Cell Injury Case Studies


CASE 7: Breast with Atypical Ductal Hyperplasia


Clinical History:

On routine physical examination, a 49-year-old woman has a "lump" palpable in her left breast. The lesion is irregular, but not fixed to any surrounding structure such as the overlying skin or chest wall. It seems to be about 1 to 2 cm in size. The patient is concerned about this finding, because an aunt died of breast cancer. A fine needle aspirate of the lesion is performed, and a cytopathologist diagnoses the findings. An excisional biopsy of the lesion is then performed.
  1. What is the cellular process illustrated here?

    2. At her age (perimenopausal or postmenopausal) the breast ducts and lobules should not reveal any proliferative activity. The increase in cells is indicative of hyperplasia. The irregularities in the cell growth suggest atypia. Thus, this is an atypical hyperplasia. When abnormal cells appear on a cytologic preparation, then a biopsy is often done to further characterize the lesion.

  2. What is the significance of this finding?

    3. An atypical hyperplasia can be a precursor to cancer.

  3. What is the significance of the family history?

    4. Breast cancer risk is increased if there is a family history.

  4. What can be done for the patient?

    5. The atypical hyperplasia is not a malignancy, so no further therapy is indicated at this time. However, the patient will need close follow-up with periodic mammograms. She can be taught breast self-examination. The patient will be the person who can best determine if any changes occur. The risk is low enough in her situation that a mastectomy is not indicated as a preventative measure.