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Breast-nonmalignant
Benign tumors / change
Sclerosing lobular hyperplasia
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 9 October 2012, last major update April 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Uncommon benign lesion of young women, with enlarged breast lobules due to ductal and acinar proliferation but normal architecture
Terminology
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Epidemiology
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● Young women, often African-American
Sites
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Etiology
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Clinical features
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● Uncommon (3-7% of benign breast lesions) benign proliferative lesion of breast
● Causes local pain
● Radiology: no associated microcalcifications
Prognostic factors
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Case reports
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● 12 year old girl with fine needle aspiration cytology (Cytojournal 2006;3:8)
● 20 year old woman with well circumscribed breast mass (Arch Pathol Lab Med 2005;129:1345)
● 22 year old woman (Case of the Week #62)
Treatment
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● Excision; does not recur
Clinical images
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Gross description (Macroscopy)
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● Well circumscribed mass, tan-white, firm, homogeneous cut surface, few scattered slit-like spaces
● No hemorrhage or necrosis
Gross images
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White, firm and homogeneous
Micro description (Histopathology)
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● Well circumscribed but not encapsulated
● Enlarged breast lobules with ductal and acinar proliferation but normal architecture
● Focal lobular hyperplasia
● Prominent fibroblastic and myofibroblastic proliferation with dense keloid-like intralobular fibrosis and slit-like areas resembling pseudoangiomatous stromal hyperplasia
● May coexist with or be overgrown by fibroadenoma (Hum Pathol 1984;15:336)
● No/rare mitotic figures, no atypia
Micro images
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Well circumscribed lesion
Multiple large lobules with increased ductules and acini
Stroma is dense collagenous fibrosis, relatively bland and acellular
Dense keloid-like collagenous fibrosis
Prominent fibroblastic and myofibroblastic proliferation forming slit-like spaces
resembling pseudoangiomatous stromal hyperplasia
Dense intralobular stroma with dilated ducts
Dense interlobular fibrosis has CK8+ lobules Myoepithelial cells are calponin+
glomeruloid pattern with trichrome stain
Fig 1: normal lobular architecture
Fig 2: marked sclerosis of stroma, more prominent at periphery
Fig 3: microscopic focus of fibroadenoma
Virtual Slides
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Videos
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Cytology description
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● Uniform, round/oval ductal epithelial cells in sheets, acini, small and large clusters; no atypia
● Occasional stromal fragments and bare nuclei
● No branched tubular fragments
● Resembles fibroadenoma
● Cytology by itself is not diagnostic
Cytology images
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Moderately cellular with mammary ductal Occasional scattered stromal fragments
epithelial and myoepithelial cells in clusters
and as tubular fragments
Ductal cells have round/oval nuclei with
dispersed chromatin and moderate
basophilic cytoplasm
Positive stains
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Epithelium:
● CK8
Fibrosis:
● Trichrome
Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Fibroadenoma: treated similarly, but has irregular proliferating ducts and loose cellular stroma
Additional references
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End of Breast-nonmalignant > Benign tumors / change > Sclerosing lobular hyperplasia
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