Atypical Ductal Hyperplasia (ADH)
General features
- ADH is important because it carries a 4-5 times relative risk of breast cancer at 10-15 yrs post biopsy.
- It causes diffuculty to diagnostic pathologists - inconsistency in diagnosis is common.
- It lies closest morphologically to low grade DCIS - it is NOT a high grade lesion.
Pathology
The following histological features are recognised:
- Microscopic features:
- Usually solitary
- Confined to a single lobular unit
- Seldom larger than 3mm
- At least focally a uniform cell population and architectural features of low grade DCIS.
- Cribriform, micropapillary or solid growth pattern
- Secondary lumina some of which are rigid while others are tapering
- Evenly spaced cells with hyperchromatic nuclei
ADH (example 1)
The following image shows a small focus of ADH. Note partial involvement of the duct
with focally a monotonous population of epithelial cells showing rigid structures and low grade
cytology - mouse over both sides of the image to see detailed views of the atypical epithelial tufts
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ADH (example 2)
The following sequence of four images show different views of a small focus of ADH. Note partial involvement of the duct, particularly in the top image, a monotonous population of epithelial cells showing
rigid structure across ducts and low grade cytology. Luminal microcalcifications are present.
ADH (example 3)
Further example of ADH. This focus was adjacent to a mucocele-like lesion. There is a known association between the two condidtions.
References:
1. Pathology Reporting of Breast Disease. NHS Cancer Screening Programmes/Royal College of Pathologists. NHS BSP Publication No 58, 2005.
2. Carter BA, Page DL, O'Malley FP Usual epithelial hyperplasia and atypical ductal hyperplasia in Foundations in diagnostic pathology
- Breast Pathology. pp 164-168. Eds O'Malley FP & Pinder SE. Churchill Livingstone, Elsevier 2006.
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