Presentation on theme: "Le lesioni colonnari Anna Sapino Università di Torino."— Presentation transcript:
1 Le lesioni colonnariAnna SapinoUniversità di Torino
2 Columnar Alteration With Prominent Apical Snouts and Secretions: A Spectrum of Changes Frequently Present in Breast Biopsies Performed for MicrocalcificationsAm J Surg Pathol Dec;22(12):Fraser JL, Raza S, Chorny K, Connolly JL, Schnitt SJ.
3 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 snoutAm J Surg Pathol Dec;22(12):
4 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
5 Columnar Cell Lesions of the Breast SJ. Schnitt, A Vincent-SalomonAdvances in Anatomic Pathology10: 113–124 (2003)Columnar cell changeColumnar cell hyperplasiaAdvances in Anatomic PathologyVol. 10, No. 3, pp. 113–124
6 Columnar cell change with atypia Advances in Anatomic PathologyVol. 10, No. 3, pp. 113–124 (2003)Columnar cell hyperplasia with atypia
7 Am J Surg Pathol 2005;29:734–746 CCC Category 1 CCC with cytological atypiaCategory 6CCHCategory 2CCH with architectural atypiaCategory 3CCH with cytological atypiaCategory 4CCH with cytological atypia+ architectural atypiaCategory 5Am J Surg Pathol 2005;29:734–746
8 WHO 2003 Traditional terminology Ductal intraepithelial terminology Usual ductal hyperplasia (UDH)Flat epithelial atypia (FEA)CCL con atipiaDuctal intraepithelial neoplasia grade 1A (DIN 1A)Atypical ductal hyperplasiaDuctal 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)
9 CCC CCH CCC with atypia FEA CCH with atypia Modern Pathology (2006) 19, 172–179Interobserver reproducibility in the diagnosisof flat epithelial atypia of the breastFrances P O’Malley, Syed K Mohsin, Sunil Badve, Shikha Bose, Laura C Collins, Marguerite Ennis, Celina G Kleer, Sarah E Pinder and Stuart J SchnittCCCCCHCCC with atypiaFEACCH with atypia
12 Am J Surg Pathol. 1999 Dec;23(12):1561 Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinomaRosen PPAm J Surg Pathol Dec;23(12):1561High Frequency of Coexistence of Columnar Cell Lesions,Lobular Neoplasia, and Low Grade Ductal CarcinomaIn Situ With Invasive Tubular Carcinoma and InvasiveLobular CarcinomaAm J Surg Pathol 2007;31:417–426The ‘‘Rosen Triad’’: Tubular Carcinoma, LobularCarcinoma In Situ, and Columnar Cell LesionsAdv Anat Pathol May;15(3):140-6.
13 Columnar Cell Lesions of the Breast: The Missing Link in Breast Cancer Progression?A Morphological and Molecular AnalysisAm J Surg Pathol 2005;29:734–746CCLs consistently harbor recurrentchromosomal abnormalities and should be seen as clonaland neoplastic rather than hyperplastic proliferations
16 The ‘‘Rosen Triad’’: Tubular Carcinoma, Lobular Carcinoma In Situ, and Columnar Cell LesionsSuzanne M. Brandt, MD, Gloria Q. Young, MD, and Syed A. Hoda, MDAdv Anat Pathol May;15(3):140-6.
17 Lesioni a cellule colonnari senza atipie Lesioni a rischio evolutivo?Escissione sempre?
18 Bonser, Dossett and Jull. 1961 Columnar metaplasiaAzzopardi Blunt duct adenosisBDA with response of the specific stroma (organoid)Non-organoid BDAMicrocystic BDA
19 Lesioni a cellule colonnari senza atipie Lesioni a rischio evolutivo?NOEscissione sempre?NO
20 Tibor Tot Aberration of the Normal Development and Involution (ANDI): clear cell changeslactational changesapocrine metaplasiafibroadenomtoid changessclerosing adenosismicrocystic changes/blunt duct adenosisetc