Atypical lobular hyperplasia

Last revised by Daniel J Bell on 13 Feb 2018

Atypical lobular hyperplasia (ALH) is a pre-malignant lesion of the breast which falls at the milder end of the spectrum of lobular neoplasia. It is therefore considered a part of borderline breast disease

It is usually asymptomatic and mammographically occult and is invariably found incidentally, in a biopsy specimen obtained for another lesion. 

ALH represents a proliferation of monomorphic cells which are morphologically identical to lobular carcinoma in situ (LCIS). The distinction is that ALH occurs in a non-distended lobule or small lobular duct, whereas LCIS is characterized by distention. 

Not surprisingly, there is a spectrum of change from ALH to LCIS. To reflect this spectrum and to avoid the connotation of malignancy per se, use of the term "lobular neoplasia" has been advocated by some authors.

Treatment is controversial. Some centers surgical excise while others do not.

Compared with the general population, the risk of subsequent breast cancer is 4-6x higher after a diagnosis of ALH (compared to approximately 11x after a diagnosis of LCIS).

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