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Atypical ductal hyperplasia

December 15, 2023

Atypical ductal hyperplasia (ADH) is the term used for a benign lesion of the breast that indicates an increased risk of breast cancer.[1]

Atypical ductal hyperplasia
Very low magnification micrograph of atypical ductal hyperplasia (ADH). The piece with ADH was circled by the pathologist with a marker, as it is so small, and sent for an additional opinion. H&E stain.
SpecialtyGynecology, pathology

The name of the entity is descriptive of the lesion; ADH is characterized by cellular proliferation (hyperplasia) within one or two breast ducts and (histomorphologic) architectural abnormalities, i.e. the cells are arranged in an abnormal or atypical way.

In the context of a core (needle) biopsy, ADH is considered an indication for a breast lumpectomy, also known as a surgical (excisional) biopsy, to exclude the presence of breast cancer.[2]

Signs and symptoms edit

ADH, generally, is asymptomatic. It usually comes to medical attention on a screening mammogram, as a non-specific suspicious abnormality that requires a biopsy.

Pathology edit

ADH, cytologically, architecturally and on a molecular basis, is identical to a low-grade ductal carcinoma in situ (DCIS);[3] however, it has a limited extent, i.e. is present in a very small amount (< 2 mm).

  •  

    Low mag.

  •  

    High mag.

Relation to low-grade ductal carcinoma in situ edit

While the histopathologic features and molecular features of ADH are that of (low-grade) DCIS, its clinical behaviour, unlike low-grade DCIS, is substantially better; thus, the more aggressive treatment for DCIS is not justified.

Diagnosis edit

 
Histological appearance of atypical ductal hyperplasia (ADH) and immunohistochemical phenotype:[4]
- A - One focus (< 2 mm) of two architecturally disarranged cross sections of tubuli showing a monotonous intraductal proliferation with secondary intraluminal architecture. Hematoxylin and Eosin stain.
- B - One area of an ADH with associated calcifications intraluminal. Hematoxylin and Eosin stain.
- C - Higher magnification of ADH shows low-grade nuclear atypia and monotonous cell proliferation along with secondary intraluminal architecture. Hematoxylin and Eosin stain.
- D - Strong and uniform expression of estrogen receptors (ER). ER immunohistochemistry.
- E - Lack of basal cytokeratins (CK5/6). CK5/6 immunohistochemistry.

It is diagnosed based on tissue, e.g. a biopsy,[5] showing ductal hyperplasia.

There is no single definite cutoff that separates atypical ductal hyperplasia from ductal carcinoma in situ, but the following are important distinctive features of atypical ductal hyperplasia, with suggested cutoffs:[6]

  • Size less than 2 mm.
  • Not involving more than one duct.
  • The atypical epithelial proliferation is admixed with a second population of proliferative cells without atypia.
  • The proliferation completely involves the terminal ductal lobular unit(s), to a limited extent.

Treatment edit

ADH, if found on a surgical (excisional) biopsy of a mammographic abnormality, does not require any further treatment, only mammographic follow-up.

If ADH is found on a core (needle) biopsy (a procedure which generally does not excise a suspicious mammographic abnormality), a surgical biopsy, i.e. a breast lumpectomy, to completely excise the abnormality and exclude breast cancer is the typical recommendation.

Prognosis edit

Cancer risk for ADH on a core biopsy edit

The rate at which breast cancer (ductal carcinoma in situ or invasive mammary carcinoma (all breast cancer except DCIS and LCIS)) is found at the time of a surgical (excisional) biopsy, following the diagnosis of ADH on a core (needle) biopsy varies considerably from hospital-to-hospital (range 4-54%).[7] In two large studies, the conversion of an ADH on core biopsy to breast cancer on surgical excision, known as "up-grading", is approximately 30%.[7][8]

Cancer risk based on follow-up edit

The 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.[9]

See also edit

References edit

  1. ^ . Archived from the original on May 27, 2010.
  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. doi:10.2214/ajr.164.5.7717215. PMID 7717215.
  3. ^ 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. PMC 1888715. PMID 17058097.
  4. ^ Rageth, Christoph J.; Rubenov, Ravit; Bronz, Cristian; Dietrich, Daniel; Tausch, Christoph; Rodewald, Ann-Katrin; Varga, Zsuzsanna (2018). "Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens". Breast Cancer. 26 (4): 452–458. doi:10.1007/s12282-018-00943-2. ISSN 1340-6868. PMC 6570781. PMID 30591993. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)
  5. ^ Eby PR, Ochsner JE, DeMartini WB, Allison KH, Peacock S, Lehman CD (January 2009). "Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge". AJR Am J Roentgenol. 192 (1): 229–34. doi:10.2214/AJR.08.1342. PMID 19098204.
  6. ^ Tozbikian, Gary; Brogi, Edi; Vallejo, Christina E.; Giri, Dilip; Murray, Melissa; Catalano, Jeffrey; Olcese, Cristina; Van Zee, Kimberly J.; Wen, Hannah Yong (2016). "Atypical Ductal Hyperplasia Bordering on Ductal Carcinoma In Situ". International Journal of Surgical Pathology. 25 (2): 100–107. doi:10.1177/1066896916662154. ISSN 1066-8969. PMC 5285492. PMID 27481892.
  7. ^ a b Deshaies, I.; Provencher, L.; Jacob, S.; Côté, G.; Robert, J.; Desbiens, C.; Poirier, B.; Hogue, JC.; Vachon, E. (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.
  8. ^ 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.
  9. ^ 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. doi:10.1001/jama.1992.03480070057030. PMID 1734106.

External links edit

  • What is atypical ductal hyperplasia? (hopkinsmedicine.org)

December 15, 2023
atypical, ductal, hyperplasia, term, used, benign, lesion, breast, that, indicates, increased, risk, breast, cancer, very, magnification, micrograph, atypical, ductal, hyperplasia, piece, with, circled, pathologist, with, marker, small, sent, additional, opini. Atypical ductal hyperplasia ADH is the term used for a benign lesion of the breast that indicates an increased risk of breast cancer 1 Atypical ductal hyperplasiaVery low magnification micrograph of atypical ductal hyperplasia ADH The piece with ADH was circled by the pathologist with a marker as it is so small and sent for an additional opinion H amp E stain SpecialtyGynecology pathologyThe name of the entity is descriptive of the lesion ADH is characterized by cellular proliferation hyperplasia within one or two breast ducts and histomorphologic architectural abnormalities i e the cells are arranged in an abnormal or atypical way In the context of a core needle biopsy ADH is considered an indication for a breast lumpectomy also known as a surgical excisional biopsy to exclude the presence of breast cancer 2 Contents 1 Signs and symptoms 2 Pathology 2 1 Relation to low grade ductal carcinoma in situ 3 Diagnosis 4 Treatment 5 Prognosis 5 1 Cancer risk for ADH on a core biopsy 5 2 Cancer risk based on follow up 6 See also 7 References 8 External linksSigns and symptoms editADH generally is asymptomatic It usually comes to medical attention on a screening mammogram as a non specific suspicious abnormality that requires a biopsy Pathology editADH cytologically architecturally and on a molecular basis is identical to a low grade ductal carcinoma in situ DCIS 3 however it has a limited extent i e is present in a very small amount lt 2 mm nbsp Low mag nbsp High mag Relation to low grade ductal carcinoma in situ edit While the histopathologic features and molecular features of ADH are that of low grade DCIS its clinical behaviour unlike low grade DCIS is substantially better thus the more aggressive treatment for DCIS is not justified Diagnosis edit nbsp Histological appearance of atypical ductal hyperplasia ADH and immunohistochemical phenotype 4 A One focus lt 2 mm of two architecturally disarranged cross sections of tubuli showing a monotonous intraductal proliferation with secondary intraluminal architecture Hematoxylin and Eosin stain B One area of an ADH with associated calcifications intraluminal Hematoxylin and Eosin stain C Higher magnification of ADH shows low grade nuclear atypia and monotonous cell proliferation along with secondary intraluminal architecture Hematoxylin and Eosin stain D Strong and uniform expression of estrogen receptors ER ER immunohistochemistry E Lack of basal cytokeratins CK5 6 CK5 6 immunohistochemistry It is diagnosed based on tissue e g a biopsy 5 showing ductal hyperplasia There is no single definite cutoff that separates atypical ductal hyperplasia from ductal carcinoma in situ but the following are important distinctive features of atypical ductal hyperplasia with suggested cutoffs 6 Size less than 2 mm Not involving more than one duct The atypical epithelial proliferation is admixed with a second population of proliferative cells without atypia The proliferation completely involves the terminal ductal lobular unit s to a limited extent Treatment editADH if found on a surgical excisional biopsy of a mammographic abnormality does not require any further treatment only mammographic follow up If ADH is found on a core needle biopsy a procedure which generally does not excise a suspicious mammographic abnormality a surgical biopsy i e a breast lumpectomy to completely excise the abnormality and exclude breast cancer is the typical recommendation Prognosis editCancer risk for ADH on a core biopsy edit The rate at which breast cancer ductal carcinoma in situ or invasive mammary carcinoma all breast cancer except DCIS and LCIS is found at the time of a surgical excisional biopsy following the diagnosis of ADH on a core needle biopsy varies considerably from hospital to hospital range 4 54 7 In two large studies the conversion of an ADH on core biopsy to breast cancer on surgical excision known as up grading is approximately 30 7 8 Cancer risk based on follow up edit The 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 9 See also editDuctal carcinoma in situ Breast cancer Collagenous spherulosisReferences edit Understanding Breast Changes National Cancer Institute Archived from the original on May 27 2010 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 doi 10 2214 ajr 164 5 7717215 PMID 7717215 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 PMC 1888715 PMID 17058097 Rageth Christoph J Rubenov Ravit Bronz Cristian Dietrich Daniel Tausch Christoph Rodewald Ann Katrin Varga Zsuzsanna 2018 Atypical ductal hyperplasia and the risk of underestimation tissue sampling method multifocality and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens Breast Cancer 26 4 452 458 doi 10 1007 s12282 018 00943 2 ISSN 1340 6868 PMC 6570781 PMID 30591993 This article is distributed under the terms of the Creative Commons Attribution 4 0 International License http creativecommons org licenses by 4 0 Eby PR Ochsner JE DeMartini WB Allison KH Peacock S Lehman CD January 2009 Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum assisted breast biopsy 9 versus 11 gauge AJR Am J Roentgenol 192 1 229 34 doi 10 2214 AJR 08 1342 PMID 19098204 Tozbikian Gary Brogi Edi Vallejo Christina E Giri Dilip Murray Melissa Catalano Jeffrey Olcese Cristina Van Zee Kimberly J Wen Hannah Yong 2016 Atypical Ductal Hyperplasia Bordering on Ductal Carcinoma In Situ International Journal of Surgical Pathology 25 2 100 107 doi 10 1177 1066896916662154 ISSN 1066 8969 PMC 5285492 PMID 27481892 a b Deshaies I Provencher L Jacob S Cote G Robert J Desbiens C Poirier B Hogue JC Vachon E 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 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 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 doi 10 1001 jama 1992 03480070057030 PMID 1734106 External links editWhat is atypical ductal hyperplasia hopkinsmedicine org Retrieved from https en wikipedia org w index php title Atypical ductal hyperplasia amp oldid 1094949729, wikipedia, wiki, book, books, library,

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