What are the other Names for this Condition? (Also known as/Synonyms)

• Columnar Alteration with Atypia of Breast
• Flat Epithelial Atypia of Breast
• Mammary Columnar Cell Lesions with Flat Epithelial Atypia

What is Columnar Cell Lesions of Breast with Flat Epithelial Atypia? (Definition/Background Information)

• Columnar Cell Lesions of Breast with Flat Epithelial Atypia is a recently introduced terminology in the WHO classification of breast tumors. A diagnosis of the condition is made when breast lesions do not have the classical features of atypical ductal hyperplasia or low-grade ductal carcinoma in situ of breast
• The condition is considered to be an atypical ductal proliferative lesion which shows an increased risk for breast cancers (in future). An “uncertain malignant potential” is associated with Columnar Cell Lesions of Breast with Flat Epithelial Atypia, and it may be a precursor lesion to breast cancer
• There are no specific predisposing factors known for Columnar Cell Lesions of Breast with Flat Epithelial Atypia. The cause of this abnormality may be due to genetic factors
• There are no significant signs and symptoms of Columnar Cell Lesions of Breast with Flat Epithelial Atypia noted. However, there is a slight increase in overall risk for breast cancer; and occasionally, some may present with ductal carcinoma in situ (DCIS) or tubular carcinoma of breast
• Columnar Cell Lesions of Breast with Flat Epithelial Atypia is diagnosed on a breast biopsy by a pathologist when examined under the microscope
• If this condition is greater than 1 cm in size than complete excision of the lesion is usually recommended. However, such a recommendation is presently a topic of debate among the medical experts. The prognosis on its surgical removal is generally excellent

Who gets Columnar Cell Lesions of Breast with Flat Epithelial Atypia? (Age and Sex Distribution)

• Columnar Cell Lesions of Breast with Flat Epithelial Atypia are fairly common conditions observed in women; rarely, it may be observed in men
• It is reported that between 4% to 10% of core biopsies of the breast may present the condition
• The condition can affect individuals of all races and ethnic backgrounds

What are the Risk Factors for Columnar Cell Lesions of Breast with Flat Epithelial Atypia? (Predisposing Factors)

• No specific risk factors have been identified for Columnar Cell Lesions of Breast with Flat Epithelial Atypia

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Columnar Cell Lesions of Breast with Flat Epithelial Atypia? (Etiology)

• The exact cause of development of Columnar Cell Lesions of Breast with Flat Epithelial Atypia is presently unknown
• Some researchers believe that it may be caused by genetic mutations such as involving the P13KCA gene (phosphatidylinositol 3 kinase catalytic subunit alpha gene)

What are the Signs and Symptoms of Columnar Cell Lesions of Breast with Flat Epithelial Atypia?

Most cases of Columnar Cell Lesions of Breast with Flat Epithelial Atypia may not exhibit any signs and symptoms.

• One or both breasts may be affected
• In some cases, the presence of a lump or lesion may be observed
• The condition is generally painless

The condition is associated with tubular carcinoma of breast in some individuals. It is often present along with lobular hyperplasia of breast.

How is Columnar Cell Lesions of Breast with Flat Epithelial Atypia Diagnosed?

Columnar Cell Lesions of Breast with Flat Epithelial Atypia may be diagnosed in the following manner:

• Complete physical examination with comprehensive medical and family history evaluation
• Breast exam to check for any lumps or unusual signs in the breasts
• Mammogram: A mammogram uses X-rays to provide images of the breast. The condition may cause abnormal features on mammograms and can be associated with calcifications
• Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast: Radiologically, the condition is classified as B3 which means “uncertain malignant potential”
• Breast biopsy: Such abnormalities are often biopsied either through core biopsies of breast or breast lumpectomies
  • A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis

Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:

• Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue
• Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
• Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis

Studies have shown that removing any residual microcalcification through lumpectomy shows a presence of atypical ductal hyperplasia/atypical lobular hyperplasia in about 20% of the patients.

The differential diagnosis to exclude conditions with similar presentations include:

• Atypical ductal hyperplasia of breast
• Columnar cell change of breast without atypia
• Ductal carcinoma in situ of breast, clinging type

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Columnar Cell Lesions of Breast with Flat Epithelial Atypia?

There may not be any significant complications of Columnar Cell Lesions of Breast with Flat Epithelial Atypia.

• The condition is associated with an increased risk for subsequent breast cancer - ductal carcinoma in situ or lobular carcinoma of breast. In about 5% of the patients, there is ductal carcinoma in situ detected
• The risk may be slightly higher for individuals who have a positive family history of breast cancer

How is Columnar Cell Lesions of Breast with Flat Epithelial Atypia Treated?

• The treatment for Columnar Cell Lesions of Breast with Flat Epithelial Atypia may involve surgery
  • The tumor may be removed during the diagnostic breast biopsy
  • Or it may be surgically removed via lumpectomy procedure
• Follow-up care with regular breast self-examinations and screening mammograms may be recommended by the healthcare provider

How can Columnar Cell Lesions of Breast with Flat Epithelial Atypia be Prevented?

Currently, no specific preventive measures are available to prevent Columnar Cell Lesions of Breast with Flat Epithelial Atypia. In general, it is important to be aware of the following:

• Regularly conduct breast self-exams to ensure that no lumps are present
• Maintain a healthy body weight and exercise regularly
• Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
• Avoid or completely stop smoking
• If taking alcohol, only drink in moderation; limit to one or (maximum) two drinks a day
• Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of such hormonal medications

What is the Prognosis of Columnar Cell Lesions of Breast with Flat Epithelial Atypia? (Outcomes/Resolutions)

The prognosis of Columnar Cell Lesions of Breast with Flat Epithelial Atypia is generally excellent on its surgical removal.

• Columnar Cell Lesions of Breast with Flat Epithelial Atypia when diagnosed on core biopsies of breast are often removed through follow-up lumpectomies
• In such lumpectomies, in about 5-15% of the cases, atypical ductal hyperplasia, atypical lobular hyperplasia, ductal carcinoma in-situ, or invasive carcinoma is detected

Additional and Relevant Useful Information for Columnar Cell Lesions of Breast with Flat Epithelial Atypia:

Following are the terminologies that have been previously used to refer to the lesions. The World Health Classification (WHO) does not recommend using such terminology, since it causes significant confusion in treating the condition.

• Low grade clinging carcinoma (monomorphous type)
• Atypical cystic lobules
• Atypical lobules type A
• Flat ductal intraepithelial neoplasia grade 1A (DIN1A)
• Atypical columnar alternation with prominent apical spouts and secretions

The following DoveMed website links are useful resources for additional information:

https://www.dovemed.com/healthy-living/womens-health/

https://www.dovemed.com/diseases-conditions/cancer/