The diagnosis and management of pre-invasive breast disease: flat epithelial atypia--classification, pathologic features and clinical significance - PubMed (original) (raw)

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The diagnosis and management of pre-invasive breast disease: flat epithelial atypia--classification, pathologic features and clinical significance

Stuart J Schnitt. Breast Cancer Res. 2003.

Abstract

Flat epithelial atypia is a descriptive term that encompasses lesions of the breast terminal duct lobular units in which variably dilated acini are lined by one to several layers of epithelial cells, which are usually columnar in shape and which display low-grade cytologic atypia. Observational studies have suggested that at least some of these lesions may represent either a precursor of ductal carcinoma in situ (DCIS) or the earliest morphological manifestation of DCIS. In contrast, the limited available clinical follow-up data suggest that the risk of both local recurrence and progression of these lesions to invasive cancer is extremely low, supporting the notion that categorizing such lesions as 'clinging carcinoma' and managing them as if they were fully developed DCIS will result in overtreatment of many patients. Additional studies are needed to better understand the biological nature and clinical significance of these lesions.

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Figures

Figure 1

Figure 1

Flat epithelial atypia: columnar cell change with atypia. (a) This terminal duct lobular unit shows variably dilated acini, many of which contain intraluminal secretions and calcifications. Most acini are lined by only one or two layers of columnar epithelial cells, many of which show prominent apical cytoplasmic snouts (hematoxylin & eosin, original magnification 10×). (b) The columnar epithelial cells lining the acini show cytologic atypia, characterized by enlarged, monotonous nuclei; the nuclear/cytoplasmic ratio is increased. Nucleoli are evident in some of the nuclei (hematoxylin & eosin, original magnification 40×).

Figure 2

Figure 2

Flat epithelial atypia: columnar cell hyperplasia with atypia. The acini in this terminal duct lobular unit are lined by a few layers of columnar epithelial cells that show low-grade cytologic atypia, characterized by relatively round, monotonous nuclei (hematoxylin & eosin, original magnification 20×).

References

    1. Tavassoli FA, Hoefler H, Rosai J, Holland R, Ellis I, Schnitt S, Lakhani SRM, Boecker W, Heywang-Kobrunner SH, Moinfar F, Peterse J. Intraductal proliferative lesions. In: Tavassoli FA, Devilee P, editor. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon: IARC Press;
    1. Tsuchiya S. Atypical ductal hyperplasia, atypical lobular hyperplasia, and interpretation of a new borderline lesion. Jpn J Cancer Clin. 1998;44:548–555.
    1. Oyama T, Iijima K, Takei H, Horiguchi J, Iino Y, Nakajima T, Koerner F. Atypical cystic lobule of the breast: an early stage of low-grade ductal carcinoma in-situ. Breast Cancer. 2000;7:326–331. - PubMed
    1. Wellings SR, Jensen HM, Marcum RG. An atlas of subgross pathology of the human breast with special reference to possible precancerous lesions. J Natl Cancer Inst. 1975;55:231–273. - PubMed
    1. Azzopardi JG. Problems in Breast Pathology. Philadelphia, PA: WB Saunders. 1979. - PubMed

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