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 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 snout
Am 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-Salomon
Advances in Anatomic Pathology
10: 113–124 (2003)
Columnar cell change
Columnar cell hyperplasia
Advances in Anatomic Pathology
Vol. 10, No. 3, pp. 113–124

6. Columnar cell change with atypia
Advances in Anatomic Pathology
Vol. 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 atypia
Category 6
CCH
Category 2
CCH with architectural atypia
Category 3
CCH with cytological atypia
Category 4
CCH with cytological atypia
+ architectural atypia
Category 5
Am 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 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)

9. CCC CCH CCC with atypia FEA CCH with atypia
Modern Pathology (2006) 19, 172–179
Interobserver reproducibility in the diagnosis
of flat epithelial atypia of the breast
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
CCC with atypia
FEA
CCH with atypia

10. CCC
OVERALL
AGREEMENT
(92.8%)
CCH

11. OVERALL
AGREEMENT
(90.4%)
FEA

12. Am J Surg Pathol. 1999 Dec;23(12):1561
Columnar cell hyperplasia is associated with lobular carcinoma in situ and tubular carcinoma
Rosen PP
Am J Surg Pathol Dec;23(12):1561
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
The ‘‘Rosen Triad’’: Tubular Carcinoma, Lobular
Carcinoma In Situ, and Columnar Cell Lesions
Adv 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 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. 1961
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? NO
Escissione sempre? NO

20. Tibor Tot 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