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Outline
Intraductal proliferative lesions– Usual ductal hyperplasia (UDH)– Atypical ductal hyperplasia (ADH)– Low grade DCIS– Flat epithelial atypia (FEA)– Clinical significance and management
recommendations
– Not discussing: lobular neoplasia, intermediate and high grade lesions.
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Intraductal proliferative lesions
A group of cytologically and architecturally diverse proliferations originating in the TDLU.
Increased risk for subsequent breast ca – but of vastly different magnitudes.
‘risk indicators’ VS ‘precursors’ Different geneticsDifferent morphology: architecture, cytology,
extent.
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UDH ADH DCIS INV CA
UDH
CCL/FEA
ADH
LG DCIS
HG DCISDIN terminology?
INV CA
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Genetics of intraductal proliferative lesions
H CA
UDH
FEA/CCL
ADH
LG DCIS
HG DCIS
Loss 16q
INV CA
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Usual ductal hyperplasia
Also known as epithelial hyperplasia of usual type
Mild, moderate, florid – of no clinical significance*
Architecture: solid, fenestrated, micropapillary (tapered), peripheral slit-like lumens, attenuated bridges
Cytology: variable size and shape, overlapping, ill-defined cell borders, streaming of cells, necrosis is allowed. Occasional mitoses allowed. Compare to normal ducts for reference.
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