Management Of Atypical Hyperplasia Research Articles

Atypical Ductal Hyperplasia and Lobular Neoplasia: Update and Easing of Guidelines.

OBJECTIVE. Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS) are among high-risk lesions that have been previously recommended for surgical excision when diagnosed on core needle biopsy. Recent studies have examined whether imaging surveillance is a reasonable alternative to surgical management for these lesions. This article synthesizes the evidence regarding management of atypical hyperplasia and LCIS diagnosed on core needle biopsy and clinical implications of these diagnoses on future breast cancer risk as well as highlights areas of further research needed to improve practice guidelines for these high-risk lesions. CONCLUSION. Although surgical excision is still recommended after diagnosis of ADH on core needle biopsy, in specific circumstances ALH and LCIS can safely be managed by imaging surveillance.

Atypical Ductal Hyperplasia of the Breast: Management of a Clinical Case at the IBN SINA Hospital Centre with Literature Review

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.

Controversies in the management of atypical hyperplasia: Conservative management vs. simple hysterectomy

Objective: Review the status of diagnosis of atypical hyperplasia. Discuss therapeutic options based on recently prospective pathologic studies. Research: Review recent prospective histopathology studies of atypical endometrial hyperplasia. Discuss recent advances in treatment of atypical endometrial hyperplasia. Review pretreatment imaging studies and their impact on treatment decision-making. Results: The diagnosis of atypical endometrial hyperplasia by endometrial biopsy is associated with a higher-than-expected incidence of invasive adenocarcinoma in hysterectomy specimens. This calls into question the safety of conservative therapy. Newer imaging studies and improved pathologic diagnosis may help to identify patients eligible for conservative therapy. Conclusions: Atypical endometrial hyperplasia is typically associated with invasive endometrial adenocarcinoma. Adequate sampling and expert pathological review may be helpful. Further research and clinical trials will answer the question of optimal treatment of atypical endometrial hyperplasia for those patients who desire preservation of fertility.