Elsevier

Human Pathology

Volume 32, Issue 8, August 2001, Pages 785-790
Human Pathology

Original Contributions
Atypical ductal hyperplasia and ductal carcinoma in situ of the breast associated with perineural invasion*,**

https://doi.org/10.1053/hupa.2001.27637Get rights and content

Abstract

Perineural invasion is a histologic feature usually diagnostic of invasion in malignancies. In the breast, however, it has been associated with benign lesions such as sclerosing adenosis (SA), complex sclerosing lesion/radial scar (CSL/RS), and ductal carcinoma in situ (DCIS). This article describes perineural invasion associated with atypical ductal hyperplasia (ADH), florid hyperplasia without atypia (FH), and DCIS. All cases with a diagnosis of perineural invasion were selected from a series of 10,000 breast consult cases. Invasive mammary carcinomas were excluded. Fourteen cases of perineural invasion were found and associated with the following diagnoses: ADH (5), DCIS (3), FH (5), and ductal adenoma (1). Nine cases developed in CSL/RS, 4 cases in SA, and 1 case in a previous biopsy site of ductal adenoma; lesions were all less than 3 mm. The glands involving nerves showed cytologic and architectural features of the adjacent ADH, DCIS, and FH. Immunostaining for protein gene product (PGP) 9.5 marked nerves, and smooth muscle actin antibody highlighted the myoepithelial cells around glands. Perineural invasion seen in association with DCIS and ADH, in a background of CSL/RS and SA, may pose difficulty in diagnosis, especially in small biopsy specimens. It should be assessed with care to avoid misinter-pretation as invasive mammary carcinoma. HUM PATHOL 32:785-790. Copyright © 2001 by W.B. Saunders Company

Section snippets

Material and methods

Ten thousand consecutive breast biopsy specimens from the files of the Breast Pathology Consultation Service at Vanderbilt University Medical Center (Nashville, TN) were reviewed, and all cases with a diagnosis of perineural invasion by epithelial glands were selected. Invasive mammary carcinomas were excluded. Histologic evaluation was performed by using hematoxylin and eosin–stained sections, and the associated underlying breast lesions were classified by using published diagnostic criteria.14

Results

Fourteen cases of perineural invasion were found and associated with the following diagnoses: ADH (5), DCIS (3), FH without atypia (5), and ductal adenoma (1). Nine cases developed within a background of CSL/RS (Fig 1), 4 cases in SA, and 1 case in a previous biopsy site of ductal adenoma (Table 1).

. (A) Complex sclerosing lesion with associated florid hyperplasia without atypia. Small benign glands are present in perineural space of adjacent nerve (arrowhead; Hematoxylin and eosin, original

Discussion

In the current series, 14 cases of perineural invasion by epithelial glands associated with DCIS, ADH, or FH are described. Perineural invasion is a phenomenon previously described in benign breast lesions such as SA, fibrocystic change,8, 9, 10 syringomatous adenoma of the nipple,11, 12 and nerve sheath myxoma.19 To our knowledge, there is only one report of perineural invasion associated with DCIS13 and no published articles on this histologic feature associated with ADH. Thirteen of 14 cases

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    *

    Supported in part by the Division of Anatomic Pathology (Breast Consultation Service), Vanderbilt University Medical Center, Nashville, TN; and Conselho Nacional de Desenvolvimento Científico e Tecnológico/Brazil (300070/88-8, NV).

    **

    Address correspondence and reprint requests to David L. Page, MD, Vanderbilt University Medical Center Department of Pathology, Medical Center North, 2201 West End Ave, Nashville, TN 37232-2561.

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