Difference between revisions of "Atypical lobular hyperplasia"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Atypical lobular hyperplasia -- high mag.jpg
| Width      =
| Caption    = Atypical lobular hyperplasia. [[H&E stain]]. (WC/Nephron)
| Synonyms  =
| Micro      = morphologic changes ('''a'''typia minimal - usually, '''b'''orders of cells distinct/visible - ''dyscohesive'', '''c'''lear cytoplasm (focal), '''d'''istend duct, '''e'''ccentric nucleus, usu. round, '''f'''illed ducts ('''no''' luminal spaces - '''key feature'''), limited extent (<50% of terminal duct lobular unit is involved)
| Subtypes  =
| LMDDx      = [[lobular carcinoma in situ]], [[lobular carcinoma]]
| Stains    =
| IHC        = E-cadherin -ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Staging    =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Atypical lobular hyperplasia''', abbreviated '''ALH''', a pre-malignant change in the [[breast]] characterized by cellular proliferation and cellular dyscohesion.
'''Atypical lobular hyperplasia''', abbreviated '''ALH''', a pre-malignant change in the [[breast]] characterized by cellular proliferation and cellular dyscohesion.


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==Microscopic==
==Microscopic==
Features:
Features:  
*Extent criterium: <50% of terminal duct lobular unit (TDLU) is involved.
#Morphologic changes - memory device ''ABCDEF'':
*See ''[[lobular carcinoma in situ]]'' for details.
#*'''A'''typia minimal - usually.
#**Relatively small ~1-2x size lymphocyte.
#*'''B'''orders of cells distinct/visible - ''dyscohesive''.
#*'''C'''lear cytoplasm (focal).
#**May have a signet ring cell-like appearance.
#*'''D'''istend duct.
#*'''E'''ccentric nucleus, usu. round.
#*'''F'''illed ducts.
#**'''No''' luminal spaces - '''key feature'''.
#***Partially filled ducts are ''not'' LCIS.
#Limited extent: <50% of terminal duct lobular unit (TDLU) is involved.  


DDx:
DDx:
*[[Lobular carcinoma in situ]].
*[[Lobular carcinoma in situ]].
*[[Lobular carcinoma]].
*[[Lobular carcinoma]].
===Images===
<gallery>
Image: Atypical lobular hyperplasia -- low mag.jpg | ALH - low mag. (WC)
Image: Atypical lobular hyperplasia -- intermed mag.jpg | ALH - intermed. mag. (WC)
Image: Atypical lobular hyperplasia -- high mag.jpg | ALH - high mag. (WC)
Image: Atypical lobular hyperplasia - E-cadherin -- intermed mag.jpg | ALH - E-cadherin - intermed. mag. (WC)
Image: Atypical lobular hyperplasia - E-cadherin -- high mag.jpg | ALH - E-cadherin - high mag. (WC)
</gallery>
<gallery>
Image: Benign breast - E-cadherin -- intermed mag.jpg | Benign breast - E-cadherin - intermed. mag. (WC)
Image: Benign breast - E-cadherin -- high mag.jpg | Benign breast - E-cadherin - high mag. (WC)
Image: Benign breast - E-cadherin - alt -- high mag.jpg | Benign breast - E-cadherin - high mag. (WC)
</gallery>


==IHC==
==IHC==

Latest revision as of 05:14, 23 January 2017

Atypical lobular hyperplasia
Diagnosis in short

Atypical lobular hyperplasia. H&E stain. (WC/Nephron)
LM morphologic changes (atypia minimal - usually, borders of cells distinct/visible - dyscohesive, clear cytoplasm (focal), distend duct, eccentric nucleus, usu. round, filled ducts (no luminal spaces - key feature), limited extent (<50% of terminal duct lobular unit is involved)
LM DDx lobular carcinoma in situ, lobular carcinoma
IHC E-cadherin -ve
Site breast
Prognosis benign

Atypical lobular hyperplasia, abbreviated ALH, a pre-malignant change in the breast characterized by cellular proliferation and cellular dyscohesion.

It can be seen as the precursor to lobular carcinoma in situ, the precursor of lobular carcinoma.

General

  • May occur with ductal involvement by cells of atypical lobular hyperplasia (abbreviated DIALH).[1]
    • ALH with DIALH has a risk of developing breast cancer that is similar to LCIS.

Microscopic

Features:

  1. Morphologic changes - memory device ABCDEF:
    • Atypia minimal - usually.
      • Relatively small ~1-2x size lymphocyte.
    • Borders of cells distinct/visible - dyscohesive.
    • Clear cytoplasm (focal).
      • May have a signet ring cell-like appearance.
    • Distend duct.
    • Eccentric nucleus, usu. round.
    • Filled ducts.
      • No luminal spaces - key feature.
        • Partially filled ducts are not LCIS.
  2. Limited extent: <50% of terminal duct lobular unit (TDLU) is involved.

DDx:

Images

  • ALH - low mag. (WC)

  • ALH - intermed. mag. (WC)

  • ALH - high mag. (WC)

  • ALH - E-cadherin - intermed. mag. (WC)

  • ALH - E-cadherin - high mag. (WC)

  • Benign breast - E-cadherin - intermed. mag. (WC)

  • Benign breast - E-cadherin - high mag. (WC)

  • Benign breast - E-cadherin - high mag. (WC)

IHC

  • E-cadherin -ve or incomplete membrane staining.

See also

References

  1. ↑ Page, DL.; Dupont, WD.; Rogers, LW. (Feb 1988). "Ductal involvement by cells of atypical lobular hyperplasia in the breast: a long-term follow-up study of cancer risk.". Hum Pathol 19 (2): 201-7. PMID 3343034.
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