- Hyperplasia (ductal or lobular)
Also known as epithelial hyperplasia or proliferative breast disease. It’s an overgrowth of the cells that line the ducts.
Based the cells under microscopic, the hyperplasia is called either ductal or lobular hyperplasia.
Diagnosis: Hyperplasia doesn’t cause a lump that can be felt, diagnosis is made by a biopsy and microscopic examination. (43)
Types of hyperplasia can affect breast cancer risk:
1) Mild hyperplasia of the usual type: does not increase the risk of breast cancer.
2) Moderate or florid hyperplasia of the usual type (without atypia), also known as usual hyperplasia: The risk of breast cancer is about 1½ to 2 times than that of a woman without breast abnormalities.
3) Atypical hyperplasia either atypical ductal hyperplasia [ADH] or atypical lobular hyperplasia [ALH]: The risk of breast cancer is about 3½ to 5 times higher than that of woman without breast abnormalities. AEH is divided in three categories: atypical ductal hyperplasia, columnar cell lesions with atypia, lobular
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In mild ductal hyperplasia, the epithelial thickness is 3 to 4 cell layers. In moderate hyperplasia, the epithelial thickness is more than 4 layers. In florid hyperplasia, the gland lumen is often obliterated by proliferative epithelium and the affected duct is enlarged. (45)
Lobular hyperplasia: is a lesion in which the lobules are larger and more cellular. The lobular hyperplasia may occur in conditions of hormonal stimulation as in pregnancy. (46)
Atypical lobular hyperplasia is characterized by proliferation of abnormal cells similar to the cell of lobular carcinoma in-situ in one or more lobules.
Atypical lobular hyperplasia increases the risk of cancer. (45)
(A) (B)
Fig.12. A & B: Atypical ductal hyperplasia. The duct is filled by atypical cells with pleomorphism and conspicuous nucleoli.