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Difference between revisions of "Florid epithelial hyperplasia"
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Florid epithelial hyperplasia (view source)
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Proliferative fibrocystic changes -- intermed mag.jpg | |||
| Width = | |||
| Caption = Proliferative fibrocystic changes (''florid epithelial hyperplasia'' together with ''fibrocystic breast changes''). [[H&E stain]]. | |||
| Synonyms = florid epithelial hyperplasia of the usual type, usual ductal hyperplasia, moderate epithelial hyperplasia | |||
| Micro = breast glands with more than four cell layers above the basement membrane with irregular cell spacing (e.g. streaming), slit-like lumina (esp. at the periphery of the duct), no [[DCIS]]-like architecture (not [[cribriform]], not papillary, not micropapillary, not solid), no nuclear atypia - usually no [[nucleoli]] | |||
| Subtypes = | |||
| LMDDx = [[mild epithelial hyperplasia]], [[atypical ductal hyperplasia]], cribriform [[ductal carcinoma in situ]] | |||
| Stains = | |||
| IHC = ER "low" (see below), CK5 "high" (see below) | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[breast]] | |||
| Assdx = [[fibrocystic breast changes]] (FEH + FCC = ''proliferative fibrocystic changes'') | |||
| Syndromes = | |||
| Clinicalhx = usually an incidental finding | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign, increased risk of [[breast cancer]] | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''Florid epithelial hyperplasia''', abbreviated '''FEH''', is a common benign [[breast pathology]] finding that is associated with a mild increased risk of [[breast cancer]]. | |||
It is also known as '''florid epithelial hyperplasia of the usual type''' (abbreviated '''FEHUT''') and '''usual ductal hyperplasia''' (abbreviated '''UDH'''). | |||
Confusingly, it may be referred to as ''epithelial hyperplasia'', term that is best avoided, as it could lead to confusion with ''[[mild epithelial hyperplasia]]''. | |||
'''Moderate epithelial hyperplasia''' redirects to this article, as it is usually lumped with FEH. '''Proliferative fibrocystic changes''' (abbreviated '''PFCC''') redirects to this article. | |||
==General== | |||
*Mild increased risk of malignancy ~ 1.5-2x.<ref>{{Ref PCPBoD8|542}}</ref> | |||
*Has to be separated from ''[[mild epithelial hyperplasia]]''. | |||
Note: | |||
*''Moderate epithelial hyperplasia'' redirects to this section. | |||
**It is generally not separated from FEH, as the prognosis is thought to be the same. | |||
==Microscopic== | |||
Features:<ref>{{Ref BP|159-160}}</ref> | |||
*Breast glands with ''more than'' four cell layers above the basement membrane - '''key feature'''. | |||
*Irregular cell spacing; streaming. | |||
*Slit-like lumina, esp. at the periphery of the duct. | |||
*No [[DCIS]]-like architecture (not [[cribriform]], not papillary, not micropapillary, not solid). | |||
*No nuclear atypia - usually no [[nucleoli]]. | |||
Memory device ''CLEAN'': | |||
*'''C'''ell spacing is irregular, '''L'''umina are slit-like, '''E'''xtent is less than 2 mm or 2 ducts, '''A'''rchitecture ''not'' DCIS-like, '''N'''uclear atypia ''not'' present. | |||
DDx: | |||
*[[Mild epithelial hyperplasia]]. | |||
*[[Atypical ductal hyperplasia]]. | |||
*Cribriform [[ductal carcinoma in situ]] | |||
===Images=== | |||
<gallery> | |||
Image: Proliferative fibrocystic changes -- low mag.jpg |PFCC - low mag. | |||
Image: Proliferative fibrocystic changes -- intermed mag.jpg |PFCC - intermed. mag. | |||
Image: Proliferative fibrocystic changes -- high mag.jpg |PFCC - high mag. | |||
Image: Proliferative fibrocystic changes -- very high mag.jpg|PFCC - very high mag. | |||
</gallery> | |||
==IHC== | |||
Features:<ref name=pmid19675450>{{Cite journal | last1 = Grin | first1 = A. | last2 = O'Malley | first2 = FP. | last3 = Mulligan | first3 = AM. | title = Cytokeratin 5 and estrogen receptor immunohistochemistry as a useful adjunct in identifying atypical papillary lesions on breast needle core biopsy. | journal = Am J Surg Pathol | volume = 33 | issue = 11 | pages = 1615-23 | month = Nov | year = 2009 | doi = 10.1097/PAS.0b013e3181aec446 | PMID = 19675450 }}</ref> | |||
*ER "low". | |||
*CK5 "high". | |||
Where: | |||
*ER "high" = diffuse strong staining in >90% of cells. | |||
*CK5 "high" = mosaic pattern of staining in >20% of cells | |||
*CK5 "low" = absent or staining in <20% of cells. | |||
Note: | |||
*ADH/DCIS: | |||
**ER "high" | |||
**CK5 "low". | |||
==Sign out== | |||
<pre> | |||
A. Left Breast (795 grams), Reduction Mammoplasty: | |||
- Benign breast tissue with usual ductal hyperplasia and skin within normal limits. | |||
B. Right Breast (685 grams), Reduction Mammoplasty: | |||
- Benign breast tissue and skin within normal limits. | |||
</pre> | |||
===UDH with cystic changes=== | |||
<pre> | |||
A. Right Breast (570 grams), Reduction Mammoplasty: | |||
- Benign breast tissue with proliferative fibrocystic changes. | |||
- Benign skin. | |||
B. Left Breast (580 grams), Reduction Mammoplasty: | |||
- Breast tissue and skin within normal limits. | |||
</pre> | |||
Note: | |||
*"Proliferative fibrocystic changes" = UDH + [[fibrocystic changes]]. | |||
==See also== | |||
*[[Breast pathology]]. | |||
*[[Atypical ductal hyperplasia]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Breast pathology]] | |||