Atypical Ductal Hyperplasia of Breast

Atypical Ductal Hyperplasia of Breast

Article
Women's Health
Diseases & Conditions
+1
Contributed byKrish Tangella MD, MBAFeb 04, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • Atypical Intraductal Hyperplasia (AIDH) of Breast
  • Mammary Atypical Ductal Hyperplasia
  • Mammary Intraepithelial Neoplasia (MIN)

What is Atypical Ductal Hyperplasia of Breast? (Definition/Background Information)

  • Atypical Ductal Hyperplasia of Breast is an atypical condition of breast which is often diagnosed under the microscope by a pathologist. The condition is often detected during routine mammogram screening and is seen in both men and women
  • The condition is diagnosed when the pathologist is unable to make a diagnosis of low-grade ductal carcinoma in situ (DCIS). This often happens when the volume of involved breast tissue is insufficient to make a diagnosis of low-grade ductal carcinoma in situ in a core biopsy or small lumpectomies
  • There are no specific predisposing factors known for Atypical Ductal Hyperplasia of Breast. The cause of this abnormality may be due to genetic factors and estrogen hormone irregularities
  • There are no significant signs and symptoms of Atypical Ductal Hyperplasia of Breast noted. However, there is a slight increase in overall risk for breast cancer (ductal carcinoma in situ)
  • A complete excision of the lesion is usually recommended. The prognosis of Atypical Ductal Hyperplasia of Breast on its removal is generally excellent

Who gets Atypical Ductal Hyperplasia of Breast? (Age and Sex Distribution)

  • Atypical Ductal Hyperplasia of Breast is a rare condition observed in both men and women. The condition is far more common in females than males
  • Individuals in the 30-40 years’ age group present the greatest number of cases
  • It is noted that approximately 5-20% of the breast biopsies present Atypical Ductal Hyperplasia of Breast
  • It is estimated that the incidence of the condition is around 1 in 3,330
  • The condition can affect individuals of all races and ethnic backgrounds

What are the Risk Factors for Atypical Ductal Hyperplasia of Breast? (Predisposing Factors)

  • Exposure to estrogen hormone may increase the risk for Atypical Ductal Hyperplasia of Breast
  • In males, it often occurs as a rare incidental finding in gynecomastia

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Atypical Ductal Hyperplasia of Breast? (Etiology)

The exact cause of development of Atypical Ductal Hyperplasia of Breast is presently unknown.

  • Some researchers believe that it is caused by genetic alterations and exposure to estrogen hormone
  • Studies have shown that the condition shares similar genetic mutations with low-grade ductal carcinoma in situ, namely gains in chromosome 1q and loss in chromosomes 16q-17p
  • Some studies have shown that reducing the postmenopausal hormonal therapy decreases the risk of development of Atypical Ductal Hyperplasia of Breast

What are the Signs and Symptoms of Atypical Ductal Hyperplasia of Breast?

Most cases of Atypical Ductal Hyperplasia of Breast may not exhibit any signs and symptoms.

  • One or both breasts may be affected; the condition can be present bilaterally in one-third of the patients
  • In some cases, the presence of a lump or lesion may be observed
  • The condition is generally painless

How is Atypical Ductal Hyperplasia of Breast Diagnosed?

Atypical Ductal Hyperplasia of Breast may be diagnosed in the following manner:

  • Complete physical examination with comprehensive medical and family history evaluation
  • Breast exam to check for any lumps or unusual signs in the breasts
  • Mammogram: A mammogram uses X-rays to provide images of the breast. The condition may cause abnormal features on mammograms and is often associated with breast calcifications
  • Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast
  • Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast: Radiologically, the condition is classified as B3 which means “uncertain malignant potential”
  • Breast biopsy: Such abnormalities are often biopsied either through core biopsies of breast or breast lumpectomies
    • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
    • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
    • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

  • Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue
  • Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
  • Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

The differential diagnosis to exclude conditions with similar presentations include:

  • Low-grade ductal carcinoma in situ of breast
  • Usual ductal hyperplasia of breast 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Atypical Ductal Hyperplasia of Breast?

There may not be any significant complications of Atypical Ductal Hyperplasia of Breast.

  • The condition is associated with an increased risk for subsequent breast cancer - the presence of atypical ductal hyperplasia is estimated to increase the risk for developing ductal carcinoma in situ by over 4-5 times (above the general population) within 5 years
  • The risk may be slightly higher for individuals who have a positive family history of breast cancer

How is Atypical Ductal Hyperplasia of Breast Treated?

  • The treatment for Atypical Ductal Hyperplasia of Breast may involve surgery
    • The tumor may be removed during the diagnostic breast biopsy
    • Or it may be surgically removed via lumpectomy procedure
  • Follow-up care with regular breast self-examinations and screening mammograms may be recommended by the healthcare provider

How can Atypical Ductal Hyperplasia of Breast be Prevented?

Currently, no specific preventive measures are available to prevent Atypical Ductal Hyperplasia of Breast. In general, it is important to be aware of the following:

  • Regularly conduct breast self-exams to ensure that no lumps are present
  • Maintain a healthy body weight and exercise regularly
  • Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
  • Avoid or completely stop smoking
  • If taking alcohol, only drink in moderation; limit to one or (maximum) two drinks a day
  • Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of such hormonal medications

What is the Prognosis of Atypical Ductal Hyperplasia of Breast? (Outcomes/Resolutions)

The prognosis of Atypical Ductal Hyperplasia of Breast is generally excellent on its surgical removal. The incidence of finding a malignant breast condition later in life when diagnosed with atypical ductal hyperplasia is increased in the following cases:

  • Younger age group at the time of diagnosis
  • Individuals with BRCA 1/BRCA 2 mutations
  • Individuals with family history of the condition
  • Individuals having multiple separate foci of atypical ductal hyperplasia

Additional and Relevant Useful Information for Atypical Ductal Hyperplasia of Breast:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/

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Krish Tangella MD, MBA picture
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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