-risk lesions.". Am J Surg 192 (4): 534-7. doi:10.1016/j.amjsurg.2006.06.003. PMID 16978969.
  5. ↑ London, SJ.; Connolly, JL.; Schnitt, SJ.; Colditz, GA. (Feb 1992). "A prospective study of benign breast disease and the risk of breast cancer.". JAMA 267 (7): 941-4. PMID 1734106.
  6. ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 258. ISBN 978-0470519035.
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