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
Collins LC: Precursor lesions of the low-grade breast neoplasia pathway. Surg Pathol Clin. 11(1):177-97, 2018
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
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
Elif A et al: Columnar cell lesions of the breast: radiological features and histological correlation. Med Ultrason. 17(2):147-54, 2015
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
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
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
Ni YB et al: Columnar cell-like changes in the male breast. J Clin Pathol. 67(1):45-8, 2014
Verschuur-Maes AH et al: Do columnar cell lesions exist in the male breast? Histopathology. 64(6):818-25, 2014
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
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
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
Schnitt SJ et al: Biopsy Interpretation of the Breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins. 107-135, 2013
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
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
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
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
Walker RA et al: Current issues in diagnostic breast pathology. J Clin Pathol. 65(9):771-85, 2012
Gomes DS et al: Lobular neoplasia: frequency and association with other breast lesions. Diagn Pathol. 6:74, 2011
Masood S et al: Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol. 18(3):190-8, 2011
Verschuur-Maes AH et al: The mucinous variant of columnar cell lesions. Histopathology. 58(6):847-53, 2011
Verschuur-Maes AH et al: Digital mammography: more microcalcifications, more columnar cell lesions without atypia. Mod Pathol. 24(9):1191-7, 2011
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
Aroner SA et al: Columnar cell lesions and subsequent breast cancer risk: a nested case-control study. Breast Cancer Res. 12(4):R61, 2010
Ellsworth RE et al: Chromosomal alterations in pure nonneoplastic breast lesions: implications for breast cancer progression. Ann Surg Oncol. 17(6):1688-94, 2010
Jara-Lazaro AR et al: Columnar cell lesions of the breast: an update and significance on core biopsy. Pathology. 41(1):18-27, 2009
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
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
Turashvili G et al: Columnar cell lesions, mammographic density and breast cancer risk. Breast Cancer Res Treat. 115(3):561-71, 2009
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
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
Feeley L et al: Columnar cell lesions of the breast. Histopathology. 52(1):11-9, 2008
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
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
Jensen KC et al: Cytologic diagnosis of columnar-cell lesions of the breast. Diagn Cytopathol. 35(2):73-9, 2007
Pandey S et al: Columnar cell lesions of the breast: mammographic findings with histopathologic correlation. Radiographics. 27 Suppl 1:S79-89, 2007
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
Pinder SE et al: Non-operative breast pathology: columnar cell lesions. J Clin Pathol. 60(12):1307-12, 2007
Dabbs DJ et al: Molecular alterations in columnar cell lesions of the breast. Mod Pathol. 19(3):344-9, 2006
Kim MJ et al: Columnar cell lesions of the breast: mammographic and US features. Eur J Radiol. 60(2):264-9, 2006
O'Malley FP et al: Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast. Mod Pathol. 19(2):172-9, 2006
Ho BC et al: Flat epithelial atypia: concepts and controversies of an intraductal lesion of the breast. Pathology. 37(2):105-11, 2005
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
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
Simpson PT et al: Molecular evolution of breast cancer. J Pathol. 205(2):248-54, 2005
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
Tremblay G et al: Overexpression of estrogen receptors in columnar cell change and in unfolding breast lobules. Breast J. 11(5):326-32, 2005
Viale G: Histopathology of primary breast cancer 2005. Breast. 14(6):487-92, 2005
Nasser SM: Columnar cell lesions: current classification and controversies. Semin Diagn Pathol. 21(1):18-24, 2004
Saqi A et al: Columnar cell lesions: fine-needle aspiration biopsy features. Diagn Cytopathol. 31(6):370-5, 2004
Sewell CW: Pathology of high-risk breast lesions and ductal carcinoma in situ. Radiol Clin North Am. 42(5):821-30, v, 2004
Siziopikou KP et al: The emerging biological and clinical significance of the columnar cell lesions of the breast. Diagn Cytopathol. 31(6):369, 2004
Hoda SA et al: Evolving entities and changing concepts in breast pathology. Breast Cancer. 10(4):294-300, 2003
Schnitt SJ et al: Columnar cell lesions of the breast. Adv Anat Pathol. 10(3):113-24, 2003
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
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
Vincent-Salomon A: [Columnar lesions: a frequent diagnosis in breast pathology!] Ann Pathol. 23(6):593-6, 2003
Gomez-Aracil V et al: Papillary neoplasms of the breast: clues in fine needle aspiration cytology. Cytopathology. 13(1):22-30, 2002
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
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
Rosen PP: Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma. Am J Surg Pathol. 23(12):1561, 1999
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
Azzopardi JG et al: Problems in breast pathology. Major Probl Pathol. 11:i-xvi, 1-466, 1979
Columnar Cell Lesions and Flat Epithelial Atypia of the Breast
Related Anatomy
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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
Collins LC: Precursor lesions of the low-grade breast neoplasia pathway. Surg Pathol Clin. 11(1):177-97, 2018
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
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
Elif A et al: Columnar cell lesions of the breast: radiological features and histological correlation. Med Ultrason. 17(2):147-54, 2015
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
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
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
Ni YB et al: Columnar cell-like changes in the male breast. J Clin Pathol. 67(1):45-8, 2014
Verschuur-Maes AH et al: Do columnar cell lesions exist in the male breast? Histopathology. 64(6):818-25, 2014
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
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
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
Schnitt SJ et al: Biopsy Interpretation of the Breast. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins. 107-135, 2013
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
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
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
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
Walker RA et al: Current issues in diagnostic breast pathology. J Clin Pathol. 65(9):771-85, 2012
Gomes DS et al: Lobular neoplasia: frequency and association with other breast lesions. Diagn Pathol. 6:74, 2011
Masood S et al: Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol. 18(3):190-8, 2011
Verschuur-Maes AH et al: The mucinous variant of columnar cell lesions. Histopathology. 58(6):847-53, 2011
Verschuur-Maes AH et al: Digital mammography: more microcalcifications, more columnar cell lesions without atypia. Mod Pathol. 24(9):1191-7, 2011
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
Aroner SA et al: Columnar cell lesions and subsequent breast cancer risk: a nested case-control study. Breast Cancer Res. 12(4):R61, 2010
Ellsworth RE et al: Chromosomal alterations in pure nonneoplastic breast lesions: implications for breast cancer progression. Ann Surg Oncol. 17(6):1688-94, 2010
Jara-Lazaro AR et al: Columnar cell lesions of the breast: an update and significance on core biopsy. Pathology. 41(1):18-27, 2009
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
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
Turashvili G et al: Columnar cell lesions, mammographic density and breast cancer risk. Breast Cancer Res Treat. 115(3):561-71, 2009
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
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
Feeley L et al: Columnar cell lesions of the breast. Histopathology. 52(1):11-9, 2008
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
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
Jensen KC et al: Cytologic diagnosis of columnar-cell lesions of the breast. Diagn Cytopathol. 35(2):73-9, 2007
Pandey S et al: Columnar cell lesions of the breast: mammographic findings with histopathologic correlation. Radiographics. 27 Suppl 1:S79-89, 2007
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
Pinder SE et al: Non-operative breast pathology: columnar cell lesions. J Clin Pathol. 60(12):1307-12, 2007
Dabbs DJ et al: Molecular alterations in columnar cell lesions of the breast. Mod Pathol. 19(3):344-9, 2006
Kim MJ et al: Columnar cell lesions of the breast: mammographic and US features. Eur J Radiol. 60(2):264-9, 2006
O'Malley FP et al: Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast. Mod Pathol. 19(2):172-9, 2006
Ho BC et al: Flat epithelial atypia: concepts and controversies of an intraductal lesion of the breast. Pathology. 37(2):105-11, 2005
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
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
Simpson PT et al: Molecular evolution of breast cancer. J Pathol. 205(2):248-54, 2005
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
Tremblay G et al: Overexpression of estrogen receptors in columnar cell change and in unfolding breast lobules. Breast J. 11(5):326-32, 2005
Viale G: Histopathology of primary breast cancer 2005. Breast. 14(6):487-92, 2005
Nasser SM: Columnar cell lesions: current classification and controversies. Semin Diagn Pathol. 21(1):18-24, 2004
Saqi A et al: Columnar cell lesions: fine-needle aspiration biopsy features. Diagn Cytopathol. 31(6):370-5, 2004
Sewell CW: Pathology of high-risk breast lesions and ductal carcinoma in situ. Radiol Clin North Am. 42(5):821-30, v, 2004
Siziopikou KP et al: The emerging biological and clinical significance of the columnar cell lesions of the breast. Diagn Cytopathol. 31(6):369, 2004
Hoda SA et al: Evolving entities and changing concepts in breast pathology. Breast Cancer. 10(4):294-300, 2003
Schnitt SJ et al: Columnar cell lesions of the breast. Adv Anat Pathol. 10(3):113-24, 2003
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
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
Vincent-Salomon A: [Columnar lesions: a frequent diagnosis in breast pathology!] Ann Pathol. 23(6):593-6, 2003
Gomez-Aracil V et al: Papillary neoplasms of the breast: clues in fine needle aspiration cytology. Cytopathology. 13(1):22-30, 2002
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
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
Rosen PP: Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma. Am J Surg Pathol. 23(12):1561, 1999
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
Azzopardi JG et al: Problems in breast pathology. Major Probl Pathol. 11:i-xvi, 1-466, 1979
Columnar Cell Lesions and Flat Epithelial Atypia of the Breast
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