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atypical ductal hyperplasia

Friday 12 December 2014

mammary atypical ductal hyperplasia, ADH

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Definition: In patient with atypical ductal hyperplasia, the risk of invasive breast carcinoma is approximately 5 times that of the general population.

Images

- ADH arising in a background of FEA- note the monomorphic-type cytologic atypia

- ADH and LCIS association. E-cadherin stain.

Microscopy

  • The proliferating cells form irregular glandular spaces.
  • Atypical cells with enlarged, irregular, hyperchromatic nuclei, uneven distribution of chromatin, and medium sized nucleoli.
  • Individually, these atypical cells have the characters of malignant cells. However, the background benign epithelial cells and myoepithelial cells remain.
  • In these foci, highly atypical cells can become quite homogeneous, however, rare myoepithelial cells with small, dark nuclei remain.
  • Solid filling of a duct can be observed.
  • The cytologic features are indistinguishable from low-grade DCIS (monomorphic cells with round or oval nuclei, micropapillary structures, tufts, fronds, cribriform areas etc).
  • But usually they are admixed with ductal hyperplasia or show partial involvement of terminal duct-lobular unit.
  • The distended lobules are occupied by atypical lobular cells with round to oval nuclei and small nucleoli. Rare myoepithelial cells with small dark nuclei remain.

Prognosis

  • In patient with atypical ductal hyperplasia, the risk of invasive breast carcinoma is approximately 5 times that of the general population.

Differential diagnosis

- low-grade DCIS

  • The cytologic features are indistinguishable from low-grade DCIS (monomorphic cells with round or oval nuclei, micropapillary structures, tufts, fronds, cribriform areas etc).
  • But usually they are admixed with ductal hyperplasia or show partial involvement of terminal duct-lobular unit.

See also

- anomalies of the breast

  • benign lesions of the breast

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