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Breast-nonmalignant
Fibrocystic disease
Pseudolactational (pregnancy-like) hyperplasia of breast
Reviewer: Hind Nassar, M.D. in June 2010 (see Authors page)
Revised: 8 October 2012, last major update June 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Pregnancy-like changes in a non-pregnant, non-lactating patient
Terminology
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● See also pregnancy / lactation, lactating adenoma
Epidemiology
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● Present in 2-3% of breast biopsies
● Identified in needle localization and core biopsies due to calcifications or presence of a mass
● Women, mean age 44 years, range 38-52 years
● Not lactating, not pregnant (by definition)
Etiology
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● May be associated with phenothiazine or other medications (Am J Clin Pathol 1987;87:23)
Clinical features
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● Often multifocal
● Associated with / may merge with cystic hypersecretory hyperplasia
● May have associated ADH or DCIS (Am J Clin Pathol 2004;122:714) but invasive carcinoma is rare (Am J Surg Pathol 2004;28:789)
Treatment
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● Recommend excision if atypia found in core biopsy (Am J Surg Pathol 2000;24:1670)
Gross description (Macroscopy)
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● No gross lesion
Micro description (Histopathology)
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●
Glands and terminal ducts with little or no secretion
● Glandular cells are swollen with abundant pale or clear, finely
granular or vacuolated cytoplasm
● Luminal cytoplasmic borders of glandular cells are frayed with small cytoplasmic blebs extending into lumen that may contain nuclei
● Small, uniform, round and darkly stained nuclei
Micro images
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Expanded acinar glands Cells have abundant pale cytoplasm
but no secretion
Micropapillary pattern of columnar cells
with luminal cytoplasmic buds
Other images: cells have finely vacuolated cytoplasm #1; #2
Differential Diagnosis
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● Apocrine adenosis or apocrine metaplasia: cytoplasm more eosinophilic, vacuoles are usually only focal
● Apocrine DCIS: abundant eosinophilic cytoplasm, architectural or cytologic atypia
● Columnar cell lesion: tightly packed columnar epithelial cells
Additional references
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End of Breast-nonmalignant > Fibrocystic disease > Pseudolactational (pregnancy-like) hyperplasia
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