Le lesioni colonnariLe lesioni colonnari

Anna SapinoUniversità 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.

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.

Am J Surg Pathol. 1998 Dec;22(12):1521-7.

8 lavori successivi

Columnar cell change

Advances in Anatomic PathologyVol. 10, No. 3, pp. 113–124

Columnar Cell Lesions of the BreastSJ. Schnitt, A Vincent-SalomonAdvances in Anatomic Pathology10: 113–124 (2003)

Columnar cell hyperplasia

Columnar cell hyperplasia with atypia Advances in Anatomic PathologyVol. 10, No. 3, pp. 113–124 (2003)

Columnar cell change with atypia

Am J Surg Pathol 2005;29:734–746

CCC Category 1

CCHCategory 2

CCC with cytological atypiaCategory 6

CCH with cytological atypiaCategory 4

CCH with architectural atypiaCategory 3

CCH with cytological atypia + architectural atypiaCategory 5

WHO 2003Traditional 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 (DCIS grade 1)

Ductal intraepithelial neoplasia grade 1C (DIN 1C)

Ductal carcinoma in situ intermediate grade (DCIS grade 2)

Ductal intraepithelial neoplasia 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 diagnosisof flat epithelial atypia of the breast

CCCCCC

CCHCCH

FEAFEACCC with atypiaCCC with atypia

CCH with atypiaCCH with atypia

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

OVERALLAGREEMENT(92.8%)

FEA

OVERALLAGREEMENT(90.4%)

Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma

Rosen PP

Am J Surg Pathol. 1999 Dec;23(12):1561

The ‘‘Rosen Triad’’: Tubular Carcinoma, LobularCarcinoma In Situ, and Columnar Cell Lesions

Adv Anat Pathol. 2008 May;15(3):140-6.

High Frequency of Coexistence of Columnar Cell Lesions,Lobular Neoplasia, and Low Grade Ductal CarcinomaIn Situ With Invasive Tubular Carcinoma and Invasive

Lobular Carcinoma

Am J Surg Pathol 2007;31:417–426

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 recurrentchromosomal abnormalities and should be seen as clonaland neoplastic rather than hyperplastic proliferations

J Pathol 2005; 205: 248–254Low grade arm

Am J Surg Pathol 2007;31:417–426

The ‘‘Rosen Triad’’: Tubular Carcinoma, LobularCarcinoma 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 colonnarisenza 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 colonnarisenza atipie

Lesioni a rischio evolutivo?

Escissione sempre?

NO

NO

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

Tibor Tot