Atypical ductal hyperplasia
Encyclopedia
Atypical ductal hyperplasia, abbreviated ADH, is the term used for a benign
lesion
of the breast that indicates an increased risk of breast cancer
.
The name of the entity is descriptive of the lesion; ADH is characterized by cellular proliferation (hyperplasia
) within one or two breast ducts and (histomorphologic) architectural abnormalities, i.e. the cells are arranged in an abnormal or atypical way.
In the context of a core (needle) biopsy, ADH is considered an indication for a breast lumpectomy, also known as a surgical (excisional) biopsy, to exclude the presence of breast cancer
.
.
. Histomorphologically, it has architectural changes seen in low-grade ductal carcinoma in situ (DCIS), e.g. cribriform architecture, and like low-grade DCIS has minimal nuclear atypia
and no necrosis
.
, architecturally
and on a molecular
basis, is identical to a low-grade ductal carcinoma in situ (DCIS); however, it has a limited extent, i.e. is present in a very small amount (< 2 mm).
in general, it is observed that tumour size is often strongly predictive of the clinical behaviour and, thus, a number of cancer
s (e.g. adenocarcinoma of the lung
, papillary renal cell carcinoma
) are defined, in part, on the basis of a minimum size.
If ADH is found on a core (needle) biopsy (a procedure which generally does not excise a suspicious mammographic abnormality), a surgical biopsy, i.e. a breast lumpectomy, to completely excise the abnormality and exclude breast cancer is the typical recommendation.
of breast cancer
based on a median follow-up of 8 years, in a case control study of US
registered nurse
s, is 3.7.
Benign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
of the breast that indicates an increased risk of breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
.
The name of the entity is descriptive of the lesion; ADH is characterized by cellular proliferation (hyperplasia
Hyperplasia
Hyperplasia means increase in number of cells/proliferation of cells. It may result in the gross enlargement of an organ and the term is sometimes mixed with benign neoplasia/ benign tumor....
) within one or two breast ducts and (histomorphologic) architectural abnormalities, i.e. the cells are arranged in an abnormal or atypical way.
In the context of a core (needle) biopsy, ADH is considered an indication for a breast lumpectomy, also known as a surgical (excisional) biopsy, to exclude the presence of breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
.
Symptoms
ADH, generally, is asymptomatic. It usually comes to medical attention on a screening mammogram, as a non-specific suspicious abnormality that requires a biopsyBiopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
.
Diagnosis
It is diagnosed based on tissue, e.g. a biopsyBiopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
. Histomorphologically, it has architectural changes seen in low-grade ductal carcinoma in situ (DCIS), e.g. cribriform architecture, and like low-grade DCIS has minimal nuclear atypia
Nuclear atypia
Nuclear atypia refers to abnormal appearance of cell nuclei. It is a term used in cytopathology. Specific abnormalities include pleomorphism....
and no necrosis
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
.
Pathology
ADH, cytologicallyCytopathology
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
, architecturally
Histopathology
Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease...
and on a molecular
Molecular pathology
Molecular pathology is an emerging discipline within pathology which is focused in the study and diagnosis of disease through the examination of molecules within organs, tissues or bodily fluids....
basis, is identical to a low-grade ductal carcinoma in situ (DCIS); however, it has a limited extent, i.e. is present in a very small amount (< 2 mm).
Relation to low-grade ductal carcinoma in situ
While the histopathologic features and molecular features of ADH are that of (low-grade) DCIS, its clinical behaviour, unlike low-grade DCIS, is substantially better; thus, the more aggressive treatment for DCIS is not justified. In oncologyOncology
Oncology is a branch of medicine that deals with cancer...
in general, it is observed that tumour size is often strongly predictive of the clinical behaviour and, thus, a number of cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
s (e.g. adenocarcinoma of the lung
Adenocarcinoma of the lung
Adenocarcinoma of the lung is a common histological form of lung cancer that contains certain distinct malignant tissue architectural, cytological, or molecular features, including gland and/or duct formation and/or production of significant amounts of mucus....
, papillary renal cell carcinoma
Renal cell carcinoma
Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products. RCC is the most common type of kidney cancer in adults, responsible for approximately 80% of cases...
) are defined, in part, on the basis of a minimum size.
Treatment
ADH, if found on a surgical (excisional) biopsy of a mammographic abnormality, does not require any further treatment, only mammographic follow-up.If ADH is found on a core (needle) biopsy (a procedure which generally does not excise a suspicious mammographic abnormality), a surgical biopsy, i.e. a breast lumpectomy, to completely excise the abnormality and exclude breast cancer is the typical recommendation.
Cancer risk for ADH on a core biopsy
The rate at which breast cancer (ductal carcinoma in situ or invasive mammary carcinoma (all breast cancer except DCIS and LCIS)) is found at the time of a surgical (excisional) biopsy, following the diagnosis of ADH on a core (needle) biopsy varies considerably from hospital-to-hospital (range 4-54%). In two large studies, the conversion of an ADH on core biopsy to breast cancer on surgical excision, known as "up-grading", is approximately 30%.Cancer risk based on follow-up
The relative riskRelative risk
In statistics and mathematical epidemiology, relative risk is the risk of an event relative to exposure. Relative risk is a ratio of the probability of the event occurring in the exposed group versus a non-exposed group....
of breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
based on a median follow-up of 8 years, in a case control study of US
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
s, is 3.7.