Columnar Cell Lesions of the Breast

Columnar cell lesions (CCLs) of the breast, formerly known as columnar alteration with prominent apical snouts and secretions (CAPPS), are characterized by lining of enlarged terminal duct lobular units by columnar epithelium. They can cause microcalcifications and are frequently found at biopsy performed for tissue charcterization of microcalcifications.

CCLs can be broken down into:

• Columnar cell change (CCC): Corresponds to an increased relative risk of breast cancer. But the overall risk is low, therefore discovery at core needle biopsy requires no additional work-up.
• Columnar cell hyperplasia (CCH): Corresponds to an increased relative risk of breast cancer. But the overall risk is low, therefore discovery at core needle biopsy requires no additional work-up.
• Flat epithelial atypia (FEA): Commonly coexists with other more significant lesions, including ADH, DCIS, and tubular carcinoma. Therefore discovery at excisional biopsy should prompt in an excisional biopsy releveling of the block and a careful search for areas of ADH and DCIS.

Mmammographic findings of CCLs include clustered, amorphous, or fine pleomorphic microcalcifications within the lumen of terminal duct lobular units.

Differential considerations for amorphous calcifications in the lobule or the terminal ducts incldues:

• DCIS
• ADH
• CCLs
• Ordinary epithelial hyperplasia
• Papillomatosis
• sclerosing adenosis

Differential considerations for fine pleomorphic calcifications located in the terminal ducts of the terminal duct lobular units includes:

• DCIS
• ADH
• CCLs
• Typical ductal hyperplasia

References

Pandey S, Kornstein MJ, Shank W, de Paredes ES. Columnar cell lesions of the breast: mammographic findings with histopathologic correlation. Radiographics. 2007 Oct;27 Suppl 1:S79-89. Review.