Columnar cell lesions of the breast - significant or not?

Columnar cell lesions (CCL) of the breast range from the innocuous CAPSS (Columnar alteration with prominent apical snouts and secretions) to DCIS. Their precancerous potential poses diagnostic and therapeutic riddles, especially for those with mammographic microcalcifications.

To document the incidence of columnar cell lesions in the breast, to study their morphologic spectrum and to study the significance of their association with benign and malignant breast lesions.

We studies 100 consecutive breast specimens. These specimens included biopsies, lumpectomies and mastectomies. Columnar cell lesions were classified as per Schnitt criteria. Associated lesions in the adjacent tissue were also studied.

Of the 100 samples (43 malignant and 57 benign), 37 cases showed CCL: CAPSS 23, columnar cell hyperplasia-11 and Columnar cell hyperplasia with atypia-3. The commonest associated lesion was fibrocystic change (n=54). Their incidence in benign and malignant lesions was 42% and 30% respectively, with no statistical significance in the difference. Lesions with atypia were seen only in malignant cases.

Columnar cell lesions are common, and often overlooked. These lesions are seen in association with both benign and malignant breast lesions. It is only the presence of atypia in CCL that warrants a special mention and necessitates follow up, and resection if indicated.