Atypical ductal hyperplasia

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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

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.