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Le lesioni colonnari Anna Sapino Università di Torino.

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Presentation on theme: "Le lesioni colonnari Anna Sapino Università di Torino."— Presentation transcript:

1 Le lesioni colonnari Anna Sapino Università di Torino

2 Columnar Alteration With Prominent Apical Snouts and Secretions: A Spectrum of Changes Frequently Present in Breast Biopsies Performed for Microcalcifications Am J Surg Pathol Dec;22(12): Fraser JLFraser JL, Raza S, Chorny K, Connolly JL, Schnitt SJ.Raza SChorny KConnolly JLSchnitt 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 snout Am J Surg Pathol Dec;22(12):

4 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 Dec;22(12): lavori successivi

5 Columnar cell change Advances in Anatomic Pathology Vol. 10, No. 3, pp. 113–124 Columnar Cell Lesions of the Breast SJ. Schnitt, A Vincent-Salomon Advances in Anatomic Pathology 10: 113–124 (2003) Columnar cell hyperplasia

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

7 Am J Surg Pathol 2005;29:734–746 CCC Category 1 CCH Category 2 CCC with cytological atypia Category 6 CCH with cytological atypia Category 4 CCH with architectural atypia Category 3 CCH with cytological atypia + architectural atypia Category 5

8 WHO 2003 Traditional terminologyDuctal intraepithelial terminology Usual ductal hyperplasia (UDH) Flat epithelial atypia (FEA) CCL con atipia Ductal 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 Modern Pathology (2006) 19, 172–179 Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast CCC CCH FEA CCC with atypia CCH with atypia Frances P OMalley, Syed K Mohsin, Sunil Badve, Shikha Bose, Laura C Collins, Marguerite Ennis, Celina G Kleer, Sarah E Pinder and Stuart J Schnitt

10 CCC CCH OVERALL AGREEMENT (92.8%)

11 FEA OVERALL AGREEMENT (90.4%)

12 Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma Rosen PP Am J Surg Pathol Dec;23(12):1561 The Rosen Triad: Tubular Carcinoma, Lobular Carcinoma In Situ, and Columnar Cell Lesions Adv Anat Pathol May;15(3): 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

13 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

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

15 Am J Surg Pathol 2007;31:417–426

16 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 May;15(3):140-6.

17 Lesioni a cellule colonnari senza atipie Lesioni a rischio evolutivo? Escissione sempre?

18 Bonser, Dossett and Jull Columnar metaplasia Azzopardi Blunt duct adenosis BDA with response of the specific stroma (organoid) Non-organoid BDA Microcystic BDA

19 Lesioni a cellule colonnari senza atipie Lesioni a rischio evolutivo? Escissione sempre? NO

20 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


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