What do I call it?? The differences between UDH, ADH & DCIS

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Usual Ductal Hyperplasia (UDH)

  • Oval, “streaming”, overlapping nuclei separated by irregular distances; nuclei tend to run parallel to the duct wall

  • Secondary lumens are irregularly shaped (often peripherally located).

  • “Florid UDH” can be used if ducts are nearly completely filled but don’t meet requirements for ADH or DCIS

Atypical Ductal Hyperplasia (ADH)

  • No currently agreed upon requirements except that it CANNOT HAVE HIGH GRADE ATYPIA (makes it high grade DCIS if present)

  • Some pathologists will call ADH if it has all the features of low grade DCIS, but <2mm or <3 ducts or only single duct involved

Low Grade DCIS (LG-DCIS)

  • Monotonous, uniform, round, evenly spaced, low grade nuclei (NO ATYPIA) (no spindled myoepithelial cells within the monotonous central proliferation)

  • Architectural pattern of DCIS present (Cribriform (circular, sharp, “punched out” lumens); Micropapillary (roman bridges, club shaped, broadened tip); Solid)

  • Most pathologists like to see >1 focus present and the lesion either measure >2mm or involve >3 ducts to call low grade-DCIS!

High Grade DCIS (HG-DCIS)

  • If there is pronounced nuclear atypia, it is automatically high grade DCIS regardless of how much is present.

  • More often associated with necrosis- look for significant nuclear atypia.

  • Make sure to rule out an invasive component!


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