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benign proliferative disease

Tuesday 7 May 2019

Three common pathologies and often mixed in an individual case:

- usual epithelial hyperplasia (UEH)
- apocrine metaplasia
- apocrine adenosis
- columnar cell change

They may all show a continuous spectrum of abnormalities from benign through atypical to in situ carcinoma.

- usual epithelial hyperplasia (UEH)

  • intraduct benign epithelial proliferation
  • epithelial and myoepithelial cells proliferate together
  • Therefore mixed pattern seen on CK 5/6 or P63 immunostaining
  • Streaming pattern usually seen
  • Peripheral slit-like spaces within ducts
  • Cells smaller, more crowded and overlapping than in atypical proliferations or CIS
  • peripheral slit-like spaces
  • streaming of ovoid shaped cells
  • presence of cellular overlap
  • heterogeneous pattern indicating two cell types
  • possible area of columnar cell change without atypia
  • The CK 5/6 stain shows abundant myoepithelial cells admixed with the proliferation

- apocrine metaplasia

  • Often associated with cysts - less frequently with calcs
  • May be seen focally within other lesions e.g. fibroadenomas
  • Intraduct benign epithelial proliferation which may extent to acini
  • Large cells with abundant eosinophilic cytoplasm, large nuclei with single prominent nucleolus
  • May form luminal papillary tufts
  • May be cytologically worrying but apocrine DCIS is uncommon.

- apocrine adenosis

- columnar cell change

  • Also known as "Columnar Alteration with Prominent Snouts & Secretions (CAPSS)
  • Often picked up at screening because of calcs
  • Range of changes from simple through atypical to DCIS
  • Tall coumnar cells with luminal-facing snouts
  • May give a worrying FNA pattern because columnar cells tend to disperse and appear as single cells on smears
  • Columnar cell hyperplasia with architectural atypia