Some types of columnar cell changes may indicate early forms of breast cancer.
The widespread use of mammography and improved breast biopsy techniques have significantly increased the detection of breast changes that may or may not be associated with the development of breast cancer. One anomaly being encountered with increasing frequency is columnar cellular change of the breast. This is a milk duct abnormality in which specific types of breast cells, namely columnar cells, may exhibit overgrowth and/or intracellular changes that deviate from what is considered normal.
Breast Anatomy
The female breast is a complex structure consisting primarily of connective tissue and fat. It also contains lymph nodes, blood vessels, milk ducts, lobes and lobules. The breast contains 15 to 18 lobes. Each lobe contains 20 to 40 basic functional units, called terminal duct lobular units, or TDLUs. Each lobular unit contains 10 to 100 small sacs, called acini, that make and hold breast milk. A network of thin tubes, called ducts, connect the lobules. Ducts also carry milk from the lobules to the nipple. Ducts within the TDLU are lined with rectangular epithelial cells, called columnar cells.
Significance
Changes in terminal duct lobular units are important because they are the sites where most breast cancers arise. Noninvasive, or in situ, breast cancer refers to those that have not spread beyond their site of origin. Invasive breast cancers spread and invade surrounding tissues. Some columnar cell changes are of concern because they may indicate early forms of low-grade ductal carcinoma in situ and invasive breast cancer. According to Christopher Montague, M.D., data suggest that the risk of columnar cell changes progressing to invasive breast cancer is low.
Types
Pathologists define columnar cell changes as a group of ducts that end abruptly without forming lobules. The duct openings are dilated to form small sacs. They categorize columnar cell changes according to the number of cell layers lining the ducts and the microscopic appearance of those cells. Columnar cell change without atypia describes lesions with one or two layers of normal-appearing columnar cells. When there are more than two layers of normal columnar cells, indicating cell overgrowth, the lesion is described as columnar cell hyperplasia. Columnar cell change with atypia and columnar cell hyperplasia with atypia refer to lesions that contain abnormal cells.
Clinical Management
While mammography is helpful in detecting breast abnormalities, it cannot differentiate between cancerous and non-cancerous cells. Consequently, a biopsy is performed to remove a sample of tissue for further examination. When small samples are sufficient, physicians perform a needle biopsy. Sometimes, they remove the entire lesion surgically, a procedure called surgical excision. When needle biopsy shows columnar cell change or columnar cell hyperplasia without evidence of atypia, additional pathology work-up or surgical excision is typically not warranted. An excisional biopsy is recommended for lesions containing atypical cells.
Tags: columnar cell, breast cancer, cell changes, columnar cells, cell change
