Image of the Quarter (2014-3)
Flat epithelial atypia
50 year old woman - small screen-detected calcs - core biopsy.
This (top) image shows columnar cell change with mild /minimal cytological atypia. The 'Mouse-over' image shows some hyperplasia (lower left with architectural complexity).
The upper right hand duct has a flat proliferation of columnar cells. The majority of cells in this image show more rounded, enlarged nuclei with some variation of nuclear
size (pleomorphism) and prominence of nucleoli. Note the luninal calcs.
These closer views further illustrate the changes described above. 'Mouse-over' for closer view. All the cells retain their basic columnar cell phenotype and when seen in the context of a
flat lesion it is designated flat epithelial atypia. Necrotic debris is present in the two lower ducts in the top image - a feature which should give rise to concern in itself.
- This is a difficult diagnostic area. Columnar cell change can be part of a spectrum from the utterly benign through to atypical proliferations and DCIS.
- It is simpler to analyse columnar cell lesions from two points of view - architecture & cytology
- Architecture may be flat or hyperplastic - either in the absence of cytological atypia is benign
- Architectural abnormalities may include the presence of 'rigid' bars/arches indicative of an ADH-like process
- Cytology may be normal, atypical in varying degrees, or malignant
- Cytological normality or abnormality may accompany either architectural pattern
- Cytological atypia or ADH-like architectural atypia in a core biopsy should trigger further investigation - usually a diagnostic biopsy (large volume core or excision)
See also... Columnar Cell Change on this site.
See also... Columnar cell hyperplasia and atypia (1) & Columnar cell hyperplasia and atypia (2) on this site.
Return to top of this page
Image of the week index
Return to Home Page