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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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Stanford University

 

End of Breast-nonmalignant > Fibrocystic disease > Pseudolactational (pregnancy-like) hyperplasia

 

 

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