Atypical Hyperplasias
In this section three lesions are discussed:
- Atypical Ductal Hyperplasia (ADH)
- Columnar Cell Change with atypia
- Atypical Lobular Hyperplasia (ALH)
All three conditions if identified in a core biopsy require at least follow up and usually a diagnostic excision biopsy and all three lesions
confer up to a four or five times increased risk of the long term development of cancer.
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.
Columnar cell change with atypia
Columnar cell change with atypia - this was adjacent to a focus of intermediate grade DCIS
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Columnar cell hyperplasia with atypia - Example 2 - this was adjacent to an area of usual epithelial hyperplasia and Columnar cell hyperplasia without atypia.
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