Atypical lobular hyperplasia

[lop]

In March, I had a wire localized excisional biopsy due to an abnormal mammogram and sonogram which showed an unpalpable mass and microcalifications.  The pathological diagnosis is:  1. Fibroadenoma, see comment.  2.  Atypical lobular hyperplasia 3.  Calcifications present.  COMMENT:  The fibroadenoma involves the inked margin and has a somewhat disrupted quality in this area; therefore complete excision cannot be ensured.  The microscopic description indicated that the lesion involves the inked surface.  There is no apparent stromal overgrowth.  Focal calcifications are identified.  Some of the entrapped ducts have epithelial hyperplasia.  At the edges of the lesion, there is some atypical lobular hyperplasia.  My surgeon advised what I have cannot turn into cancer.  I have a follow up mammogram in Sept and then I see the surgeon again a week later.  I'm confused with what I've been reading.  It seems that this is a "precursor" or "marker" for cancer.  I've also read that atypical hyperplasia is very subjective and pathologists interpret it differently.  I am 43 years old.  The entire lesion and calcifications were not removed.  Should I be concerned?  Can it turn into cancer?  Should the rest be removed? Thanks!!!

[CCF-RN,MSN-rf]

Dear lop:  First, your biopsy is negative.  You do not have cancer or precancer.  Atypical lobular hyperplasia does not turn into cancer.  In technical terms it is not a "precurser lesion."  Atypical lobular hyperplasia is considered to be a risk factor for developing cancer.  So, you do not need more surgery now.  You need to be monitored perhaps more closely than if you had no known risk factors.  Monitoring would include mammography.  Your scheduled time in September is appropriate.  Next steps will depend upon what the next mammogram shows.

[surgeon]

a fibroadenoma is benign, harmless. It sounds like there's a slight chance it could come back, but that in and of itself is not something to worry about. They are very common, and if one knows what they are, it's ok to leave them. As to the description of the microscopic exam, fibroadenomas vary a lot; such terminology is of some interest, but not really worrisome, especially when seen in the fibroadenoma but not the rest of the breast. Atypical lobular hyperplasia is generally a very low-level marker for cancer risk, if any at all. It doesn't sound like there's a reason to have more surgery or to worry. Like any woman, you need regular screening.

[lop]

Thanks for your input.  Is is safe to presume that if there were further problems or an incorrect pathology diagnosis, something would show up at my follow-up mammo in September which is 7 months post surgery?  The surgeon did confirm with me previously that the lesion has not been completely removed nor have the calcifications.  I still am a little unsettled I guess until after that follow up mammogram and visit with the surgeon. Thanks so much for your help!  It puts my mind a little bit more at ease!  The radiologist report did suggest "a short interval followup to document complete removal".  Do you think that suggests a 2nd surgery to remove the rest of the lesion or do you think that is just to have on record for a new base line mammogram???

[surgeon]

Of course, it's always best to ask your questions of the surgeon involved; the issue is, I suppose, whether the calcifications in question were within the mass. Fibroadenomas often develop them. The report did say there were calcifications in it. So, were there additional calcifications elsewhere that were of concern, or did they turn out to be within the fibroademoa. If the latter, it sounds like there's no reason for concern. If there were others, and there's a question of whether they were sampled, then it may still be an open question. That, it would seem, would be best addressed to your doctors. It's always my habit to get a new baseline mammogram after a biopsy, usually between 3 and 6 months.

[lop]

Thanks for your comments!  I really don't know if there were calcifications elsewhere but I do know that there are some remaining according to my surgeon.  He told me that he removed a "significant" part of the lesion and "most" of the calcifications.  There were definitely calcifications within the mass though.  The pathology report indicates atypical lobular hyperplasia at the edges of the lesion.  The only thing I didn't advise you before was the added comment "in these areas, some of which are involved by the fibroadenoma, there are somewhat plump lobular cells with a dyscohesive quality which do not "significantly" distend the lobules."  I don't know if this, too, is an area of concern or not.  It's hard to say if everything is due to the fibroadenoma or not.  I will follow up with the mammogram and surgeon in September.  I still wonder, though, if there are any abnormal changes, would they show up between my March biopsy and the September mammogram?  It'd be nice to have some definitive answers at that time so I don't have to be worried every time I go in for a mammogram.  I guess the only other thing that concerned me was the surgeon's (and radiologist's) comments that what he saw is "almost always cancer".  I just hope they know what they are doing!