Don't be Fooled by Necrosis

An 82 year old woman underwent a lumpectomy following a needle core biopsy.

Image 1.  An exuberant epithelial proliferation is present, associated with a sclerosed micropapilloma (upper left).  Focal luminal necrosis is present.

mage 3.  Indistinct cell borders, nuclear variability and overlap are associated with central necrosis.   

Image 2.   The epithelial proliferation forms irregular secondary spaces that are peripherally placed and show tapering bars. 

Image 4.  The same features of nuclear variability, overlap, and irregular secondary spaces are present in this space, lacking luminal necrosis.

Diagnosis:  Florid hyperplasia without atypia.

Discussion:  While necrosis is commonly associated with ductal carcinoma in situ, occasionally florid hyperplasia without atypia may contain luminal necrosis.  The presence of necrosis does not affect the diagnosis if the epithelial proliferation is otherwise characteristic of hyperplasia without atypia.  Necrosis is not a feature of atypical ductal hyperplasia.