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**Small nuclei.
***Small indistinct nucleoli.
*Limited extent ([[diagnostic size cutoffs]]) - either:<ref>{{Ref DCHH|258}}</ref>
*#< Two complete ducts.
*#< 2 mm. ‡
DDx:
*Low-grade [[ductal carcinoma in situ]] (DCIS).
*[[Florid epithelial hyperplasia of the usual type]] (FEHUT).
Notes:
*''High-grade DCIS'' is '''not''' in the [[DDx]] of ADH.
* ‡ 3 mm is used in papillary lesions.{{fact}}
===Images===
<gallery>
Image:Atypical_ductal_hyperplasia_-_very_low_mag.jpg|ADH. Very low mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_low_mag.jpg|ADH - low mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_intermed_mag.jpg|ADH - intermed. mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_high_mag.jpg|ADH - high mag. (WC/Nephron)
Image:Atypical_ductal_hyperplasia_-_very_high_mag.jpg|ADH - very high mag. (WC/Nephron)
</gallery>
==IHC==
*CK5 <20% +ve.
*ER +ve - diffusely.
**Heterogenous in [[FEHUT]].
==See also==
*[[Non-invasive breast carcinoma]].
*[[Ductal carcinoma in situ]].
*[[Atypical lobular hyperplasia]].
==References==
{{Reflist|1}}
[[Category:Breast pathology]]
[[Category:Diagnosis]]
6f59e1c4135a71b2275cee80f2b6556ec7633ec0b708925fd2af6b4926ed6ba0 librepath-adh.txt
'''Anaplastic astrocytoma''' (AKA: ''high-grade astrocytoma'') is a infiltrating neoplasm of the diffuse astrocytic and oligodendroglial tumor group occurring in the CNS white matter.
* Most common grade III WHO glioma in adults (peaks between 40-50 years).
* Approx 5% of all [[glioma]]s.<ref>{{Cite journal | last1 = Ohgaki | first1 = H. | last2 = Kleihues | first2 = P. | title = Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. | journal = J Neuropathol Exp Neurol | volume = 64 | issue = 6 | pages ...
* Usually shows progression to [[glioblastoma]] sooner or later.
WHO 2016 categorization combines morphology and genetics into following groups:<ref>{{Cite journal | last1 = Louis | first1 = DN. | last2 = Perry | first2 = A. | last3 = Reifenberger | first3 = G. | last4 = von Deimling | first4 = A. | last5 = Figarella-Branger | first5 = D. | last6 = Cavenee | first6 = WK. | last7 = ...
*Anaplastic astrocytoma, IDH-mutant (ICD-O: 9401/3).
*Anaplastic astrocytoma, IDH-wildtype (ICD-O: 9401/3).
*Anaplastic astrocytoma,NOS (ICD-O: 9401/3) - genetic data missing.
==Radiology/Clinic==
*Mass effect.
*Seizures.
*Neurologic decifit.
*The majority are contrast-enhanching, T2 bright.
==Prognosis==
*Overall prognosis is rather poor (average survival 2-3 years).
*IDH-mutant tumors share a similiar prognosis to grade II IDH-mutant tumors.<ref>{{Cite journal | last1 = Reuss | first1 = DE. | last2 = Mamatjan | first2 = Y. | last3 = Schrimpf | first3 = D. | last4 = Capper | first4 = D. | last5 = Hovestadt | first5 = V. | last6 = Kratz | first6 = A. | last7 = Sahm | first7 = F. | ...
*Anaplastic astrocytoma, IDH-wildtype perform worse than glioblastoma, IDH-mutant despite grading differences.<ref>{{Cite journal | last1 = Hartmann | first1 = C. | last2 = Hentschel | first2 = B. | last3 = Wick | first3 = W. | last4 = Capper | first4 = D. | last5 = Felsberg | first5 = J. | last6 = Simon | first6 = M....
==Macroscopy==
*No clear demarcation from white matter.
*Invaded structures may appear enlarged.
*Softer consistency and opacity.
*No necrosis.
==Histology==
Features: <ref name=AFIP2007>{{Ref AFIP2007|34}}</ref>
*Increased cellularity (compared to [[Diffuse Astrocytoma]]).
**Specimens with low cellularity but plenty mitoses are also considered anaplastic.
*Distinct nuclear atypia and pleomorphism.
**May include multinucleated cells.
*Cytoplasm highly variable (even within the same tumour).
*Mitoses present (a single mitosis in a small specimen indicates a high-grade tumor).
*Microcystic spaces of the background (none to extensive).
*No necrosis, no vascular proliferations.
**Except radiation necrosis after pretreatment.
*Lymphocytic cuffing (mostly in gemistocytic type).
*Rosenthal fibers usu. absent.
<gallery>
File:Mitoses_astro_III.jpg | Marked mitotic activity in anaplastic astrocytoma (WC/jensflorian).
File:405551M-ANAPLASTIC_ASTROCYTOMA.jpg | Marked nuclear pleomorphism (AFIP).
</gallery>
==IHC==
*[[GFAP]]+ve.
*[[MAP2]]+ve (especially in cell processes).
*Vimentin+ve (often perinuclear).
*S-100+ve.
*MIB-1: usu. 5-10& (overlaps with grade II tumors).
*[[IDH-1]] (R132H)+ve in 60-70%.
**'Note:'' This antibody does not detect other rare IDH1/2 mutations.
*[[ATRX]] nuclear loss in 70%.
==Molecular==
*TERT promotor mutations in 20-25%<ref>{{Cite journal | last1 = Lee | first1 = Y. | last2 = Koh | first2 = J. | last3 = Kim | first3 = SI. | last4 = Won | first4 = JK. | last5 = Park | first5 = CK. | last6 = Choi | first6 = SH. | last7 = Park | first7 = SH. | title = The frequency and prognostic effect of TERT promote...
*Approximately 80 % of IDH wildtype astrocytomas in fact represent underdiagnosed GBM.<ref>{{Cite journal | last1 = Reuss | first1 = DE. | last2 = Kratz | first2 = A. | last3 = Sahm | first3 = F. | last4 = Capper | first4 = D. | last5 = Schrimpf | first5 = D. | last6 = Koelsche | first6 = C. | last7 = Hovestadt | firs...