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    Columnar Cell Change and Columnar Cell Hyperplasia of the Breast

    Definition

    • 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

    Clinical

    • 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

    Report

    • 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

    Lists

    Intraductal and Intralobular Proliferative Lesions

    Bibliography

    • 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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