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In specific clinical scenarios, such as gynaecomastia, adolescent breast tissue and fibroepithelial lesions, epithelial proliferations may appear morphologically and immunophenotypically worrisome for neoplasia, yet the clinical context supports a non-neoplastic process. Rather than representing conventional clonal neoplasia, these changes may reflect hormonally driven or stromal-induced luminal differentiation and often lack the sharp demarcation typical of conventional neoplasia. This narrative review delineates these context-dependent diagnostic pitfalls and proposes an integrated framework that emphasises architectural features, clonal demarcation and the clinical setting. By positioning these borderline lesions within a biological continuum and refining diagnostic thresholds in context, this approach aims to improve diagnostic reproducibility, mitigate the risk of overdiagnosis and support appropriate, risk-adapted patient management.<\/jats:p>","DOI":"10.1136\/jcp-2026-210821","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:20:19Z","timestamp":1780075219000},"page":"587-592","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Contextual interpretation of luminal phenotype in low-grade breast epithelial proliferations"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5009-5525","authenticated-orcid":false,"given":"Emad A","family":"Rakha","sequence":"first","affiliation":[{"name":"School of Medicine, University of Nottingham - University Park Campus, Nottingham, UK"},{"name":"Pathology Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"2026082005150924000_79.9.587.1","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1097\/PRS.0000000000008815","article-title":"Incidental Pathologic Findings in Young Men with Gynecomastia","volume":"149","author":"Maroney","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"2026082005150924000_79.9.587.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-018-05117-4","article-title":"Atypical ductal hyperplasia in men with gynecomastia: what is their breast cancer risk?","volume":"175","author":"Coopey","year":"2019","journal-title":"Breast Cancer Res Treat"},{"key":"2026082005150924000_79.9.587.3","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1177\/229255031402200210","article-title":"Is routine pathological evaluation of tissue from gynecomastia necessary? 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