Atypical ductal hyperplasia

Atypical ductal hyperplasia (ADH) is a histologically borderline lesion that has some, but not all the features of ductal carcinoma in situ (DCIS). Sometimes the distinction between ADH and DCIS is simply based on the number of ducts involved. 

Atypical ductal hyperplasia is a lesion with a lot of malignant potential. It lacks the strict criteria for ductal carcinoma in situ. A qualitatively similar lesion to DCIS yet quantitatively is inadequate (< 2 ducts involved) is termed as atypical ductal hyperplasia 3

Grouped or regional amorphous calcifications. Less likely punctate or fine pleomorphic calcifications 6.

Solid or intracystic mass.

Non-specific features on MRI ranging from a round, oval or irregular shape mass to non-mass enhancement in focal, linear, segmental or regional distribution 6.

ADH is considered a high risk breast lesion. Therefore surgical excision is advised as under-estimation of ductal carcinoma in situ is encountered when atypical ductal hyperplasia is retrieved on a large core needle biopsy (up to one-third of cases may be upstaged to DCIS). Tamoxifen may be used as a chemopreventative agent.

Usual ductal hyperplasia, DCIS (low grade), flat epithelial atypia, fibrocystic changes, adenosis and sclerosis adenosis 6.

Breast imaging and pathology

Article information

rID: 12683
System: Breast, Oncology
Synonyms or Alternate Spellings:
  • Atypical ductal hyperplasia (ADH)

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