Difference between revisions of "Atypical ductal hyperplasia"

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#redirect [[Non-invasive_breast_carcinoma#Atypical_ductal_hyperplasia]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Atypical_ductal_hyperplasia_-_very_high_mag.jpg
| Width      =
| Caption    = Atypical ductal hyperplasia. [[H&E stain]]. (WC/Nephron)
| 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 in size
| Subtypes  =
| LMDDx      = [[ductal carcinoma in situ]], [[invasive ductal carcinoma of the breast]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Staging    =
| Site      = [[breast]] - see ''[[non-invasive breast carcinoma]]''
| 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 excisional specimen
}}
'''Atypical ductal hyperplasia''', abbreviated '''ADH''', is a benign [[breast pathology|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.<ref>{{Cite journal  | last1 = Ghofrani | first1 = M. | last2 = Tapia | first2 = B. | last3 = Tavassoli | first3 = FA. | title = Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey. | journal = Virchows Arch | volume = 449 | issue = 6 | pages = 609-16 | month = Dec | year = 2006 | doi = 10.1007/s00428-006-0245-y | PMID = 17058097 }}</ref>
*ADH is considered an indication for a lumpectomy.<ref name=pmid7717215>{{cite journal |author=Liberman L, Cohen MA, Dershaw DD, Abramson AF, Hann LE, Rosen PP |title=Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy |journal=AJR Am J Roentgenol |volume=164 |issue=5 |pages=1111–3 |year=1995 |month=May |pmid=7717215 |doi= |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=7717215}}</ref>
**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%.<ref name=pmid20619647>{{Cite journal  | last1 = Deshaies | first1 = I. | last2 = Provencher | first2 = L. | last3 = Jacob | first3 = S. | last4 = Côté | first4 = G. | last5 = Robert | first5 = J. | last6 = Desbiens | first6 = C. | last7 = Poirier | first7 = B. | last8 = Hogue | first8 = JC. | last9 = Vachon | first9 = E. | title = Factors associated with upgrading to malignancy at surgery of atypical ductal hyperplasia diagnosed on core biopsy. | journal = Breast | volume = 20 | issue = 1 | pages = 50-5 | month = Feb | year = 2011 | doi = 10.1016/j.breast.2010.06.004 | PMID = 20619647 }}</ref><ref name=pmid16978969>{{Cite journal  | last1 = Margenthaler | first1 = JA. | last2 = Duke | first2 = D. | last3 = Monsees | first3 = BS. | last4 = Barton | first4 = PT. | last5 = Clark | first5 = C. | last6 = Dietz | first6 = JR. | title = Correlation between core biopsy and excisional biopsy in breast high-risk lesions. | journal = Am J Surg | volume = 192 | issue = 4 | pages = 534-7 | month = Oct | year = 2006 | doi = 10.1016/j.amjsurg.2006.06.003 | PMID = 16978969 }}</ref>
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.<ref name=pmid1734106>{{Cite journal  | last1 = London | first1 = SJ. | last2 = Connolly | first2 = JL. | last3 = Schnitt | first3 = SJ. | last4 = Colditz | first4 = GA. | title = A prospective study of benign breast disease and the risk of breast cancer. | journal = JAMA | volume = 267 | issue = 7 | pages = 941-4 | month = Feb | year = 1992 | doi =  | PMID = 1734106 }}</ref>
==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:<ref>{{Ref DCHH|258}}</ref>
*#< Two complete ducts.
*#< 2 mm. ‡
DDx:
*Low-grade [[ductal carcinoma in situ]] (DCIS).
*[[Florid epithelial hyperplasia of the usual type]] (FEHUT).
Notes:
*''High-grade DCIS'' is '''not''' in the [[DDx]] of ADH.
* ‡ 3 mm is used in papillary lesions.{{fact}}
===Images===
<gallery>
Image:Atypical_ductal_hyperplasia_-_very_low_mag.jpg|ADH. Very low mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_low_mag.jpg|ADH - low mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_intermed_mag.jpg|ADH - intermed. mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_high_mag.jpg|ADH - high mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_very_high_mag.jpg|ADH - very high mag. (WC/Nephron)
</gallery>
==IHC==
*CK5 <20% +ve.
*ER +ve - diffusely.
**Heterogenous in [[FEHUT]].
==See also==
*[[Non-invasive breast carcinoma]].
*[[Ductal carcinoma in situ]].
*[[Atypical lobular hyperplasia]].
==References==
{{Reflist|1}}
[[Category:Breast pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 20:11, 30 April 2016

Atypical ductal hyperplasia
Diagnosis in short

Atypical ductal hyperplasia. H&E stain. (WC/Nephron)
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 in size
LM DDx ductal carcinoma in situ, invasive ductal carcinoma of the breast
Site breast - see non-invasive breast carcinoma
Symptoms none
Prevalence relatively common
Radiology suspicious calcifications
Prognosis benign, increased risk of malignancy
Treatment lumpectomy when found on biopsy, follow-up if on excisional specimen

Atypical ductal hyperplasia, abbreviated ADH, is 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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