Surgical Pathology Criteria

Atypical Lobular Hyperplasia of the Breast

Differential Diagnosis

LCIS vs. Atypical Lobular Hyperplasia (ALH)

Normal Breast Acini vs. Atypical Lobular Hyperplasia (ALH)

Ductal vs. Lobular differentiation may be a problem in pagetoid or complete involvement of ducts by ALH or in lobular involvement by DCIS cells (cancerization of lobules)

DCIS ALH
Cohesive Non-cohesive
May show moderate to marked pleomorphism Mild to moderate pleomorphism
No pagetoid involvement of ducts May show pagetoid pattern in ducts
Frequent intraductal cribriform or micropapillary pattern No cribriform spaces or micropapillae
E-cadherin positive E-cadherin negative
Indeterminate cases should be treated as DCIS (excision with clear margins)

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