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Columnar Cell Lesions
Marion E. Scoggins, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Columnar cell lesions (CCL)
            • Synonyms

              • Columnar cell change/hyperplasia (CCC/CCH) without atypia
              • Columnar alteration with prominent apical snouts and secretions (CAPSS) without atypia
              • Enlarged lobular units with columnar alteration
              • Blunt duct adenosis, columnar metaplasia
            • Definitions

              • Enlarged terminal duct lobular units (TDLUs) lined by columnar-type epithelial cells, often with luminal secretions, Ca⁺⁺
              • Flat epithelial atypia (FEA) = CCL with atypia

            IMAGING

            • General Features

              • Mammographic Findings

                • Imaging Recommendations

                  • Ultrasonographic Findings

                    • Image-Guided Biopsy

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Collins LC: Precursor lesions of the low-grade breast neoplasia pathway. Surg Pathol Clin. 11(1):177-97, 2018
                                        2. Ahn HS et al: Diagnosis of columnar cell lesions and atypical ductal hyperplasia by ultrasound-guided core biopsy: findings associated with underestimation of breast carcinoma. Ultrasound Med Biol. 42(7):1457-63, 2016
                                        3. Yamashita Y et al: Does flat epithelial atypia have rounder nuclei than columnar cell change/hyperplasia? A morphometric approach to columnar cell lesions of the breast. Virchows Arch. 468(6):663-73, 2016
                                        4. Elif A et al: Columnar cell lesions of the breast: radiological features and histological correlation. Med Ultrason. 17(2):147-54, 2015
                                        5. Björner S et al: Epithelial and stromal microRNA signatures of columnar cell hyperplasia linking Let-7c to precancerous and cancerous breast cancer cell proliferation. PLoS One. 9(8):e105099, 2014
                                        6. Gomes DS et al: Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia and ductal carcinoma in situ of the breast. Diagn Pathol. 9:121, 2014
                                        7. Neal L et al: Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc. 89(4):536-47, 2014
                                        8. Ni YB et al: Columnar cell-like changes in the male breast. J Clin Pathol. 67(1):45-8, 2014
                                        9. Verschuur-Maes AH et al: Do columnar cell lesions exist in the male breast? Histopathology. 64(6):818-25, 2014
                                        10. Verschuur-Maes AH et al: Analysis of gene copy number alterations by multiplex ligation-dependent probe amplification in columnar cell lesions of the breast. Cell Oncol (Dordr). 37(2):147-54, 2014
                                        11. Ichihara S et al: Pseudo-micropapillary structures associated with columnar cell lesions of the breast are an artifact due to traumatic epithelial detachment: a potential pitfall which can lead to overtreatment. Virchows Arch. 463(1):93-5, 2013
                                        12. Seo M et al: Columnar cell lesions without atypia initially diagnosed on breast needle biopsies: is imaging follow-up enough? AJR Am J Roentgenol. 201(4):928-34, 2013
                                        13. Schnitt SJ et al: Biopsy Interpretation of the Breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins. 107-135, 2013
                                        14. Boulos FI et al: Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions: evidence against a precursor role. Cancer. 118(9):2372-7, 2012
                                        15. Go EM et al: Relationship between columnar cell changes and low-grade carcinoma in situ of the breast--a cytogenetic study. Hum Pathol. 43(11):1924-31, 2012
                                        16. Verschuur-Maes AH et al: Epigenetic progression of columnar cell lesions of the breast to invasive breast cancer. Breast Cancer Res Treat. 136(3):705-15, 2012
                                        17. Verschuur-Maes AH et al: Columnar cell lesions on breast needle biopsies: is surgical excision necessary? A systematic review. Ann Surg. 255(2):259-65, 2012
                                        18. Walker RA et al: Current issues in diagnostic breast pathology. J Clin Pathol. 65(9):771-85, 2012
                                        19. Gomes DS et al: Lobular neoplasia: frequency and association with other breast lesions. Diagn Pathol. 6:74, 2011
                                        20. Masood S et al: Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol. 18(3):190-8, 2011
                                        21. Verschuur-Maes AH et al: The mucinous variant of columnar cell lesions. Histopathology. 58(6):847-53, 2011
                                        22. Verschuur-Maes AH et al: Digital mammography: more microcalcifications, more columnar cell lesions without atypia. Mod Pathol. 24(9):1191-7, 2011
                                        23. Verschuur-Maes AH et al: Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies. Int J Cancer. 129(11):2674-80, 2011
                                        24. Aroner SA et al: Columnar cell lesions and subsequent breast cancer risk: a nested case-control study. Breast Cancer Res. 12(4):R61, 2010
                                        25. Ellsworth RE et al: Chromosomal alterations in pure nonneoplastic breast lesions: implications for breast cancer progression. Ann Surg Oncol. 17(6):1688-94, 2010
                                        26. Jara-Lazaro AR et al: Columnar cell lesions of the breast: an update and significance on core biopsy. Pathology. 41(1):18-27, 2009
                                        27. Recavarren RA et al: Columnar cell lesions and pseudoangiomatous hyperplasia like stroma: is there an epithelial-stromal interaction? Int J Clin Exp Pathol. 3(1):87-97, 2009
                                        28. Senetta R et al: Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations. Mod Pathol. 22(6):762-9, 2009
                                        29. Turashvili G et al: Columnar cell lesions, mammographic density and breast cancer risk. Breast Cancer Res Treat. 115(3):561-71, 2009
                                        30. Boulos FI et al: Histologic associations and long-term cancer risk in columnar cell lesions of the breast: a retrospective cohort and a nested case-control study. Cancer. 113(9):2415-21, 2008
                                        31. Carley AM et al: Frequency and clinical significance of simultaneous association of lobular neoplasia and columnar cell alterations in breast tissue specimens. Am J Clin Pathol. 130(2):254-8, 2008
                                        32. Feeley L et al: Columnar cell lesions of the breast. Histopathology. 52(1):11-9, 2008
                                        33. Turashvili G et al: Are columnar cell lesions the earliest histologically detectable non-obligate precursor of breast cancer? Virchows Arch. 452(6):589-98, 2008
                                        34. Abdel-Fatah TM et al: 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. 31(3):417-26, 2007
                                        35. Jensen KC et al: Cytologic diagnosis of columnar-cell lesions of the breast. Diagn Cytopathol. 35(2):73-9, 2007
                                        36. Pandey S et al: Columnar cell lesions of the breast: mammographic findings with histopathologic correlation. Radiographics. 27 Suppl 1:S79-89, 2007
                                        37. Pinder SE et al: Lobular in situ neoplasia and columnar cell lesions: diagnosis in breast core biopsies and implications for management. Pathology. 39(2):208-16, 2007
                                        38. Pinder SE et al: Non-operative breast pathology: columnar cell lesions. J Clin Pathol. 60(12):1307-12, 2007
                                        39. Dabbs DJ et al: Molecular alterations in columnar cell lesions of the breast. Mod Pathol. 19(3):344-9, 2006
                                        40. Kim MJ et al: Columnar cell lesions of the breast: mammographic and US features. Eur J Radiol. 60(2):264-9, 2006
                                        41. O'Malley FP et al: Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast. Mod Pathol. 19(2):172-9, 2006
                                        42. Ho BC et al: Flat epithelial atypia: concepts and controversies of an intraductal lesion of the breast. Pathology. 37(2):105-11, 2005
                                        43. Sahoo S et al: Triad of columnar cell alteration, lobular carcinoma in situ, and tubular carcinoma of the breast. Breast J. 11(2):140-2, 2005
                                        44. Simpson PT et al: Columnar cell lesions of the breast: the missing link in breast cancer progression? A morphological and molecular analysis. Am J Surg Pathol. 29(6):734-46, 2005
                                        45. Simpson PT et al: Molecular evolution of breast cancer. J Pathol. 205(2):248-54, 2005
                                        46. Tan PH et al: Pathological diagnosis of columnar cell lesions of the breast: are there issues of reproducibility? J Clin Pathol. 58(7):705-9, 2005
                                        47. Tremblay G et al: Overexpression of estrogen receptors in columnar cell change and in unfolding breast lobules. Breast J. 11(5):326-32, 2005
                                        48. Viale G: Histopathology of primary breast cancer 2005. Breast. 14(6):487-92, 2005
                                        49. Nasser SM: Columnar cell lesions: current classification and controversies. Semin Diagn Pathol. 21(1):18-24, 2004
                                        50. Saqi A et al: Columnar cell lesions: fine-needle aspiration biopsy features. Diagn Cytopathol. 31(6):370-5, 2004
                                        51. Sewell CW: Pathology of high-risk breast lesions and ductal carcinoma in situ. Radiol Clin North Am. 42(5):821-30, v, 2004
                                        52. Siziopikou KP et al: The emerging biological and clinical significance of the columnar cell lesions of the breast. Diagn Cytopathol. 31(6):369, 2004
                                        53. Hoda SA et al: Evolving entities and changing concepts in breast pathology. Breast Cancer. 10(4):294-300, 2003
                                        54. Schnitt SJ et al: Columnar cell lesions of the breast. Adv Anat Pathol. 10(3):113-24, 2003
                                        55. Schnitt SJ: The diagnosis and management of pre-invasive breast disease: flat epithelial atypia--classification, pathologic features and clinical significance. Breast Cancer Res. 5(5):263-8, 2003
                                        56. Tavassoli FA et al: Intraductal proliferative lesions. In Tavassoli FA et al: World Health Organization Classification of Tumors: Pathology and Genetics of the Breast and Female Genital Organs. Lyon: IARC Press, 2003
                                        57. Vincent-Salomon A: [Columnar lesions: a frequent diagnosis in breast pathology!] Ann Pathol. 23(6):593-6, 2003
                                        58. Gomez-Aracil V et al: Papillary neoplasms of the breast: clues in fine needle aspiration cytology. Cytopathology. 13(1):22-30, 2002
                                        59. Jacobs TW et al: Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 26(9):1095-110, 2002
                                        60. Moinfar F et al: Genetic abnormalities in mammary ductal intraepithelial neoplasia-flat type ("clinging ductal carcinoma in situ"): a simulator of normal mammary epithelium. Cancer. 88(9):2072-81, 2000
                                        61. Rosen PP: Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma. Am J Surg Pathol. 23(12):1561, 1999
                                        62. Fraser JL et al: Columnar alteration with prominent apical snouts and secretions: a spectrum of changes frequently present in breast biopsies performed for microcalcifications. Am J Surg Pathol. 22(12):1521-7, 1998
                                        63. Azzopardi JG et al: Problems in breast pathology. Major Probl Pathol. 11:i-xvi, 1-466, 1979
                                        64. Columnar Cell Lesions and Flat Epithelial Atypia of the Breast
                                        Related Anatomy
                                        Loading...
                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Columnar cell lesions (CCL)
                                                  • Synonyms

                                                    • Columnar cell change/hyperplasia (CCC/CCH) without atypia
                                                    • Columnar alteration with prominent apical snouts and secretions (CAPSS) without atypia
                                                    • Enlarged lobular units with columnar alteration
                                                    • Blunt duct adenosis, columnar metaplasia
                                                  • Definitions

                                                    • Enlarged terminal duct lobular units (TDLUs) lined by columnar-type epithelial cells, often with luminal secretions, Ca⁺⁺
                                                    • Flat epithelial atypia (FEA) = CCL with atypia

                                                  IMAGING

                                                  • General Features

                                                    • Mammographic Findings

                                                      • Imaging Recommendations

                                                        • Ultrasonographic Findings

                                                          • Image-Guided Biopsy

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Collins LC: Precursor lesions of the low-grade breast neoplasia pathway. Surg Pathol Clin. 11(1):177-97, 2018
                                                                              2. Ahn HS et al: Diagnosis of columnar cell lesions and atypical ductal hyperplasia by ultrasound-guided core biopsy: findings associated with underestimation of breast carcinoma. Ultrasound Med Biol. 42(7):1457-63, 2016
                                                                              3. Yamashita Y et al: Does flat epithelial atypia have rounder nuclei than columnar cell change/hyperplasia? A morphometric approach to columnar cell lesions of the breast. Virchows Arch. 468(6):663-73, 2016
                                                                              4. Elif A et al: Columnar cell lesions of the breast: radiological features and histological correlation. Med Ultrason. 17(2):147-54, 2015
                                                                              5. Björner S et al: Epithelial and stromal microRNA signatures of columnar cell hyperplasia linking Let-7c to precancerous and cancerous breast cancer cell proliferation. PLoS One. 9(8):e105099, 2014
                                                                              6. Gomes DS et al: Inter-observer variability between general pathologists and a specialist in breast pathology in the diagnosis of lobular neoplasia, columnar cell lesions, atypical ductal hyperplasia and ductal carcinoma in situ of the breast. Diagn Pathol. 9:121, 2014
                                                                              7. Neal L et al: Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc. 89(4):536-47, 2014
                                                                              8. Ni YB et al: Columnar cell-like changes in the male breast. J Clin Pathol. 67(1):45-8, 2014
                                                                              9. Verschuur-Maes AH et al: Do columnar cell lesions exist in the male breast? Histopathology. 64(6):818-25, 2014
                                                                              10. Verschuur-Maes AH et al: Analysis of gene copy number alterations by multiplex ligation-dependent probe amplification in columnar cell lesions of the breast. Cell Oncol (Dordr). 37(2):147-54, 2014
                                                                              11. Ichihara S et al: Pseudo-micropapillary structures associated with columnar cell lesions of the breast are an artifact due to traumatic epithelial detachment: a potential pitfall which can lead to overtreatment. Virchows Arch. 463(1):93-5, 2013
                                                                              12. Seo M et al: Columnar cell lesions without atypia initially diagnosed on breast needle biopsies: is imaging follow-up enough? AJR Am J Roentgenol. 201(4):928-34, 2013
                                                                              13. Schnitt SJ et al: Biopsy Interpretation of the Breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins. 107-135, 2013
                                                                              14. Boulos FI et al: Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions: evidence against a precursor role. Cancer. 118(9):2372-7, 2012
                                                                              15. Go EM et al: Relationship between columnar cell changes and low-grade carcinoma in situ of the breast--a cytogenetic study. Hum Pathol. 43(11):1924-31, 2012
                                                                              16. Verschuur-Maes AH et al: Epigenetic progression of columnar cell lesions of the breast to invasive breast cancer. Breast Cancer Res Treat. 136(3):705-15, 2012
                                                                              17. Verschuur-Maes AH et al: Columnar cell lesions on breast needle biopsies: is surgical excision necessary? A systematic review. Ann Surg. 255(2):259-65, 2012
                                                                              18. Walker RA et al: Current issues in diagnostic breast pathology. J Clin Pathol. 65(9):771-85, 2012
                                                                              19. Gomes DS et al: Lobular neoplasia: frequency and association with other breast lesions. Diagn Pathol. 6:74, 2011
                                                                              20. Masood S et al: Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol. 18(3):190-8, 2011
                                                                              21. Verschuur-Maes AH et al: The mucinous variant of columnar cell lesions. Histopathology. 58(6):847-53, 2011
                                                                              22. Verschuur-Maes AH et al: Digital mammography: more microcalcifications, more columnar cell lesions without atypia. Mod Pathol. 24(9):1191-7, 2011
                                                                              23. Verschuur-Maes AH et al: Progression risk of columnar cell lesions of the breast diagnosed in core needle biopsies. Int J Cancer. 129(11):2674-80, 2011
                                                                              24. Aroner SA et al: Columnar cell lesions and subsequent breast cancer risk: a nested case-control study. Breast Cancer Res. 12(4):R61, 2010
                                                                              25. Ellsworth RE et al: Chromosomal alterations in pure nonneoplastic breast lesions: implications for breast cancer progression. Ann Surg Oncol. 17(6):1688-94, 2010
                                                                              26. Jara-Lazaro AR et al: Columnar cell lesions of the breast: an update and significance on core biopsy. Pathology. 41(1):18-27, 2009
                                                                              27. Recavarren RA et al: Columnar cell lesions and pseudoangiomatous hyperplasia like stroma: is there an epithelial-stromal interaction? Int J Clin Exp Pathol. 3(1):87-97, 2009
                                                                              28. Senetta R et al: Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations. Mod Pathol. 22(6):762-9, 2009
                                                                              29. Turashvili G et al: Columnar cell lesions, mammographic density and breast cancer risk. Breast Cancer Res Treat. 115(3):561-71, 2009
                                                                              30. Boulos FI et al: Histologic associations and long-term cancer risk in columnar cell lesions of the breast: a retrospective cohort and a nested case-control study. Cancer. 113(9):2415-21, 2008
                                                                              31. Carley AM et al: Frequency and clinical significance of simultaneous association of lobular neoplasia and columnar cell alterations in breast tissue specimens. Am J Clin Pathol. 130(2):254-8, 2008
                                                                              32. Feeley L et al: Columnar cell lesions of the breast. Histopathology. 52(1):11-9, 2008
                                                                              33. Turashvili G et al: Are columnar cell lesions the earliest histologically detectable non-obligate precursor of breast cancer? Virchows Arch. 452(6):589-98, 2008
                                                                              34. Abdel-Fatah TM et al: 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. 31(3):417-26, 2007
                                                                              35. Jensen KC et al: Cytologic diagnosis of columnar-cell lesions of the breast. Diagn Cytopathol. 35(2):73-9, 2007
                                                                              36. Pandey S et al: Columnar cell lesions of the breast: mammographic findings with histopathologic correlation. Radiographics. 27 Suppl 1:S79-89, 2007
                                                                              37. Pinder SE et al: Lobular in situ neoplasia and columnar cell lesions: diagnosis in breast core biopsies and implications for management. Pathology. 39(2):208-16, 2007
                                                                              38. Pinder SE et al: Non-operative breast pathology: columnar cell lesions. J Clin Pathol. 60(12):1307-12, 2007
                                                                              39. Dabbs DJ et al: Molecular alterations in columnar cell lesions of the breast. Mod Pathol. 19(3):344-9, 2006
                                                                              40. Kim MJ et al: Columnar cell lesions of the breast: mammographic and US features. Eur J Radiol. 60(2):264-9, 2006
                                                                              41. O'Malley FP et al: Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast. Mod Pathol. 19(2):172-9, 2006
                                                                              42. Ho BC et al: Flat epithelial atypia: concepts and controversies of an intraductal lesion of the breast. Pathology. 37(2):105-11, 2005
                                                                              43. Sahoo S et al: Triad of columnar cell alteration, lobular carcinoma in situ, and tubular carcinoma of the breast. Breast J. 11(2):140-2, 2005
                                                                              44. Simpson PT et al: Columnar cell lesions of the breast: the missing link in breast cancer progression? A morphological and molecular analysis. Am J Surg Pathol. 29(6):734-46, 2005
                                                                              45. Simpson PT et al: Molecular evolution of breast cancer. J Pathol. 205(2):248-54, 2005
                                                                              46. Tan PH et al: Pathological diagnosis of columnar cell lesions of the breast: are there issues of reproducibility? J Clin Pathol. 58(7):705-9, 2005
                                                                              47. Tremblay G et al: Overexpression of estrogen receptors in columnar cell change and in unfolding breast lobules. Breast J. 11(5):326-32, 2005
                                                                              48. Viale G: Histopathology of primary breast cancer 2005. Breast. 14(6):487-92, 2005
                                                                              49. Nasser SM: Columnar cell lesions: current classification and controversies. Semin Diagn Pathol. 21(1):18-24, 2004
                                                                              50. Saqi A et al: Columnar cell lesions: fine-needle aspiration biopsy features. Diagn Cytopathol. 31(6):370-5, 2004
                                                                              51. Sewell CW: Pathology of high-risk breast lesions and ductal carcinoma in situ. Radiol Clin North Am. 42(5):821-30, v, 2004
                                                                              52. Siziopikou KP et al: The emerging biological and clinical significance of the columnar cell lesions of the breast. Diagn Cytopathol. 31(6):369, 2004
                                                                              53. Hoda SA et al: Evolving entities and changing concepts in breast pathology. Breast Cancer. 10(4):294-300, 2003
                                                                              54. Schnitt SJ et al: Columnar cell lesions of the breast. Adv Anat Pathol. 10(3):113-24, 2003
                                                                              55. Schnitt SJ: The diagnosis and management of pre-invasive breast disease: flat epithelial atypia--classification, pathologic features and clinical significance. Breast Cancer Res. 5(5):263-8, 2003
                                                                              56. Tavassoli FA et al: Intraductal proliferative lesions. In Tavassoli FA et al: World Health Organization Classification of Tumors: Pathology and Genetics of the Breast and Female Genital Organs. Lyon: IARC Press, 2003
                                                                              57. Vincent-Salomon A: [Columnar lesions: a frequent diagnosis in breast pathology!] Ann Pathol. 23(6):593-6, 2003
                                                                              58. Gomez-Aracil V et al: Papillary neoplasms of the breast: clues in fine needle aspiration cytology. Cytopathology. 13(1):22-30, 2002
                                                                              59. Jacobs TW et al: Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 26(9):1095-110, 2002
                                                                              60. Moinfar F et al: Genetic abnormalities in mammary ductal intraepithelial neoplasia-flat type ("clinging ductal carcinoma in situ"): a simulator of normal mammary epithelium. Cancer. 88(9):2072-81, 2000
                                                                              61. Rosen PP: Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma. Am J Surg Pathol. 23(12):1561, 1999
                                                                              62. Fraser JL et al: Columnar alteration with prominent apical snouts and secretions: a spectrum of changes frequently present in breast biopsies performed for microcalcifications. Am J Surg Pathol. 22(12):1521-7, 1998
                                                                              63. Azzopardi JG et al: Problems in breast pathology. Major Probl Pathol. 11:i-xvi, 1-466, 1979
                                                                              64. Columnar Cell Lesions and Flat Epithelial Atypia of the Breast