atypical ductal hyperplasia
Post on 17-Feb-2016
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Atypical ductal hyperplasia
“A diagnosis of ADH should not be made unless a diagnosis of low grade DCIS is being seriously considered” WHO Breast 2012
A matter of quantityArchitecture: cribriform spaces, micropapillae
(bulbous), rigid barsCytology: ‘clonal’, monotonous, mild nuclear
atypia, enlarged, nucleoli, distinct cell borders. Same as LG-DCIS
ADH/DCIS
When does ADH become DCIS?A matter of quantity. Criteria still vary and are not standardizedWHO states: > 2 mm and/or completely
involving at least two duct spaces.Any intraductal proliferation with moderate-
high grade nuclear features = DCIS (no size criteria).
Sometimes ADH and UDH co-exist
IHC
IHC : UDH vs ADH/DCIS CK5/6 and ER Caveat: Not helpful in columnar cell change or
apocrine change.
Practical point
If a core biopsy shows borderline features of ADH/DCIS, be conservative and call it ‘at least ADH’
An upgrade rate to DCIS on excision is well known and accepted.
Harder to explain DCIS, limited to the core.
ER
CK5/6
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