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de Boer M, Verschuur-Maes AHJ, Moelans C, van Diest PJ. Papillomatous breast lesions with atypical columnar cell features. J Clin Pathol 2023; 76:228-233. [PMID: 36693714 DOI: 10.1136/jcp-2022-208389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023]
Abstract
AIMS Columnar cell lesions (CCLs) are recognised breast cancer precursor lesions. Intraductal papillomas are usually lined by benign (polyclonal) cells. Although papillomas with monoclonal lesions (atypical ductal hyperplasia (ADH)/ductal carcinoma in situ (DCIS)) have been described, CCLs have not been described in papillomas. METHODS We present two papillary breast lesions lined by a single layer of luminal cells resembling atypical CCL/flat epithelial atypia (FEA). We compared these two lesions with 13 benign intraductal papillomas, and 2 papillomas with ADH/DCIS grade 1 features as controls were immunohistochemically stained for the oestrogen receptor alpha (oestrogen receptor) and progesterone receptors (PR), cytokeratin 5 (CK5) and cyclin D1. RESULTS Oestrogen receptor/PR expression was variable, with areas with ≥85% hormone receptor positivity in both morphologically normal papillomas and papillomas with ADH. In ADH areas, CK5 expression was seen in ≤5% of cells while cyclin D1 expression was high (>60%). The two papillary lesions with FEA were 100% oestrogen receptor and 90% cyclin D1 positive, and low on PR/CK5. There was only one morphologically normal papilloma with similar areas of low CK5 (5%) and high cyclin D1 expression; in all other morphologically benign papillomas CK5 expression varied between 10% and 50% and cyclin D1 expression was ≤50%. The papillary lesion with FEA that could be tested showed 16q losses, the hallmark genetic change in low nuclear grade breast neoplasias, in contrast to nine morphologically benign papillomas that could be tested. CONCLUSION We present two papillomatous breast lesions with atypical CCL morphology and 16q loss, for which we propose the term papillary FEA.
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Affiliation(s)
- Mirthe de Boer
- Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Cathy Moelans
- Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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de Boer M, van Diest PJ. Dimorphic cells: a common feature throughout the low nuclear grade breast neoplasia spectrum. Virchows Arch 2023; 482:369-375. [PMID: 36378325 PMCID: PMC9931813 DOI: 10.1007/s00428-022-03438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
Columnar cell lesions (CCLs) are recognized precursor lesions of the low nuclear grade breast neoplasia family. CCLs are cystic enlarged terminal duct lobular units with monotonous (monoclonal) columnar-type luminal cells. CCLs without atypia are regarded as benign and CCLs with atypia as true precursor lesions with clonal molecular changes, a certain progression risk, and an association with more advanced lesions. However, reproducibility of designating atypia in CCL is not optimal, and no objective markers of atypia have been identified, although 16q loss seems to be associated with atypical CCLs. Dimorphic ("pale") cell populations have been described in low nuclear grade ductal carcinoma in situ (DCIS) but not in CCLs and atypical ductal hyperplasia (ADH). Therefore, we searched for pale cells in CCL (N = 60), ADH (N = 41), and DCIS grade 1 (N = 84). Diagnostic criteria were derived from the WHO, and atypia was designated according to the Schnitt criteria. Pale cells occurred in 0% (0/30), 73% (22/30), 56% (23/41), and 76% (64/84) of CCLs without atypia, CCLs with atypia, ADH, and DCIS grade 1, respectively. Pale cells expressed ERα, E-cadherin and p120 and variably cyclin D1, and lacked expression of CK5 and p63. In conclusion, dimorphic "pale" cells occur throughout the low nuclear grade progression spectrum, increasing in frequency with progression. Interestingly, CCL lesions without atypia do not seem to bear showed pale cells, indicating that the presence of pale cells may serve as a diagnostic morphological feature of atypia in CCLs.
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Affiliation(s)
- Mirthe de Boer
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
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Strickland S, Turashvili G. Are Columnar Cell Lesions the Earliest Non-Obligate Precursor in the Low-Grade Breast Neoplasia Pathway? Curr Oncol 2022; 29:5664-5681. [PMID: 36005185 PMCID: PMC9406596 DOI: 10.3390/curroncol29080447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Columnar cell lesions (CCLs) of the breast comprise a spectrum of morphologic alterations of the terminal duct lobular unit involving variably dilated and enlarged acini lined by columnar epithelial cells. The World Health Organization currently classifies CCLs without atypia as columnar cell change (CCC) and columnar cell hyperplasia (CCH), whereas flat epithelial atypia (FEA) is a unifying term encompassing both CCC and CCH with cytologic atypia. CCLs have been increasingly recognized in stereotactic core needle biopsies (CNBs) performed for the assessment of calcifications. CCLs are believed to represent the earliest non-obligate precursor of low-grade invasive breast carcinomas as they share molecular alterations and often coexist with entities in the low-grade breast neoplasia pathway. Despite this association, however, the risk of progression of CCLs to invasive breast carcinoma appears low and may not exceed that of concurrent proliferative lesions. As the reported upgrade rates of pure CCL/FEA when identified as the most advanced high-risk lesion on CNB vary widely, the management of FEA diagnosed on CNB remains controversial. This review will include a historical overview of CCLs and will examine histologic diagnostic criteria, molecular alterations, prognosis and issues related to upgrade rates and clinical management.
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Affiliation(s)
- Sarah Strickland
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence:
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All pure flat atypical atypia lesions of the breast diagnosed using percutaneous vacuum-assisted breast biopsy do not need surgical excision. Breast 2018; 40:4-9. [DOI: 10.1016/j.breast.2018.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/18/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022] Open
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Dion L, Racin A, Brousse S, Beltjens F, Cauchois A, Levêque J, Coutant C, Lavoué V. Atypical epithelial hyperplasia of the breast: state of the art. Expert Rev Anticancer Ther 2016; 16:943-53. [PMID: 27367571 DOI: 10.1080/14737140.2016.1204916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atypical epithelial hyperplasia (AEH) of the breast is considered benign histological lesions with breast cancer risk. This review focuses on clinical signification and management of AEH that remains controversial. AREAS COVERED A review of published studies was performed using medline database. In this review, we fully describe the current evidence available. In particular, we describe 1) data from immunohistochemistry and molecular studies that suggest AEH is a precursor of breast cancer; 2) epidemiological studies demonstrate low rate of breast cancer in women with AEH; 3) surgical excision is necessary after diagnosis of AEH, such as lobular carcinoma in situ or atypical ductal hyperplasia, on core needle biopsy; 4) although current recommendations are evolving to fewer (if not no) excisions for flat epithelial with atypia and classic lobular neoplasia found on percutaneous biopsy (without radiologic indications for excision). Expert commentary: HEA management steel need prospective evidences, but recent retrospective data give some clue for less invasive management for some of HEA.
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Affiliation(s)
- Ludivine Dion
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Adelaïde Racin
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Susie Brousse
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France
| | - Françoise Beltjens
- b Department of Tumour Pathology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France.,c University of Burgundy-Franche Comté , Dijon , France.,d Department of Surgical Oncology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France
| | - Aurélie Cauchois
- e Department of Tumour Pathology , Rennes University Hospital, University of Rennes 1 , Rennes , France
| | - Jean Levêque
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France.,f Regional University Centre of Mastology, CRLCC Eugène Marquis , Rennes , Cedex , France.,g ER440, Oncogenesis, Stress and Signaling , INSERM , Rennes , France
| | - Charles Coutant
- b Department of Tumour Pathology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France.,c University of Burgundy-Franche Comté , Dijon , France.,d Department of Surgical Oncology , Georges-François Leclerc Cancer Centre - Unicancer , Dijon , France
| | - Vincent Lavoué
- a Department of Gynaecology , Rennes University Hospital , Rennes , Cedex 2 , France.,f Regional University Centre of Mastology, CRLCC Eugène Marquis , Rennes , Cedex , France.,g ER440, Oncogenesis, Stress and Signaling , INSERM , Rennes , France
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Shariff S. Changing Paradigms in Breast Carcinoma:A Review. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2015. [DOI: 10.46347/jmsh.2015.v01i02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chen Z, Dong H, Jia C, Song Q, Chen J, Zhang Y, Lai P, Fan X, Zhou X, Liu M, Lin J, Yang C, Li M, Gao T, Bai X. Activation of mTORC1 in collecting ducts causes hyperkalemia. J Am Soc Nephrol 2013; 25:534-45. [PMID: 24203997 DOI: 10.1681/asn.2013030225] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Mutation of TSC (encoding tuberous sclerosis complex protein) and activation of mammalian target of rapamycin (mTOR) have been implicated in the pathogenesis of several renal diseases, such as diabetic nephropathy and polycystic kidney disease. However, the role of mTOR in renal potassium excretion and hyperkalemia is not known. We showed that mice with collecting-duct (CD)-specific ablation of TSC1 (CDTsc1KO) had greater mTOR complex 1 (mTORC1) activation in the CD and demonstrated features of pseudohypoaldosteronism, including hyperkalemia, hyperaldosteronism, and metabolic acidosis. mTORC1 activation caused endoplasmic reticulum stress, columnar cell lesions, and dedifferentiation of CD cells with loss of aquaporin-2 and epithelial-mesenchymal transition-like phenotypes. Of note, mTORC1 activation also reduced the expression of serum- and glucocorticoid-inducible kinase 1, a crucial regulator of potassium homeostasis in the kidney, and decreased the expression and/or activity of epithelial sodium channel-α, renal outer medullary potassium channel, and Na(+), K(+)-ATPase in the CD, which probably contributed to the aldosterone resistance and hyperkalemia in these mice. Rapamycin restored these phenotypic changes. Overall, this study identifies a novel function of mTORC1 in regulating potassium homeostasis and demonstrates that loss of TSC1 and activation of mTORC1 results in dedifferentiation and dysfunction of the CD and causes hyperkalemia. The CDTsc1KO mice provide a novel model for hyperkalemia induced exclusively by dysfunction of the CD.
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Uzoaru I, Morgan BR, Liu ZG, Bellafiore FJ, Gaudier FS, Lo JV, Pakzad K. Flat epithelial atypia with and without atypical ductal hyperplasia: to re-excise or not. Results of a 5-year prospective study. Virchows Arch 2012; 461:419-23. [DOI: 10.1007/s00428-012-1312-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 08/27/2012] [Accepted: 08/31/2012] [Indexed: 11/25/2022]
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Peres A, Becette V, Guinebretiere JM, Cherel P, Barranger E. [The lesions of flat epithelial atypia diagnosed on breast biopsy]. ACTA ACUST UNITED AC 2011; 39:579-85. [PMID: 21924938 DOI: 10.1016/j.gyobfe.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 02/25/2011] [Indexed: 11/16/2022]
Abstract
Among pre-invasive breast diseases, the lesion of flat epithelial atypia has a level of risk that remains unclear. The clinical significance of these lesions and how to behave during their diagnostic biopsy (monitoring vs. surgery) are still uncertain, because few studies (including monitoring) are available and because of the polymorphic spectrum of lesions and their many denominations across the studies in the literature. This article aims to update our knowledge and provide elements for the management of these lesions diagnosed on breast biopsy.
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Affiliation(s)
- A Peres
- Service de chirurgie générale, hôpital René-Huguenin, institut Curie, 35 rue Dailly, Saint-Cloud, France
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Woolley AG, Algie M, Samuel W, Harfoot R, Wiles A, Hung NA, Tan PH, Hains P, Valova VA, Huschtscha L, Royds JA, Perez D, Yoon HS, Cohen SB, Robinson PJ, Bay BH, Lasham A, Braithwaite AW. Prognostic association of YB-1 expression in breast cancers: a matter of antibody. PLoS One 2011; 6:e20603. [PMID: 21695211 PMCID: PMC3112203 DOI: 10.1371/journal.pone.0020603] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 05/05/2011] [Indexed: 11/18/2022] Open
Abstract
The literature concerning the subcellular location of Y-box binding protein 1 (YB-1), its abundance in normal and cancer tissues, and its prognostic significance is replete with inconsistencies. An explanation for this could be due in part to the use of different antibodies in immunohistochemical and immunofluorescent labeling of cells and tissues. The inconsistencies could also be due to poor resolution of immunohistochemical data. We analyzed two cohorts of breast tumours for both abundance and subcellular location of YB-1 using three different antibodies; two targeting N-terminal epitopes (AB-a and AB-b) and another (AB-c) targeting a C-terminal epitope. We also investigated stress-induced nuclear translocation of YB-1 in cell culture. We report that both AB-a and AB-c detected increased YB-1 in the cytoplasm of high-grade breast cancers, and in those lacking estrogen and progesterone receptors; however the amount of YB-1 detected by AB-a in these cancers is significantly greater than that detected by AB-c. We confirm our previously published findings that AB-b is also detecting hnRNP A1, and cannot therefore be used to reliably detect YB-1 by immunohistochemistry. We also report that AB-a detected nuclear YB-1 in some tumour tissues and stress treated cells, whereas AB-c did not. To understand this, cancer cell lines were analyzed using native gel electrophoresis, which revealed that the antibodies detect different complexes in which YB-1 is a component. Our data suggest that different YB-1 antibodies show different staining patterns that are determined by the accessibility of epitopes, and this depends on the nature of the YB-1 complexes. It is important therefore to standardize the protocols if YB-1 is to be used reproducibly as a prognostic guide for different cancers.
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Affiliation(s)
- Adele G Woolley
- Department of Pathology, University of Otago, Dunedin, New Zealand.
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12
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Papillary apocrine metaplasia and columnar cell lesion with atypia: is there a shared common pathway? Ann Diagn Pathol 2010; 14:425-31. [DOI: 10.1016/j.anndiagpath.2010.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 06/28/2010] [Accepted: 06/29/2010] [Indexed: 11/19/2022]
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13
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Columnar cell lesions and subsequent breast cancer risk: a nested case-control study. Breast Cancer Res 2010; 12:R61. [PMID: 20691043 PMCID: PMC2949654 DOI: 10.1186/bcr2624] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/21/2010] [Accepted: 08/06/2010] [Indexed: 12/03/2022] Open
Abstract
Introduction Histologic and genetic evidence suggests that at least some columnar cell lesions (CCL) of the breast represent precursor lesions in the low-grade breast neoplasia pathway. However, the risk of subsequent breast cancer associated with the presence of CCL in a benign breast biopsy is poorly understood. Methods The authors examined the association between the presence of CCL and subsequent breast cancer risk in a nested case-control study of benign breast disease (BBD) and breast cancer within the Nurses' Health Studies (394 cases, 1,606 controls). Benign breast biopsy slides were reviewed by pathologists and CCL presence assessed. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the association between CCL and breast cancer risk. Results Women with CCL (140 cases, 448 controls) had an increased risk of breast cancer compared with those without CCL (OR = 1.44, 95% CI: 1.14 to 1.83), although this was attenuated and became non-significant after adjustment for the histologic category of BBD (OR = 1.20, 95% CI: 0.94 to 1.54). CCL presence was associated with the greatest risk of breast cancer for those with nonproliferative BBD (OR = 1.36, 95% CI: 0.79 to 2.37) and the lowest risk for those with atypical hyperplasia (AH) (OR = 1.10, 95% CI: 0.65 to 1.87); however, this apparent heterogeneity in risk across BBD categories was not significant (P for interaction between CCL presence and BBD category = 0.77). Conclusions These results provide evidence that CCL may be an important marker of breast cancer risk in women with BBD but suggest that CCL do not increase breast cancer risk independently of concurrent proliferative changes in the breast.
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Lee TYJ, Macintosh RF, Rayson D, Barnes PJ. Flat epithelial atypia on breast needle core biopsy: a retrospective study with clinical-pathological correlation. Breast J 2010; 16:377-83. [PMID: 20459431 DOI: 10.1111/j.1524-4741.2010.00934.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There are limited data to guide clinical management when flat epithelial atypia (FEA) is identified in breast needle core biopsies (NCBs). Our objectives were to determine the frequency of malignancy in subsequent breast excisions following NCB diagnosis of FEA, and to characterize the pathological and clinical features of associated tumors. Two hundred and fifty-six breast NCBs from a retrospective search (January 1999-July 2007) were blindly reviewed for FEA/other columnar cell lesions (CCLs). NCBs with co-existing carcinoma were excluded. The study included 211 NCBs: 116 (55%) with CCLs without atypia; 40 (19%) with CCLs with atypical ductal hyperplasia (ADH), 15 (7%) with FEA and 40 (19%) with FEA and ADH; 94 cases had follow-up excisions. Ductal carcinoma in situ and/or invasive carcinoma were present in: 4/26 (15%) excisions with CCLs on NCB, 11/30 (37%) with CCLs + ADH, 1/7 (14%) with FEA alone, and 9/31 (29%) with FEA + ADH. (a) FEA was more frequently seen with ADH, than without ADH in NCBs, (b) FEA and CCLs were more frequently associated with malignancy when with ADH, and (c) tumors excised following NCB diagnosis of FEA+/-ADH had favorable prognostic factors. A conservative excision is warranted following a NCB diagnosis of FEA and ADH, and may be warranted for FEA alone.
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Affiliation(s)
- Tsu-Yee Joseph Lee
- Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Moinfar F. Flat ductal intraepithelial neoplasia of the breast: evolution of Azzopardi's “clinging” concept. Semin Diagn Pathol 2010; 27:37-48. [DOI: 10.1053/j.semdp.2009.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lavoué V, Bertel C, Tas P, Bendavid C, Rouquette S, Foucher F, Audrain O, Bouriel C, Levêque J. Hyperplasie épithéliale atypique du sein : bilan des connaissances et pratique clinique. ACTA ACUST UNITED AC 2010; 39:11-24. [DOI: 10.1016/j.jgyn.2009.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 08/22/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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Moinfar F. Flat Ductal Intraepithelial Neoplasia of the Breast: A Review of Diagnostic Criteria, Differential Diagnoses, Molecular-Genetic Findings, and Clinical Relevance—It Is Time to Appreciate the Azzopardi Concept! Arch Pathol Lab Med 2009; 133:879-92. [DOI: 10.5858/133.6.879] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—More than 25 years ago, John G. Azzopardi described a distinctive intraepithelial neoplastic breast lesion, which he designated “clinging carcinoma in situ”; he considered it as another variant of ductal carcinoma in situ, an early lesion that can easily be missed because the changes are mainly cytologic rather than architectural. The lesion remained widely unrecognized and/or ignored until recent years when its neoplastic nature was confirmed at the molecular-genetic level.
Objective.—To deal with historical aspects of the evolving concept of “clinging” and to focus on several important issues such as characteristic morphologic features with particular attention to the diagnostic criteria and differential diagnoses, recent molecular-genetic findings, appropriate terminology and classification, as well as the significance of this type of lesion for both surgical pathologists and clinicians.
Data Sources.—A thorough search of the literature was performed and publications using a variety of designations including “clinging carcinoma in situ,” “flat epithelial atypia,” “ductal intraepithelial neoplasia-flat type,” “atypical cystic lobules,” “columnar cell change with atypia,” “columnar cell hyperplasia with or without atypia,” “columnar alteration with prominent apical snouts and secretion,” and so forth were reviewed.
Conclusions.—This distinctive lesion represents one of the earliest morphologically recognizable neoplastic alterations of the breast that is commonly associated with mammographically suspicious microcalcifications. It is characterized by mildly to severely atypical cells simply replacing the single layer of native epithelial cells in a flat fashion without appreciable proliferation; tufting, intraluminal bridging, micropapillary structures, and so forth are typically absent or very focal and minimal, if present at all. Based on the degree of cytologic atypia, low- and high-grade flat ductal intraepithelial neoplasia need to be separated. Although additional studies are needed to better understand the clinical significance of flat ductal intraepithelial neoplasia, several lines of evidence strongly support the concept of clinging. Indeed, as pointed out by Azzopardi, surgical pathologists need to pay more attention to the cytologic alterations of the breast lesions by analyzing the involved cell populations using high-power magnification.
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Affiliation(s)
- Farid Moinfar
- From the Unit of Breast and Gynecologic Pathology, Department of Pathology, Medical University of Graz, Graz, Austria
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Jara-Lazaro AR, Tse GMK, Tan PH. Columnar cell lesions of the breast: an update and significance on core biopsy. Pathology 2009; 41:18-27. [PMID: 19089736 DOI: 10.1080/00313020802563486] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Columnar cell lesions of the breast refer to the morphological spectrum of alterations of the epithelial lining of variably dilated acini of the terminal duct lobular unit (TDLU), often related to secretions and calcifications. After decades of varied terminologies, the term of 'flat epithelial atypia' by the World Health Organization (WHO) consensus group encompasses the part of the spectrum where columnar cell change or columnar cell hyperplasia acquires low grade cytological atypia, merging with atypical ductal hyperplasia and low grade ductal carcinoma in situ. Its association with low grade invasive carcinoma and lobular neoplasia, whether by proximity to these lesions, or by similar molecular expressions, has prompted greater scrutiny into its clinical significance. Although recent literature attempts to refine the term 'flat epithelial atypia', the applicability of its morphological criteria in routine diagnostic practice remains to be seen, and interobserver variability is highly possible. This poses even greater challenges especially in limited samples of breast tissue, such as in core biopsies, for pre-operative decision-making. The purpose of this review is to elucidate evolving clinical and diagnostically relevant principles that surround and influence the significance of this still controversial entity, especially when discovered on core biopsy in the initial phase of breast diagnosis and management.
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Abstract
Fatty acid synthase (FASN) expression has been reported in many different tumors, including breast cancer. In gene microarray studies, the fatty acid synthase gene co-clustered with cytokeratins 5 and 17 and other genes that defined the basal-like subset of breast cancers. To define the use of this marker in breast pathology, a rabbit polyclonal antiserum (S143) to a peptide fragment of this gene was produced and compared with a commercially available monoclonal antibody by immunohistochemistry on various tissue microarrays and whole tissue sections. The tissue microarrays included 1090 breast cancers and 244 normal breast tissues. Whole tissue sections consisted of benign and malignant tissues from breast resection specimens. In contrast to other 'basal' markers identified by gene expression profiling data, the fatty acid synthase (FASN) expression pattern in normal breast was notable for its expression in only a small subset of basal and suprabasal cells. Dual staining experiments revealed that the subpopulation of cells labeling with FASN did not coexpress myoepithelial markers CK5/6 or p63, but did coexpress e-cadherin. In addition to staining a subset of basal and suprabasal cells, the antiserum highlighted apocrine differentiation, and stained 106/144 (74%) cases of columnar cell lesions and five of five cases of flat epithelial atypia. Despite its association with basal keratins in gene array studies, FASN expression did not correlate significantly with the outcome in breast cancer. We describe an expression pattern that highlights only a subset of basal and suprabasal cells in normal breast ducts and we show by dual expression studies that this subset of cells is different from myoepithelial and basal cytokeratin-positive cells. In addition, FASN expression is described in apocrine metaplasia, columnar cell lesions, and flat epithelial atypia.
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Wood CE, Hester JM, Appt SE, Geisinger KR, Cline JM. Estrogen effects on epithelial proliferation and benign proliferative lesions in the postmenopausal primate mammary gland. J Transl Med 2008; 88:938-48. [PMID: 18607345 PMCID: PMC2691895 DOI: 10.1038/labinvest.2008.64] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Proliferative lesions of the mammary gland are risk markers and potential precursors for the development of breast cancer in postmenopausal women. In this study we evaluated mammary epithelial proliferation and proliferative lesions in a group of 63 aged postmenopausal macaques randomized by social group to receive one of three experimental diets for 8 months: (1) control; (2) control with 17beta-estradiol (E2) at the human equivalent dose of 1.0 mg per day; and (3) control with the soy phytoestrogen equol (EQ) at the human equivalent dose of 105 mg per day. In normal mammary epithelium, treatment with E2 but not EQ resulted in greater proliferation, epithelial area, and progesterone receptor expression (P<0.05 for all). Mammary lesions included columnar cell change (26/63), columnar cell hyperplasia with and without atypia (13/63), atypical ductal hyperplasia (6/63), and atypical lobular hyperplasia (3/63). Lesions were most common within terminal ductal lobular units. The prevalence of columnar cell hyperplasia (total and atypical cases) was higher in animals treated with E2 compared to control (P<0.05 for both). Compared to normal mammary epithelium, columnar cell lesions (CCLs) showed greater constitutive expression of estrogen receptor-alpha across all groups (P<0.001) and greater expression of progesterone receptor in response to E2 (P<0.01). Independent of treatment, animals with CCLs on histology had greater gene expression of estrogen receptor-alpha and markers of estrogen receptor activity (trefoil factor 1) and proliferation (gene for Ki67 antigen) at a site contralateral to the CCL (P<0.05 for all). These findings demonstrate that the terminal ductal lobular units of the postmenopausal mammary gland contain morphologically distinct cell populations that may hyperrespond to E2 exposure, resulting in specific types of hyperplastic lesions.
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Affiliation(s)
- Charles E Wood
- Department of Pathology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1040, USA.
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Turashvili G, Hayes M, Gilks B, Watson P, Aparicio S. Are columnar cell lesions the earliest histologically detectable non-obligate precursor of breast cancer? Virchows Arch 2008; 452:589-98. [DOI: 10.1007/s00428-008-0609-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/11/2008] [Accepted: 03/13/2008] [Indexed: 10/22/2022]
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Response and Resistance to the Endocrine Prevention of Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2008; 617:201-11. [DOI: 10.1007/978-0-387-69080-3_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Polat A. c-KIT expression in columnar cell lesions of the breast accompanied by benign and malignant breast diseases. Pathol Res Pract 2007; 203:765-9. [DOI: 10.1016/j.prp.2007.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 08/02/2007] [Indexed: 11/25/2022]
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