Genetic abnormalities in mammary ductal intraepithelial neoplasia-flat type (?clinging ductal carcinoma in situ?)

Moinfar, Farid; Man, Yan‐gao; Bratthauer, Gary L.; Ratschek, Manfred; Tavassoli, Fattaneh A.

doi:10.1002/(sici)1097-0142(20000501)88:9<2072::aid-cncr13>3.0.co;2-h

Cited by 217 publications

(154 citation statements)

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“…This can be summarized by the consistent loss of 16q in columnar cell atypia as in this entire family of lowgrade breast lesions, and by the similar loss of heterozygosity and nonrandom X chromosome inactivation profiles between columnar cell atypia and adjacent tubular carcinomas. 28 An accumulation of genetic abnormalities has also been demonstrated in lesions of increasing severity (columnar cell atypia to invasive carcinoma), and elegantly tabulated by Abdel-Fatah and colleagues. 3 As compelling as these findings may be, they do not a priori establish a causal relationship between columnar cell Original Article atypia and AH or carcinoma.…”

Section: Discussionmentioning

confidence: 95%

Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

Boulos

Dupont

Schuyler

et al. 2011

Cancer

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BACKGROUND: Columnar cell lesions are frequently associated with atypical ductal hyperplasia, lobular neoplasia, and tubular carcinoma, and have been suggested as a precursor lesion for low-grade carcinomas. However, in longterm follow-up studies, columnar cell lesions are associated with only a slight increase in later breast cancer development. If columnar cell lesions are precursor lesions, one would expect subsequent cancers to develop at the same site as the biopsy and to be preferentially of low grade. The goal of this article is to review the clinical and pathologic features of carcinomas that develop after a diagnosis of columnar cell lesion to try to establish whether these lesions are precursors to low-grade invasive carcinoma. METHODS: The authors reviewed biopsies containing columnar cell lesions, using the criteria of Schnitt and Vincent-Salomon, from 77 women in the Nashville Breast Cohort who developed subsequent breast carcinoma. Clinicopathologic features including laterality, type, and grade of the subsequent cancer were recorded. RESULTS: Breast cancer developed a median of 11 years after initial biopsy. The median age at diagnosis was 60 years. The majority of invasive carcinomas were of no special type and of intermediate grade. Moreover, the carcinomas were as likely to occur in the contralateral breast as in the breast that was originally diagnosed with columnar cell lesion, regardless of columnar cell lesion subtype (P ¼ .48). CONCLUSIONS: Carcinoma subsequent to columnar cell lesions may occur in either breast and tends to show a similar grade and type distribution as sporadic breast cancer. These findings argue against columnar cell lesions being a true precursor for lowgrade invasive carcinoma.

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Section: Discussionmentioning

confidence: 95%

Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

Boulos

Dupont

Schuyler

et al. 2011

Cancer

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“…A subset of these lesions is characterized by enlarged terminal duct lobular units in which the acini are lined by one to several layers of cuboidal to columnar epithelial cells with low-grade/monomorphic-type cytologic atypia similar to that seen in low-grade DCIS. Lesions with this constellation of features have long been recognized by pathologists under a Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast FP O'Malley et al wide variety of names including atypical cystic duct, 27 atypical lobules type A, 4 clinging carcinoma, 6,20 hypersecretory hyperplasia with atypia, 8,10 small ectatic ducts lined by atypical ductal cells with apical snouts, 5 columnar alteration with prominent apical snouts and secretions with atypia, 3 atypical cystic lobules, 9 ductal intraepithelial neoplasia-flat type, 18 and columnar cell hyperplasia with atypia. 11,13 Most recently, the WHO Working Group on the Pathology and Genetics of Tumours of the Breast introduced the term 'flat epithelial atypia'…”

Section: Discussionmentioning

confidence: 99%

“…Emerging evidence suggests that FEA may have an important role in neoplastic progression in the breast. 18,19 Whereas its ultimate role in breast tumorigenesis remains to be more clearly defined, available observational data have indicated that FEA often coexists with other lesions for which the clinical implications and management considerations are better understood such as ADH, DCIS, invasive carcinoma (particularly tubular carcinoma) and lobular neoplasia. 3,5,22,23 Therefore, the recognition of FEA is of importance for surgical pathologists because this serves as a 'red flag', particularly in core biopsies, for the possible presence of these other lesions.…”

Section: Discussionmentioning

confidence: 99%

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Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast

et al. 2006

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and 8 Addenbrooke's NHS Trust, Cambridge, UK Columnar cell lesions (CCLs) of the breast with low-grade/monomorphic-type cytologic atypia are being identified increasingly in biopsies performed owing to mammographic microcalcifications. The WHO Working Group on the Pathology and Genetics of Tumours of the Breast recently introduced the term 'flat epithelial atypia' (FEA) for these lesions. However, the ability of pathologists to reproducibly diagnose FEA and to distinguish it from CCLs without atypia has not been previously evaluated. Eight pathologists with an interest in breast pathology participated in a study to address this issue. The study reference pathologist provided the other seven study pathologists with a Powerpoint tutorial that included written criteria for, and representative images of, FEA and CCLs without atypia (ie, columnar cell change and columnar cell hyperplasia). Following review of the tutorial, the study pathologists examined images in Powerpoint format from 30 CCLs and were instructed to categorize each as either 'FEA' or 'not atypical'. Overall agreement among the eight pathologists was 91.8% (95% CI, 84.0-96.9%), and the multi-rater kappa value was 0.83 (95% CI, 0.67-0.94), which is within the 'excellent agreement' range. Agreement was slightly better for determining absence of FEA (92.8%: 95% CI, 84.1-97.4%), than for determining its presence (90.4%: 95% CI, 79.9-96.7%). We conclude that the diagnosis of FEA and its distinction from CCLs without atypia is highly reproducible with the use of available diagnostic criteria.

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“…11 On the other hand, it has been shown that the columnar cell lesions frequently coexist with and show the same genetic alterations of hormonedependent lesions, such as low-grade ductal carcinoma in situ (particularly, micropapillary and cribriform type), lobular intraepithelial neoplasia, and invasive tubular carcinoma. 8,12,13 All these data may be considered for postmenopausal women with a history of columnar cell lesions who are currently receiving or considering for hormone replacement therapy. Moreover, several experts in breast pathology underline that there is an urgent need for large, comprehensive studies describing more accurately the risk of finding malignant diseases after a diagnosis of columnar cell lesions on core biopsy specimens.…”

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confidence: 99%

Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

et al. 2009

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Columnar cell lesions of the breast are increasingly recognized at mammography for their tendency to calcify. We studied 392 vacuum-assisted core biopsies performed solely for calcifications to evaluate the frequency of columnar cell lesions, their relationship with radiological risk, appearance of calcifications, and clinical data. Management and follow-up of columnar cell lesions without and with atypia (flat epithelial atypia) was analyzed. Cases with architectural atypia (cribriform spaces and/or micropapillae) were excluded from flat epithelial atypia. Calcifications were within the lumen of acini affected by columnar cell lesions in 137 out of 156 biopsies diagnosed with some columnar cell lesions. These represented 37% of vacuum-assisted core biopsies and 62% of low radiological risk (BI-RADS3) calcifications. High-risk (BI-RADS5) calcifications were never associated with columnar cell lesions. Age and menopausal status were comparable in columnar and in not-columnar cell lesions. Atypia was associated with long-term hormone replacement therapy in both lesions. Surgical biopsy was recommended for all cases with atypia. Flat epithelial atypia, as the only histological findings on vacuum-assisted core biopsies, was never associated with malignancy at surgery. In conclusion, we suggest that surgical excision is not mandatory when flat epithelial atypia is found as the most advanced lesion on vacuum-assisted core biopsy performed for low radiological risk calcifications, and that women should be advised of the possible hormone dependency of this entity. Modern Pathology ( Keywords: columnar cell lesions; flat epithelial lesion; calcifications Stereotactic vacuum-assisted core biopsy is currently used to diagnose indeterminate or suspicious breast calcifications that are histologically related to a spectrum of breast lesions encompassing ductal carcinomas in situ and preneoplastic and benign lesions. Often this type of calcification resides in so-called 'columnar cell lesions', 1 entities characterized by the presence of columnar epithelial cells lining the terminal duct lobular units that typically show flocculant or secretory material and microcalcifications in the lumen. The Breast Imaging Reporting and Data System (BI-RADS) 2 has standardized the description and management of findings identified on mammograms, thereby facilitating communication between radiologists and referring physicians. However, to our knowledge, there are no specific studies evaluating whether specific calcification descriptors are associate with columnar cell lesions.Columnar cell lesions have been described under a variety of names. [3][4][5][6][7] According to Schnitt and Vincent-Salomon, 1 columnar cell lesions have been grouped into the categories of columnar cell change and columnar cell hyperplasia without or with atypia. Other authors 8 have proposed a subcategorization of columnar cell lesions depending on the presence of architectural and/or cytological atypia. The unifying term 'flat epithelial atypia' has been proposed by ...

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Genetic abnormalities in mammary ductal intraepithelial neoplasia-flat type (?clinging ductal carcinoma in situ?)

Cited by 217 publications

References 10 publications

Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

Interobserver reproducibility in the diagnosis of flat epithelial atypia of the breast

Columnar cell lesions associated with breast calcifications on vacuum-assisted core biopsies: clinical, radiographic, and histological correlations

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