Breast - nonmalignant
Benign tumors / changes
Sclerosing lobular hyperplasia

Author: Cansu Karakas, M.D. (see Authors page)

Revised: 13 November 2015, last major update November 2015

Copyright: (c) 2002-2015, PathologyOutlines.com, Inc.

PubMed Search: Sclerosing lobular hyperplasia [title]
Cite this page: Sclerosing lobular hyperplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastsclerosinglobularhyperplasia.html. Accessed December 8th, 2016.
Definition / General
  • Benign proliferative tumor of young women, characterized by enlarged lobules with an increased number of acini and variable interlobular fibrosis
Epidemiology
Clinical Features
Radiology Description
  • Mammography: non-specific findings of well defined mass or normal mammogram
  • May be obscured by relatively denser glandular tissues in younger patients
  • Sonography: usually hypoechoic mass (Eur Radiol 2003;13:1645)
  • Microcalcifications may be seen occasionally, especially in older women
Prognostic Factors
Case Reports
Treatment
Gross Description
  • Relatively well circumscribed, soft to firm, nodular mass
  • Cut surface is solid, gray-white with a few scattered slit-like spaces
  • Usually lacks the sharp demarcation and whiteness of a fibroadenoma
  • No hemorrhage or necrosis
Gross Images

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White, firm and homogeneous

Micro Description
  • Well circumscribed but not encapsulated
  • Enlarged breast lobules with an increased number of acini
  • The acini have the normal breast architecture with distinct single layers of epithelial and myoepithelial cells
  • Intralobular stroma is collagenized, with variable interlobular stromal fibrosis
  • Sclerosing lobular hyperplasia is found in surrounding breast tissue of 50% of fibroadenomas (Hum Pathol 1984;15:336)
  • No / rare mitotic figures, no atypia
Micro Images

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Well circumscribed

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Large lobules, increased ductules, dense stroma with collagenous fibrosis, bland and acellular

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Prominent fibroblastic and myofibroblastic proliferation forming slit-like spaces, resembles pseudoangiomatous stromal hyperplasia

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Dense interlobular fibrosis has glomeruloid pattern with trichrome stain

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CK8+ lobules

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Myoepithelial cells are calponin+



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Well circumscribed

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Large lobules

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Dense keloid-like

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Normal lobular architecture

Cytology Description
  • Cytology by itself is not diagnostic
  • Uniform round/oval ductal epithelial cells in monolayered sheets and round acinar clusters; no atypia (Diagn Cytopathol 2004;31:340, Cytojournal 2006;3:8)
  • Occasional stromal fragments and a fair number of bare nuclei
  • No branched tubular fragments
  • Complete absence of stromal fragments and rarity of bare nuclei are not consistent features of sclerosing lobular hyperplasia, and may not help to distinguish from fibroadenoma
Cytology Images

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FNA, moderately cellular

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Scattered fragments of stroma

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Round to oval nuclei

Positive Stains
Differential Diagnosis
  • Fibroadenoma: more clearly demarcated; irregular proliferating elongated and distorted ducts and loose cellular stroma; both are treated similarly
  • Hamartoma: clearly demarcated, lacks the enlarged lobular architecture of sclerosing lobular hyperplasia; may contain fatty and myoid component
  • Tubular adenoma: tight packing of acinar structures (no or few ductal elements), with little intervening stroma