Atypical ductal hyperplasia “A diagnosis of ADH should not be made unless a diagnosis of low grade...
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Transcript of Atypical ductal hyperplasia “A diagnosis of ADH should not be made unless a diagnosis of low grade...
![Page 1: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/1.jpg)
![Page 2: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/2.jpg)
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
![Page 3: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/3.jpg)
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
![Page 4: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/4.jpg)
IHC
IHC : UDH vs ADH/DCIS CK5/6 and ER Caveat: Not helpful in columnar cell change or
apocrine change.
![Page 5: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/5.jpg)
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.
![Page 6: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/6.jpg)
![Page 7: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/7.jpg)
![Page 8: 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.](https://reader035.fdocuments.in/reader035/viewer/2022062417/551b382c550346cf5a8b64b8/html5/thumbnails/8.jpg)
ER
CK5/6