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. Author manuscript; available in PMC: 2017 Dec 1.
Published in final edited form as: Histopathology. 2016 Sep 23;69(6):1028–1046. doi: 10.1111/his.13035

Figure 9.

Figure 9

Example images from a case with a single region of potential interest to screen but borderline monotony (UDH vs ADH) and solid/subtle architecture. On higher power (panels C and D) subtle microacini are apparent with polarization of cells towards the lumen. This case had an almost even distribution between three diagnostic categories with 31% of participants recording an ADH diagnosis, 34% recording a Benign diagnosis (100% recorded UDH), and 34% recording a DCIS for the case (29 total interpretations). The differential in this case includes UDH due to the nuclear crowding and slit like spaces but also ADH because of the subtle polarized spaces being formed. The subtly hyperchromatic nuclear cytology also raises the differential of a low-intermediate grade DCIS. Additional levels, immunohistochemistry (CK5/6, ER or the ADH5 stain) and additional opinions can be helpful in this differential. Based on the presence of a single lesion measuring < 2 mm and involving only two membrane bound spaces on this H&E alone, classification as ADH was considered the best diagnosis by the expert consensus panel.