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Outline

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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Outline

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  1. 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.

  2. 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 genetics • Different morphology: architecture, cytology, extent.

  3. UDH ADH DCIS INV CA CCL/FEA DIN terminology? UDH ADH HG DCIS LG DCIS INV CA

  4. Genetics of intraductal proliferative lesions H CA Loss 16q FEA/CCL UDH ADH HG DCIS LG DCIS INV CA

  5. 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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