Abstract
Objective: To report a case of difficulties in the management of atypical ductal hyperplasia (ADH). Presentation of the case: Mrs. G, 50 years old, is consulting following the discovery at autopalpation of a lesion on her left breast. In its history: radical mastectomy Right Patey in 2004 for ductal carcinoma Infiltrant associated with carcinoma in situ; 2 N+ /14; Positive hormone receptors. Adjuvant treatment performed: chemotherapy, radiotherapy and hormone therapy. Summary of the clinical case: Left breast examination: Superior External Quadrant nodule 5 cm × 4, mobile, hard, without inflammatory signs, there is no palpable lymph node. The surgical scar of the right breast is without particularity. Mammography and left breast ultrasound show an ACR4 lesion according to BIRADS. Microbiopsy: intradural papillomatous lesion requiring verification of the myoepithelial layer (P63 and CK5/6). Immunohistochemistry: atypical ductal hyperplasia (ADH) with no sign of transformation. Normal CA15-3 dosage. Treatment: broad surgical removal of the lesion. Analysis of the part shows a lesion with all the criteria of an HCA measuring 2 mm in its largest axis. The postoperative consequences are simple. Conclusion: The management of atypical hyperplasia is not consensual and is often undervalued. The type of lesion characterizing HCA is decisive for therapeutic orientation.
Highlights
Atypical ductal hyperplasia (ADH) is an intra-channel monomorphic cell proliferation with certain cytological and architectural characteristics of ductal carcinomas in situ (CCIS) [1]
In its history: radical mastectomy Right Patey in 2004 for ductal carcinoma Infiltrant associated with carcinoma in situ; 2 N+ /14; Positive hormone receptors
Precursor of breast cancer, of these atypical hyperplasias is discussed; they are classified into three types: HCA, lobular neoplasia (NL), and cylindrical metaplasia with atypia [1]
Summary
Atypical ductal hyperplasia (ADH) is an intra-channel monomorphic cell proliferation with certain cytological and architectural characteristics of ductal carcinomas in situ (CCIS) [1]. The discovery of HCA is often fortuitous on breast tissue [1], and management is not consensual [2]. There are no specific recommendations on the technique for removing atypical hyperplasia lesions discovered on percutaneous biopsy; these lesions are often subclinical. This surgery requires preoperative identification [1]. Many advances have been made in their histological diagnosis, classification and pathogenesis, but there is still no consensus on their management, surgical management, which remains controversial [3].
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