Other nonneoplastic
Usual ductal hyperplasia

Topic Completed: 1 March 2010

Minor changes: 22 May 2020

Copyright: 2002-2019,, Inc.

PubMed Search: usual ductal hyperplasia [title]

Hind Warzecha, M.D.
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Cite this page: Warzecha H. Usual ductal hyperplasia. website. Accessed July 2nd, 2020.
Definition / general
  • Benign ductal proliferative lesion that typically has secondary lumens and streaming of central proliferating cells
  • Also called usual ductal hyperplasia, intraductal hyperplasia, hyperplasia of usual type, papillomatosis (but this term may be confused with papilloma or florid papillomatosis of nipple), epitheliosis
  • Common form of fibrocystic disease
  • May be due to increase in mitotic rate of epithelial cells compared to apoptotic rate, causing an increased number of epithelial cells within preexisting glandular components (Hum Pathol 1998;29:1539, Breast Cancer Res 2001;3:276)
  • Appears to derive from a CK5+ committed stem cell lesion with the same differentiation potential as normal breast, in contrast to ADH / DCIS, which displays a differentiated glandular immunophenotype (CK8 / 18 / 19+, CK5-, J Pathol 2002;198:458)
  • May be influenced by EZH2 upregulation and colocalization with beta catenin (Am J Pathol 2009;175:1246)
Clinical features
  • No treatment needed
Microscopic (histologic) description
  • Streaming (parallel arrangement) of central cells with indistinct cell borders, irregularly shaped and sized secondary lumens, often peripheral; tufts of cells project into lumina
  • Peripheral elongated clefts (not round, not central), irregularly shaped bridges connect opposite portions of wall with nuclei parallel to long axis of the bridge (not Roman bridges)
  • Cells have acidophilic and granular cytoplasm, oval normochromatic nuclei with slight overlap, small or indistinct nucleoli
  • Myoepithelial cells and foamy macrophages are present
  • Individual cells are well supported by their stroma
  • Variable apocrine metaplasia, variable intraluminal or stromal calcifications, variable intranuclear round eosinophilic bodies (helioid inclusions); occasional fibrosis, elastosis or chronic inflammation; rarely necrosis
  • Perineural invasion is rare, usually associated with sclerosing adenosis or radial scar (Hum Pathol 2001;32:785, Arch Pathol Lab Med 2000;124:465)
  • No / minimal mitotic figures; no psammoma bodies, no atypia, no prominent nucleoli
  • Mild hyperplasia: 2 - 4 epithelial layers; no increased risk for invasive carcinoma
  • Moderate hyperplasia: 4 or more epithelial layers; 1.5 to 2x increased risk for invasive carcinoma, higher if age 50+ years
  • Florid hyperplasia: epithelium almost completely fills duct but with fenestrations (irregular lumina at periphery) and papillomatosis; 1.5 to 2x increased risk for invasive carcinoma
  • Gynecomastia-like hyperplasia: micropapillary, resembles gynecomastia of male breast
  • Thyroid-like hyperplasia: resembles tall cell variant of papillary thyroid carcinoma (see also Tall cell-like tumors in Breast malignant chapter)
Microscopic (histologic) images
Contributed by
Dr. Mark R. Wick

Florid simple

 AFIP images

Oval / spindled epithelial cells and elongated with dense chromatin

Distention of duct by
cellular proliferation
with irregular and
slit-like spaces

Micropapillary ductal
hyperplasia with parallel
arrangement of most cells
and uniform nuclei

Secondary lumina have irregular shapes

Apocrine metaplasia
forming secondary
lumina with foam cells


Secondary lumina adjacent to
basement membrane are more
rounded than smaller central lumina
and cell population is heterogeneous


Spindled epithelial cells parallel
to long axis of intraductal cellular bridges;
cell bridges merge to form secondary lumina;
myoepithelial cell present along borders

Images hosted on other servers:

Perineural invasion

Mild hyperplasia

Apocrine metaplasia
forming secondary
lumina with foam cells

Florid hyperplasia

Proliferating cells form solid sheets

Cribriform pattern

Without nuclear atypia

Compact florid hyperplasia

Spaces irregular and appear compressible

Fibrocystic changes

Usual ductal hyperplasia (CK903+) versus ADH (CK903-)

Cytology description
  • May rarely be hyperchromatic with increased N/C ratio and loss of 2 cell layers; however, be cautious if radiologic imaging and physical exam are not definitive for malignancy (Breast Cancer 2007;14:388)
Cytology images

Images hosted on other servers:

With apocrine metaplasia


Histopathology breast - epithelial hyperplasia
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