Atypical Ductal Hyperplasia (ADH)
- ADH is important because it carries a 4-5 times relative risk of breast cancer at 10-15 yrs post biopsy.
- It causes diffuculty to diagnostic pathologists - inconsistency in diagnosis is common.
- It lies closest morphologically to low grade DCIS - it is NOT a high grade lesion.
The following histological features are recognised:
- Microscopic features:
- Usually solitary
- Confined to a single lobular unit
- Seldom larger than 3mm
- At least focally a uniform cell population and architectural features of low grade DCIS.
- Cribriform, micropapillary or solid growth pattern
- Secondary lumina some of which are rigid while others are tapering
- Evenly spaced cells with hyperchromatic nuclei
ADH (example 1)
The following image shows a small focus of ADH. Note partial involvement of the duct
with focally a monotonous population of epithelial cells showing rigid structures and low grade
cytology - mouse over both sides of the image to see detailed views of the atypical epithelial tufts
ADH (example 2)
The following sequence of four images show different views of a small focus of ADH. Note partial involvement of the duct, particularly in the top image, a monotonous population of epithelial cells showing
rigid structure across ducts and low grade cytology. Luminal microcalcifications are present.
ADH (example 3)
Further example of ADH. This focus was adjacent to a mucocele-like lesion. There is a known association between the two condidtions.
1. Pathology Reporting of Breast Disease. NHS Cancer Screening Programmes/Royal College of Pathologists. NHS BSP Publication No 58, 2005.
Return to top of page
2. Carter BA, Page DL, O'Malley FP Usual epithelial hyperplasia and atypical ductal hyperplasia in Foundations in diagnostic pathology
- Breast Pathology. pp 164-168. Eds O'Malley FP & Pinder SE. Churchill Livingstone, Elsevier 2006.