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Atypical ductal hyperplasia

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 quantity Architecture: cribriform spaces, micropapillae (bulbous), rigid bars

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Atypical ductal hyperplasia

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  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 • A matter of quantity • Architecture: cribriform spaces, micropapillae (bulbous), rigid bars • Cytology: ‘clonal’, monotonous, mild nuclear atypia, enlarged, nucleoli, distinct cell borders. Same as LG-DCIS

  2. ADH/DCIS • When does ADH become DCIS? • A matter of quantity. • Criteria still vary and are not standardized • WHO 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

  3. IHC • IHC : UDH vs ADH/DCIS • CK5/6 and ER • Caveat: Not helpful in columnar cell change or apocrine change.

  4. 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.

  5. ER CK5/6

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