Columnar Alteration With Prominent Apical Snouts and Secretions

Abstract

We have noted in breast biopsies performed for microcalcifications a spectrum of lesions in the terminal duct lobular unit (TDLU) characterized by columnar epithelial cells with prominent apical cytoplasmic snouts, intraluminal secretions, and varying degrees of nuclear atypia and architectural complexity. The appearance of some of these lesions is worrisome, but diagnostic difficulties arise because the histologic features do not fulfill established criteria for the diagnosis of atypical ductal hyperplasia or ductal carcinoma in situ (DCIS). We have termed such lesions columnar alteration with prominent apical snouts and secretions (CAPSS). The purpose of this study was to define the pathologic spectrum and mammographic features of these lesions. We reviewed histologic sections and mammograms from 100 consecutive breast biopsies performed for microcalcifications. The prevalence and histologic features of CAPSS and the association with other histologic findings were recorded. CAPSS was identified in 42% of cases. At the lower end of the spectrum were lesions similar to columnar alteration of lobules but in which apical cytoplasmic secretion and nuclear stratification were more pronounced and cells with a hobnail configuration were common. More advanced lesions showed columnar epithelial cell tufts, bridges, and micropapillations with prominent apical cytoplasmic snouts and with greater degrees of nuclear stratification and atypia. At the upper end of the spectrum were lesions that could arguably be considered DCIS. Calcifications were present within CAPSS in 74% of cases, were frequently psammomatous, and were typically nonbranching and often round on mammography. Columnar alteration of lobules was more common in biopsies with than without CAPSS (74 versus 36%, p < 0.001). Ductal carcinoma in situ was seen with similar frequency in biopsies with and without CAPSS (38 versus 41%). However, DCIS in cases with CAPSS was more often of the low-grade micropapillary-cribriform type than in cases without CAPSS (56 versus 17%, p < 0.01), and CAPSS and DCIS commonly coexisted in the same or adjacent TDLUs. In conclusion, 1) CAPSS encompasses a spectrum of lesions bounded at the lower end by columnar alteration of lobules and at the upper end by low-grade DCIS. Lesions recently described by Page as "hypersecretory hyperplasia with atypia" fall within this spectrum. 2) Some CAPSS lesions present architectural or cytologic features that create diagnostic difficulties and raise the possibility of atypical ductal hyperplasia or DCIS; however, the level of cancer risk associated with CAPSS lesions that do not fulfill established criteria for atypical ductal hyperplasia or DCIS is unknown and requires evaluation in follow-up studies.

Molecular alterations in columnar cell lesions of the breast

“…Biomarker studies of estrogen and progesterone (ER/PR) receptors, 8,19 -bcl-2, 19 CyclinD1 22 on columnar cell alterations have demonstrated alterations compared to normal lobules. Columnar cell lesions routinely display strong and diffuse ER/PR compared to the focal and variable immunostaining of surrounding lobules.…”

Columnar cell lesions: Fine‐needle aspiration biopsy features

“…8 Fraser et al found CAPSS in 42% of 100 consecutive biopsies performed for microcalcifications. 1 Although 8/20 (40%) biopsies in our series had microcalcifications, the stated indications for the biopsies were the presence of masses/densities/nodularities. Therefore, CCLs are also found incidentally in biopsies of fibroadenomas and fibrocystic changes and are not limited to biopsies performed for microcalcifications.…”

“…CCLs with atypia not satisfying the usual criteria for ADH are best classified as CCLs with atypia; however, if the usual criteria for a diagnosis of ADH are present, a diagnosis of ADH is preferable. 1 Lesions with the latter features were not included in this study.…”

“…Fraser et al refer to this constellation of findings as "columnar alteration with prominent apical snouts and secretions (CAPSS)". 1 Histologically, CCLs span a spectrum from columnar cell change with or without atypia to lesions with cellular proliferation, termed columnar cell hyperplasia (CCH), with or without atypia.…”

Histologia mamária após uso de esteróides sexuais - estudo em ratas

“…Segundo a classificação da Organização Mundial da Saúde, seria uma lesão intermediária entre a HDT e HDA 21 . A atipia epitelial plana tem sido denominada por outros patologistas como alteração ou hiperplasia de células colunares com atipias [22][23] ou ainda CAPSS -columnar alteration with prominent apical snouts and secretions 24 (alteração colunar epitelial com secreção do tipo decapitação 25 ). Atualmente, o nível de risco para o desenvolvimento de carcinoma invasivo associado com estas lesões é desconhecido.…”