Columnar cell change without atypia breast lesions are characterized by enlarged terminal ductal lobular units lined by columnar epithelial cells which substitute the normal cuboid epithelial layer.
They are also associated with prominent apical cytoplasmic snouts and intraluminal secretions. The average age of presentation is between 35 and 50 years old 1.
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Terminology
- lesions without atypia are called columnar cell change
- columnar cell hyperplasia is the term used to describe lesions with the same cytologic findings as columnar cell change plus cell stratification (more than two cell layers) and cellular crowding
- lesions with atypia are called flat epithelial atypia 2
Clinical presentation
Columnar cell change without atypia is mostly asymptomatic. Usually detected on 37-42% of biopsies secondary to screen-detected calcifications.
Radiographic features
Mammography
Punctate, round or coarse heterogeneous calcifications in regional or grouped distribution. Less likely pleomorphic calcifications, mass or asymmetry 1.
Ultrasound
Columnar cell change without atypia is usually non-detectable on ultrasound.
Treatment and prognosis
Although this entity does not require treatment, as for other proliferative lesions it increases by 1.5x the relative risk of subsequent breast cancer.