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Atypical ductal hyperplasia

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Last Updated: 15 September 2020

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Atypical ductal hyperplasia

SpecialtyGynecology , pathology

Atypical hyperplasia is a term which refers to the accumulation of abnormal cells in breast tissue. It is not cancer, but can be a pre - cancerous condition where abnormal cells causing hyperplasia keep dividing in an uncontrolled manner. It may lead to non - invasive or invasive breast cancer in the long term. People diagnosed with atypical hyperplasia have a higher risk of developing breast cancer in future than those who do have the condition. Hence, breast cancer screening and medications to lower the risk of breast cancer are recommended for women with atypical hyperplasia. However, it is worth noting that the majority of women with atypical hyperplasia never go on to develop breast cancer in their lifetime. There are two types of atypical hyperplasia - ductal and lobular. This indicates the origin of abnormal cells. Ductal means abnormal cells are detected in one of the ducts through which breast milk travels to reach the nipple. Lobular means abnormal cell growth in lobules, which are areas in the breast that make milk. While atypical ductal hyperplasia increases breast cancer risk in the area where it was find, atypical lobular hyperplasia increases cancer risk in both breasts.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Pathology

A normal breast is made of ducts that end in group of sacs called lobules. Hyperplasia is a term used when there is growth of cells within ducts and / or lobules of the breast that are not cancerous. Normally, ducts and lobules are lined by 2 layers of cells. Hyperplasia means that there are more cells than usual and they are no longer lined up in just 2 layers. If growth looks much like the normal pattern under the microscope, hyperplasia may be called normal. Some growths look more abnormal, and may be called atypical hyperplasia. Two major patterns of hyperplasia in the breast are ductal hyperplasia and lobular hyperplasia. What makes hyperplasia ductal or lobular is based more on what cells look like under the microscope rather than whether hyperplasia is occurring within ducts or lobules.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Diagnosis

Atypical hyperplasia is usually discovered after biopsy to evaluate suspicious area found on mammogram or during Clinical Breast exam. During the biopsy, tissue samples are removed and sent for analysis by a specially trained doctor. Tissue samples are examined under microscope, and the pathologist identifies atypical hyperplasia, if it's present. To further evaluate atypical hyperplasia, your doctor may recommend surgery to remove a larger sample of tissue to look for breast cancer. Diagnosis of atypical hyperplasia may lead to surgical biopsy to remove all of the affected tissue. Pathologists look at larger specimens for evidence of in situ or invasive cancer.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Treatment

To reduce your risk of developing breast cancer, your doctor may recommend that you: take preventive medications. Treatment with selective estrogen receptor modulator, such as tamoxifen or raloxifene, for five years may reduce the risk of breast cancer. These drugs work by blocking estrogen from binding to estrogen receptors in breast tissue. Estrogen is thought to fuel growth of some breast cancers. Tamoxifen is the only drug approved for use in premenopausal women. Another option for postmenopausal women may be aromatase inhibitors, such as exemestane and anastrozole, which decrease production of estrogen in the body. Avoid menopausal hormone therapy. Researchers have concluded that combination hormone therapy to treat symptoms of menopause, estrogen plus progestin increases breast cancer risk in postmenopausal women. Many breast cancers depend on hormones for growth. Participate in a clinical trial. Clinical trials test new treatments not yet available to the public at large that may prove helpful in reducing breast cancer risk associated with atypical hyperplasia. Ask your doctor if you are a candidate for any clinical trials. Consider risk - reducing mastectomy. For women at very high risk of breast cancer, risk - reducing mastectomy surgery to remove one or both breasts reduces the risk of developing breast cancer in future. You might be considered at very high risk of breast cancer if you have a genetic mutation in one of breast cancer genes or you have a very strong family history of breast cancer that suggests the likelihood of having such a genetic mutation. But this surgery isn't right for everyone. Discuss with your doctor the risks, benefits and limitations of this risk - reducing surgery in light of your personal circumstances. If you have a strong family history of breast cancer, you might benefit from meeting with genetic counselor to evaluate your risk of carrying genetic mutation and the role of genetic testing in your situation.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Atypical Ductal Hyperplasia (ADH)

First, there is no need to panic. If pathology findings are limited to atypical ductal hyperplasia, you do not have breast cancer - but you do have an increased risk of developing it in future. Not all ADH cells need to be remove, but your doctor should be aware of findings. The most important thing to do now is find a breast Center where your breast health can be closely monitor. Women with diagnosis of ADH alone should not need to undergo voluntary mastectomy. The risk of developing breast cancer is higher than it is in the average population, but most women just need to be closely monitor. Some can even take medication, such as Tamoxifen, to reduce the risk of developing breast cancer. Our physicians and staff are specially trained to help women understand ADH and their risks of developing breast cancer. If a woman has ADH cells found on biopsy, as well as other risk factors for breast cancer, further evaluation can be done to calculate her risk of one day developing breast cancer and appropriate preventative steps can be recommend. This may include lifestyle changes, medications or surgery. At Johns Hopkins Breast Center, many of our patients with ADH benefit by joining our high - risk clinic program, Johns Hopkins Breast and Ovarian Surveillance Service. The program focuses on ways to reduce the risk of developing breast cancer and give women tools to manage knowledge that they are at higher risk. A medical oncologist can assess your overall risk and recommend ways to reduce risk in future, such as hormonal therapy for breast cancer prevention.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Overview

Atypical hyperplasia is a precancerous condition that affects cells in the breast. Atypical hyperplasia describes accumulation of abnormal cells in the breast. Atypical hyperplasia isn't cancer, but it can be a forerunner to the development of breast cancer. Over the course of your lifetime, if atypical hyperplasia cells keep dividing and become more abnormal, this can transition into noninvasive breast cancer or invasive breast cancer. If you 've been diagnosed with atypical hyperplasia, you have an increased risk of developing breast cancer in future. For this reason, doctors often recommend intensive breast cancer screening and medications to reduce breast cancer risk.


Atypical Ductal Hyperplasia (ADH)

Adh is defined as intraductal lesion characterized by proliferation of evenly distribute, monomorphic cells, which bear remarkable morphologic resemblance to low - grade forms of DCIS. Despite controversy in terms of histopathologic criteria for diagnosing ADH raised by some authorites, molecular genetic analysis has highlighted similarities between ADH and well - differentiate DCIS and positioned ADH as non - obligate precursor in multistep model of breast carcinogenesis. Whilst third to half of all ADH show no genetic changes when studied by CGH, others show profile that overlap with those of well - differentiate DCIS, including loss of 16q and gains of 17p. These data corroborate previous LOH studies in which loss at 16q and 17p were concurrently observed in paired ADH and DCIS, and give support to non - obligate precursor nature of ADH. These data highlight that morphologic similarities between ADH and low - grade DCIS are mirrored at genetic level, casting some doubts about the validity of separating ADH and DCIS. On the other hand, as there are morphologic and prognostic differences between ADH and DCIS, data gives support for the concept of ADH being either part of the spectrum of or precursor to low - grade DCIS and hence of grade I invasive carcinoma.


Pathology

When AD is identify, one must always first correlate finding with patients ' surgical history, as the most common cause of AD is previous surgery, secondary to either benign or malignant disease. If no surgical history is find, AD is considered a suspicious finding and malignancy must be exclude. Malignant etiologies include invasive ductal or lobular cancer. Give that IDC is more common, most malignant AD will represent IDC, including NOS or well - differentiate invasive tubular carcinoma. Ilc traditionally accounts for 5% to 10% of all invasive breast cancers and can be extremely subtle or occult on 2D mammography. Early studies indicate that the rate of ILC may be higher among suspicious AD seen only on tomosynthesis, thus potentially improving the rate of detection of this invasive subtype. Although infrequent, ductal carcinoma in situ may also present as AD see only on tomosynthesis. Dcis typically presented as suspicious linear, branching, and / or pleomorphic microcalcifications, but has been reported to present as AD on 2D mammography in 2% to 10% of DCIS cases. On tomosynthesis, DCIS may present as subtle AD with variable density, with or without associate suspicious microcalcifications. In addition to postoperative scars and invasive and / or in situ cancers, other histologies presented as AD include high - risk radial sclerosing lesions, atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ. Stromal fibrosis, sclerosing adenosis, and rarely granular cell tumor or breast fibromatosis may also present as AD see only on tomosynthesis. Radial sclerosing lesions, composed of both radial scars and complex sclerosing lesions, may also present as AD on tomosynthesis and are indistinguishable from carcinoma. These lesions are histologically similar and are unrelated to trauma or prior surgery and may be secondary to localized inflammatory reaction and chronic ischemia. Complex sclerosing lesions are distinguished from radial scars by being more complex histologically and generally greater than 1 cm. Radial sclerosing lesions have been reported to be associated with atypia and / or malignancy, although data has been primarily based on 2D mammography. Understanding of the association of malignancy with radial sclerosing lesions found in tomosynthesis is still evolving.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Causes

The specific cause for atypical ductal hyperplasia is unknown. Normal cells overproduce. And as that continue, they begin to become irregular. If the condition is not properly manage, it will continue to progress and eventually become breast cancer. It may also affect nearby tissues. Risk factors for ADH are similar to those for all types of breast cancer, including: getting older: risk for breast cancer and benign breast conditions increase with age; most breast cancers are diagnosed after age 50. Genetic mutations: inherit mutation of certain genes, such as BRCA1 and BRCA2 Reproductive health history: This includes early menstruation and starting menopause after age 55. Having pregnant after age 30, not breastfeeding, and never having full - term pregnancy are also risk factors. Have Dense breast tissue: Dense breasts have more connective tissue than fatty tissue, which allows cancerous cells room to grow. Family history: women's risk is higher if she has a first - degree relative who has had breast cancer, or multiple family members who have had breast cancer. Previous radiation treatments: woman who has had previous radiation therapy to her chest or breasts before age 30 has a higher risk of getting breast cancer later Activity level and / or weight: not being active and / or being overweight after menopause can increase your risk. Taking hormones: Birth control pills and hormone replacement therapy have been shown to raise risk. Alcohol consumption: Overconsumption of alcohol may play a role. Carcinogen Exposure: Exposure to substances that cause cancer, including via smoking, also increases the risk for breast cancer and benign breast conditions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Complications

Atypical hyperplasia forms when breast cells become abnormal in number, size, shape, growth pattern and appearance. The appearance of abnormal cells determines the type of atypical hyperplasia: atypical ductal hyperplasia causes abnormal cells that appear similar to cells of breast ducts. Atypical lobular hyperplasia causes abnormal cells that appear similar to cells of breast lobules. Atypical hyperplasia is thought to be part of complex transition of cells that may evolve into breast cancer. Progression to breast cancer typically involve: hyperplasia. The process begins when normal cell development and growth become disrupt, causing overproduction of normal - looking cells. Atypical hyperplasia. Excess cells stack upon one another and begin to take on an abnormal appearance. At this point, cells have some, but not all, of the changes needed to become cancer. Noninvasive cancer. Abnormal cells continue to progress in appearance and multiply, evolving into in - situ cancer, in which cancer cells remain confined to the area where they start growing. Invasive cancer. Left untreated, cancer cells may eventually become invasive cancer, invading surrounding tissue, blood vessels or lymph channels.


Increased risk of breast cancer

If you 've been diagnosed with atypical hyperplasia, you have an increased risk of developing breast cancer in future. Women with atypical hyperplasia have a lifetime risk of breast cancer that is about four times higher than that of women who don't have atypical hyperplasia. The risk of breast cancer is the same for women with atypical ductal hyperplasia and women with atypical lobular hyperplasia. Recent research has revealed that the risk of breast cancer increases in the years after atypical hyperplasia diagnosis: at 5 years after diagnosis, about 7 percent of women with atypical hyperplasia may develop breast cancer. Put another way, for every 100 women diagnosed with atypical hyperplasia, 7 can expected to develop breast cancer five years after diagnosis. And 93 will not be diagnosed with breast cancer. 10 years after diagnosis, about 13 percent of women with atypical hyperplasia may develop breast cancer. That means for every 100 women diagnosed with atypical hyperplasia, 13 can expetected develop breast cancer 10 years after diagnosis. And 87 will not develop breast cancer. 25 years after diagnosis, about 30 percent of women with atypical hyperplasia may develop breast cancer. Put another way, for every 100 women diagnosed with atypical hyperplasia, 30 can expected to develop breast cancer 25 years after diagnosis. And 70 will not develop breast cancer. Being diagnosed with atypical hyperplasia at a younger age may increase the risk of breast cancer even more. For example, women diagnosed with atypical hyperplasia before age 45 seem to have greater risk of developing breast cancer during their lifetimes. Discuss your risk of breast cancer with your doctor. Understanding your risk can help you make decisions about breast cancer screening and risk - reducing medications.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

About Atypical Hyperplasia

Atypical hyperplasia means that there are abnormal cells in breast tissue that was biopsied. These are high - risk lesions, but are benign. These findings account for 10 percent of benign breast biopsies. There are two types of atypical hyperplasia - atypical ductal hyperplasia and atypical lobular hyperplasia. Atypical ductal hyperplasia means that abnormal cells are located in the breast duct. Atypical lobular hyperplasia means that abnormal cells are in the breast lobule. Another high - risk lesion is lobular carcinoma in situ, which is more extensive involvement of atypical cells in breast lobules.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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