Florid epithelial hyperplasia

Florid epithelial hyperplasia, abbreviated FEH, is a common benign breast pathology finding that is associated with a mild increased risk of breast cancer.

It is also known as florid epithelial hyperplasia of the usual type (abbreviated FEHUT) and usual ductal hyperplasia (abbreviated UDH).

Confusingly, it may be referred to as epithelial hyperplasia, term that is best avoided, as it could lead to confusion with mild epithelial hyperplasia.

Moderate epithelial hyperplasia redirects to this article, as it is usually lumped with FEH. Proliferative fibrocystic changes redirects to this article.

General

• Mild increased risk of malignancy ~ 1.5-2x.
• Has to be separated from mild epithelial hyperplasia.

Note:

• Moderate epithelial hyperplasia redirects to this section.
  • It is generally not separated from FEH, as the prognosis is thought to be the same.

Microscopic

Features:

• Breast glands with more than four cell layers above the basement membrane - key feature.
• Irregular cell spacing; streaming.
• Slit-like lumina, esp. at the periphery of the duct.
• No DCIS-like architecture (not cribriform, not papillary, not micropapillary, not solid).
• No nuclear atypia - usually no nucleoli.

Memory device CLEAN:

• Cell spacing is irregular, Lumina are slit-like, Extent is less than 2 mm or 2 ducts, Architecture not DCIS-like, Nuclear atypia not present.

DDx:

• Mild epithelial hyperplasia.
• Atypical ductal hyperplasia.
• Cribriform ductal carcinoma in situ

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A. Right Breast (570 grams), Reduction Mammoplasty:
- Benign breast tissue with proliferative fibrocystic changes.
- Benign skin.

B. Left Breast (580 grams), Reduction Mammoplasty:
- Breast tissue and skin within normal limits.

Note:

• "Proliferative fibrocystic changes" = UDH + fibrocystic changes.

See also

• Breast pathology.