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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Focal Pregnancy-like Change of the Breast

Definition

  • Focal lactational change in a non-lactating, non-pregnant patient

Alternate/Historical Names

  • Focal lactational change
  • Pseudolactational change
  • Focal lactating effect

Diagnostic Criteria

  • The patient must be currently non-lactating and non-pregnant
    • May be of any age
  • Dilated acini lined by abundant pale vacuolated cytoplasm
    • Lumenal cytoplasmic blebs
    • Nuclei frequently contained in apical blebs
  • Nuclei typically small, round, uniform
    • Four cases reported with cytologic atypia, of unknown clinical significance (Shin)
      • Increased nucleo/cytoplasmic ratio, pleomorphic nuclei, large nucleoli, mitoses identified
      • Micropapillary architecture
      • All four cases had associated cystic hypersecretory hyperplasia
  • Intraluminal calcifications described (Shin)
    • Smooth contours, frequent eosinophilic border, uneven laminations
    • “Precalcified” laminated proteinaceous deposits described

    Richard L Kempson MD
    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting: May 15, 2006

 

Supplemental studies

Immunohistology

  • none

Differential Diagnosis

Lactating Adenoma Focal Pregnancy-like Change
Circumscribed mass Focal change in breast parenchyma

 

Clinical

  • Generally considered an incidental finding
    • 12 cases reported associated with calcification or other mammographic abnormality (Shin)
  • May follow pregnancy by 3-24 years
    • Occasionally no history of pregnancy
    • Patient may be of any age
  • May be associated with drug therapy (Tavassoli)
    • Hormones
      • Reported in males receiving estrogen for prostate carcinoma
    • Antipsychotic drugs
    • Antihypertensive drugs
  • Benign, no association with carcinoma

Bibliography

  • Mills SE, Fraire AE. Pregnancy-like change of the breast. An ultrastructural study. Diagn Gynecol Obstet. 1981 Fall;3(3):187-91.
  • Mills SE, Fechner RE. Focal pregnancy-like change of the breast. Diagn Gynecol Obstet. 1980 Spring;2(1):67-70.
  • Kiaer HW, Andersen JA. Focal pregnancy-like changes in the breast. Acta Pathol Microbiol Scand [A]. 1977 Nov;85(6):931-41.
  • Tavassoli FA, Yeh IT. Lactational and clear cell changes of the breast in nonlactating, nonpregnant women. Am J Clin Pathol. 1987 Jan;87(1):23-9.
  • Shin SJ, Rosen PP. Pregnancy-like (pseudolactational) hyperplasia: a primary diagnosis in mammographically detected lesions of the breast and its relationship to cystic hypersecretory hyperplasia. Am J Surg Pathol. 2000 Dec;24(12):1670-4.
 
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