Columnar Cell Lesions of the Breast

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Columnar Cell Lesions of the Breast Savitri
Krishnamurthy, M.D. Associate Professor UT MD
Anderson Cancer Center Houston, Texas
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Columnar Cell Lesions of the Breast
LESIONS WIT COLUMNAR CELLS LINING THE TDLUs
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Columnar Cell Lesions of the Breast

• Columnar Cell Columnar Cell
• Change Hyperplasia
• Variably dilated TDLUs
• Associated with calicifications
• One or two layers More than two layers
• of columnar cells of columnar cells

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Columnar Cell Lesions of the Breast

• Ovoid to elongated nuclei oriented in a
  regular fashion perpendicular to basement
  membrane
• Mitotic figures absent
• Apical cytoplasmic blebs or snouts

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Columnar Cell Lesions of the Breast
Columnar Cell Columnar
Cell Change Hyperplasia CYTOLOGIC
ATYPIA
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Columnar Cell Lesions with Cytologic Atypia
Flat Epithelial Atypia W H O working group on
the pathology and genetics of tumors of the
breast.
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Columnar Cell Lesions of the Breast

• Several terms breast lesions with columnar
  morphology
• Atypical cystic lobule
• Columnar cell hyperplasia
• Hypersecretory hyperplasia with atypia
• Columnar alteration with prominent
• apical snouts and secretions
• Mammary duct intraepithelical neoplasia-
• flat type

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Columnar Cell Lesions with Cytologica Atypia

• Columnar cells with round or ovoid nuclei vs
  elongated nuclei
• Nuclei not oriented perpendicular to basement
  membrane ie loss of polarity
• Slight increase in nuclear-cytoplasmic ratio
• Nuclear chromatin, evenly distributed or
  slightly marginated
• Nucleoli variably prominent

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Columnar Cell Lesions of the Breast
Complex architectural patterns Well
developed micropapillae Rigid cellular
bridges, bars, arcades, sieve- like
fenestrations. Columnar cell change or
hyperplasia with ADH or DCIS based on the
severity and extent of cytologic and
architectural features.
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Columnar Cell Lesions with Flat Epithelial Atypia

• Can occur in isolation
• Often coexists with areas that fulfill the
  criteria for ADH/DCIS
• Presence of flat epithelial atypia should lead to
  a diligent search for ADH/DCIS
• Mitotic figures may be seen but are uncommon

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Columnar Cell Lesions

• Various combinations of columnar cell
  lesions coexist in the same breast, in the
  same TDLU and even within the same
  space.
• These diagnosis should not be considered
  mutually exclusive

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Columnar Cell Lesions
Association with LOBULAR NEOPLASIA - in
geographically separate areas -
coexistance in the same TDLU

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ESTROGEN RECEPTOR
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ESTROGEN RECEPTOR
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Columnar Cell Lesions of the Breast

• Immunophenotype
• CK19 positive
• CK5/6, 34ßE12 negative
• Intense expression of ER, PR
• Strong cytoplasmic positivity for bCL2
• Low Ki67 labeling

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Columnar Cell Lesions Clinical Significance

• Relationship Between Some Columnar Cell Lesions
  with Atypia
• Low-grade DCIS Tubular carcinoma
• ? Neoplastic proliferations that may be a
  precursor to carcinoma.

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Columnar Cell Lesions

• Clinical Significance
• Relationship of these lesions with in situ and
  invasive carcinoma
• Coexsistance in same breast
• Cytologic, immunophenotypic and genetic
  similarities.

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Columnar Cell Lesions

• OUTCOME STUDIES
• Limited Likelihood of progression
• LOW
• FOLLOW-UP STUDIES URGENTLY NEEDED

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Recommendation for Management

• Columnar Cell Lesions
• Without Atypia With Atypia
• Core Bx Excisional Bx Core Bx Excisional
  Bx
• No excision No further Excision -thorough
  sampling
• work-up -multiple levels