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Surgical Pathology Criteria

Columnar Cell Change and Columnar Cell Hyperplasia of the Breast


  • Breast lesions characterized by a variably proliferative, cytologically bland columnar epithelium, lining dilated terminal duct-lobular units, often with luminal secretions and cytoplasmic blebs on the lining cells

Alternate/Historical Names

  • Columnar alteration with prominent apical snouts and secretions (CAPSS) without atypia
  • Columnar alterations of lobules
  • Columnar metaplasia
  • Pretubular hyperplasia

Diagnostic Criteria

  • Columnar cell change
    • Involves dilated terminal duct-lobular units
    • Lined by uniform, ovoid-to-elongate, non-atypical columnar cells
      • One or two cell layers thick
      • Chromatin evenly dispersed
      • Inconspicuous nucleoli
  • Columnar cell hyperplasia
    • Involves dilated terminal duct-lobular units
    • Lined by columnar cells identical to those seen in columnar cell change
      • Lining greater than two cells thick
      • May form small mounds, tufts and micropapillations
      • Architectural complexity must be short of that seen in low grade ductal carcinoma in situ
        • No partial or complete filling of ducts
        • Arcades, microacini and micropapillary formations absent or very rare
  • Both frequently exhibit prominent apical snouts
  • Flat epithelial atypia (similar lesion but with nuclear atypia) is considered separately

Kristin C Jensen MD
Richard L Kempson MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: January 16, 2007

Supplemental studies

Immunohistology / Genetic Analysis

  • No diagnostically useful markers are currently reported

Differential Diagnosis


Flat Epithelial Atypia Columnar Cell Change / Hyperplasia
Enlarged atypical ovoid to round nuclei Bland oval to elongate nuclei
Chromatin may be marginated Bland chromatin
Nucleoli may be prominent Nucleoli not prominent
Basal polarization of nuclei usually lacking Nuclei usually basally polarized
Frequently more abundant cytoplasm Moderate amount of cytoplasm


Low Grade Ductal Carcinoma In Situ and Atypical Ductal Hyperplasia Columnar Cell Change / Hyperplasia
Architectural complexity manifested by a) partial or complete filling of ducts or b) arcades or micropapillary formations Essentially a flat lesion, lacks architectural complexity
Low grade nuclear atypia present (except some cases of ADH that have architectural complexity) Cytologically bland


Apocrine Metaplasia Columnar Cell Change / Hyperplasia
Cuboidal with voluminous eosinophilic cytoplasm Lacks architectural complexity
Frequent prominent nucleoli Bland oval nuclei


Fibrocystic Change vs Columnar Cell Change / Hyperplasia

  • Clinically irrelevant distinction
  • Fibrocystic change frequently exhibits apocrine metaplasia


  • Columnar cell lesions are frequently associated with microcalcifications
    • They are increasingly being recognized and diagnosed in biopsies of mammographically detected lesions
  • Columnar cell lesions may be associated with or adjacent to ductal carcinoma in situ or invasive carcinoma

Grading / Staging / Report

Grading / Staging

  • Not applicable for columnar cell lesions without atypia


  • Current recommendations for cases with associated/adjacent carcinoma in situ (based on limited data)
    • Do not include in size measurement for DCIS
    • Does not represent a positive margin if transected
    • These findings, if present, should be noted in the report


Intraductal and Intralobular Proliferative Lesions


  • Fraser JL, Raza S, Chorny K, Connolly JL, Schnitt SJ. Columnar alteration with prominent apical snouts and secretions: a spectrum of changes frequently present in breast biopsies performed for microcalcifications. Am J Surg Pathol. 1998 Dec;22(12):1521-7.
  • Schnitt SJ, Vincent-Salomon A. Columnar cell lesions of the breast. Adv Anat Pathol. 2003 May;10(3):113-24.
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