Le lesioni colonnari
Anna Sapino
Università di Torino
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.
Fraser JL, Raza S, Chorny K, Connolly JL, Schnitt SJ.
Columnar alteration of lobules.
This lesion is characterized by an enlarged
lobule with slightly dilated acini (A).
The acini are lined by a single layer of
columnar epithelial cells with elongated nuclei
(B).
Apical snout
Am J Surg Pathol. 1998 Dec;22(12):1521-7.
Am J Surg Pathol. 1998 Dec;22(12):1521-7.
Lobules are composed of slightly
dilated acini (A). The epithelial cells
have enlarged, ovoid to round nuclei
and vesicular chromatin, with variably
prominent nucleoli. In some lesions,
these atypical cells are present in a
single layer (B). In others, there is
epithelial cell stratification and tufting
(C).
Although the lesions illustrated in (B)
and (C) show cytologic atypia, they
do not have architectural features
diagnostic
of
atypical
ductal
hyperplasia or ductal carcinoma in
situ. (D) A lesion with similar cytologic
features but in which arcades and
bridges are also prominent. Given the
architectural pattern, such lesions are
probably best designated atypical
ductal
hyperplasia.
8 lavori successivi
Columnar Cell Lesions of the Breast
SJ. Schnitt, A Vincent-Salomon
Advances in Anatomic Pathology
10: 113–124 (2003)
Columnar cell change
Columnar cell hyperplasia
Advances in Anatomic Pathology
Vol. 10, No. 3, pp. 113–124
Columnar cell change with atypia
Columnar cell hyperplasia with atypia
Advances in Anatomic Pathology
Vol. 10, No. 3, pp. 113–124 (2003)
CCC
Category 1
CCH
Category 2
CCC with cytological atypia
Category 6
CCH with architectural atypia
Category 3
CCH with cytological atypia
Category 4
CCH with cytological atypia
+ architectural atypia
Category 5
Am J Surg Pathol 2005;29:734–746
WHO 2003
Traditional terminology
Ductal intraepithelial terminology
Usual ductal hyperplasia (UDH)
Usual ductal hyperplasia (UDH)
Flat epithelial atypia (FEA)
CCL con atipia
Ductal intraepithelial neoplasia
grade 1A (DIN 1A)
Atypical ductal hyperplasia
Ductal intraepithelial neoplasia
grade 1B (DIN 1B)
Ductal carcinoma in situ low grade Ductal intraepithelial neoplasia
(DCIS grade 1)
grade 1C (DIN 1C)
Ductal carcinoma in situ
Ductal intraepithelial neoplasia
intermediate grade (DCIS grade 2) grade 2 (DIN 2)
Ductal carcinoma in situ high
grade (DCIS grade 3)
Ductal intraepithelial neoplasia
grade 3 (DIN 3)
Modern Pathology (2006) 19, 172–179
Interobserver reproducibility in the diagnosis
of flat epithelial atypia of the breast
Frances P O’Malley, Syed K Mohsin, Sunil Badve, Shikha Bose, Laura C Collins, Marguerite Ennis, Celina G Kleer,
Sarah E Pinder and Stuart J Schnitt
CCC
CCH
CCC with atypia
FEA
CCH with atypia
CCC
OVERALL
AGREEMENT
(92.8%)
CCH
OVERALL
AGREEMENT
(90.4%)
FEA
Columnar cell hyperplasia is associated with lobular carcinoma in situ and
tubular carcinoma
Rosen PP
Am J Surg Pathol. 1999 Dec;23(12):1561
High Frequency of Coexistence of Columnar Cell Lesions,
Lobular Neoplasia, and Low Grade Ductal Carcinoma
In Situ With Invasive Tubular Carcinoma and Invasive
Lobular Carcinoma
Am J Surg Pathol 2007;31:417–426
The ‘‘Rosen Triad’’: Tubular Carcinoma, Lobular
Carcinoma In Situ, and Columnar Cell Lesions
Adv Anat Pathol. 2008 May;15(3):140-6.
Columnar Cell Lesions of the Breast:
The Missing Link in Breast Cancer Progression?
A Morphological and Molecular Analysis
Am J Surg Pathol 2005;29:734–746
CCLs consistently harbor recurrent
chromosomal abnormalities and should be
seen as clonal
and neoplastic rather than hyperplastic
proliferations
Low grade arm
J Pathol 2005; 205: 248–254
Am J Surg Pathol 2007;31:417–426
The ‘‘Rosen Triad’’: Tubular Carcinoma, Lobular
Carcinoma In Situ, and Columnar Cell Lesions
Suzanne M. Brandt, MD, Gloria Q. Young, MD, and Syed A. Hoda, MD
Adv Anat Pathol. 2008 May;15(3):140-6.
Lesioni a cellule colonnari
senza atipie
Lesioni a rischio evolutivo?
Escissione sempre?
Bonser, Dossett and Jull. 1961
Columnar metaplasia
Azzopardi 1979. Blunt duct adenosis
•BDA with response of the specific stroma (organoid)
•Non-organoid BDA
•Microcystic BDA
Lesioni a cellule colonnari
senza atipie
Lesioni a rischio evolutivo?
NO
Escissione sempre?
NO
Tibor Tot
Aberration of the Normal Development and Involution (ANDI):
•
•
•
•
•
•
•
clear cell changes
lactational changes
apocrine metaplasia
fibroadenomtoid changes
sclerosing adenosis
microcystic changes/blunt duct adenosis
etc