DOI: 10.1148/rg.27si075515
Columnar Cell Lesions of the Breast: Mammographic Findings with Histopathologic Correlation1
Shilpa Pandey, MD,
Michael J. Kornstein, MD,
Whitney Shank, and
Ellen Shaw de Paredes, MD
1 From the School of Medicine, Virginia Commonwealth University, Richmond, Va (S.P.); Commonwealth Laboratory Consultants, Henrico Doctors’ Hospital-Forest Campus, Richmond, Va (M.J.K.); and Ellen Shaw de Paredes Institute for Women’s Imaging, 4480 Cox Rd, Suite 100, Glen Allen, VA 23060 (W.S., E.S.d.P.). Recipient of a Certificate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received April 2, 2007; revision requested April 24 and received May 28; accepted June 5. Supported in part by a grant from the Ellen Shaw de Paredes Research Foundation.
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Figure 1a. CCC. (a, b) Left craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are clustered amorphous microcalcifications at the 12-o’clock position (circled) that are suggestive of malignancy. Biopsy was performed. (c) Specimen radiograph of the core biopsy samples shows numerous fine microcalcifications (arrows) in the tissue. (d) High-power photomicrograph (hematoxylin-eosin [H-E] stain) demonstrates one to two layers of columnar cells with uniform nuclei, absent nucleoli, and apical snouts (arrow). (e) Photomicrograph (H-E stain) demonstrates prominent apical snouts (arrow) and intraluminal calcifications.
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Figure 1b. CCC. (a, b) Left craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are clustered amorphous microcalcifications at the 12-o’clock position (circled) that are suggestive of malignancy. Biopsy was performed. (c) Specimen radiograph of the core biopsy samples shows numerous fine microcalcifications (arrows) in the tissue. (d) High-power photomicrograph (hematoxylin-eosin [H-E] stain) demonstrates one to two layers of columnar cells with uniform nuclei, absent nucleoli, and apical snouts (arrow). (e) Photomicrograph (H-E stain) demonstrates prominent apical snouts (arrow) and intraluminal calcifications.
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Figure 1c. CCC. (a, b) Left craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are clustered amorphous microcalcifications at the 12-o’clock position (circled) that are suggestive of malignancy. Biopsy was performed. (c) Specimen radiograph of the core biopsy samples shows numerous fine microcalcifications (arrows) in the tissue. (d) High-power photomicrograph (hematoxylin-eosin [H-E] stain) demonstrates one to two layers of columnar cells with uniform nuclei, absent nucleoli, and apical snouts (arrow). (e) Photomicrograph (H-E stain) demonstrates prominent apical snouts (arrow) and intraluminal calcifications.
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Figure 1d. CCC. (a, b) Left craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are clustered amorphous microcalcifications at the 12-o’clock position (circled) that are suggestive of malignancy. Biopsy was performed. (c) Specimen radiograph of the core biopsy samples shows numerous fine microcalcifications (arrows) in the tissue. (d) High-power photomicrograph (hematoxylin-eosin [H-E] stain) demonstrates one to two layers of columnar cells with uniform nuclei, absent nucleoli, and apical snouts (arrow). (e) Photomicrograph (H-E stain) demonstrates prominent apical snouts (arrow) and intraluminal calcifications.
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Figure 1e. CCC. (a, b) Left craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are clustered amorphous microcalcifications at the 12-o’clock position (circled) that are suggestive of malignancy. Biopsy was performed. (c) Specimen radiograph of the core biopsy samples shows numerous fine microcalcifications (arrows) in the tissue. (d) High-power photomicrograph (hematoxylin-eosin [H-E] stain) demonstrates one to two layers of columnar cells with uniform nuclei, absent nucleoli, and apical snouts (arrow). (e) Photomicrograph (H-E stain) demonstrates prominent apical snouts (arrow) and intraluminal calcifications.
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Figure 2a. CCC. (a, b) Left mediolateral oblique (a) and magnified craniocaudal (b) mammograms show clustered fine pleomorphic microcalcifications at the 9-o’clock position (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates normal TDLUs (black arrow) and expanded TDLUs (white arrow), the latter representing an area of CCC. (d) High-power photomicrograph (H-E stain) demonstrates a single layer of epithelial cells with apical snouts (arrow) and flocculent secretions.
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Figure 2b. CCC. (a, b) Left mediolateral oblique (a) and magnified craniocaudal (b) mammograms show clustered fine pleomorphic microcalcifications at the 9-o’clock position (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates normal TDLUs (black arrow) and expanded TDLUs (white arrow), the latter representing an area of CCC. (d) High-power photomicrograph (H-E stain) demonstrates a single layer of epithelial cells with apical snouts (arrow) and flocculent secretions.
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Figure 2c. CCC. (a, b) Left mediolateral oblique (a) and magnified craniocaudal (b) mammograms show clustered fine pleomorphic microcalcifications at the 9-o’clock position (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates normal TDLUs (black arrow) and expanded TDLUs (white arrow), the latter representing an area of CCC. (d) High-power photomicrograph (H-E stain) demonstrates a single layer of epithelial cells with apical snouts (arrow) and flocculent secretions.
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Figure 2d. CCC. (a, b) Left mediolateral oblique (a) and magnified craniocaudal (b) mammograms show clustered fine pleomorphic microcalcifications at the 9-o’clock position (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates normal TDLUs (black arrow) and expanded TDLUs (white arrow), the latter representing an area of CCC. (d) High-power photomicrograph (H-E stain) demonstrates a single layer of epithelial cells with apical snouts (arrow) and flocculent secretions.
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Figure 3a. CCC. (a, b) Standard (a) and magnified (b) right craniocaudal mammograms show heterogeneously dense tissue with architectural distortion (arrow in a) surrounding amorphous microcalcifications at the 9-o’clock position (circled in b). (c) Intermediate-power photomicrograph (H-E stain) shows dilated ducts and uniform nuclei oriented perpendicular to the basement membrane. (d) High-power photomicrograph (H-E stain) shows dilated ducts with an irregular contour lined by a single layer of epithelial cells (white arrow) with apical snouts (black arrows).
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Figure 3b. CCC. (a, b) Standard (a) and magnified (b) right craniocaudal mammograms show heterogeneously dense tissue with architectural distortion (arrow in a) surrounding amorphous microcalcifications at the 9-o’clock position (circled in b). (c) Intermediate-power photomicrograph (H-E stain) shows dilated ducts and uniform nuclei oriented perpendicular to the basement membrane. (d) High-power photomicrograph (H-E stain) shows dilated ducts with an irregular contour lined by a single layer of epithelial cells (white arrow) with apical snouts (black arrows).
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Figure 3c. CCC. (a, b) Standard (a) and magnified (b) right craniocaudal mammograms show heterogeneously dense tissue with architectural distortion (arrow in a) surrounding amorphous microcalcifications at the 9-o’clock position (circled in b). (c) Intermediate-power photomicrograph (H-E stain) shows dilated ducts and uniform nuclei oriented perpendicular to the basement membrane. (d) High-power photomicrograph (H-E stain) shows dilated ducts with an irregular contour lined by a single layer of epithelial cells (white arrow) with apical snouts (black arrows).
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Figure 3d. CCC. (a, b) Standard (a) and magnified (b) right craniocaudal mammograms show heterogeneously dense tissue with architectural distortion (arrow in a) surrounding amorphous microcalcifications at the 9-o’clock position (circled in b). (c) Intermediate-power photomicrograph (H-E stain) shows dilated ducts and uniform nuclei oriented perpendicular to the basement membrane. (d) High-power photomicrograph (H-E stain) shows dilated ducts with an irregular contour lined by a single layer of epithelial cells (white arrow) with apical snouts (black arrows).
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Figure 4a. CCH. (a, b) Left mediolateral (a) and magnified craniocaudal (b) mammograms show dense parenchyma. There are clustered fine pleomorphic microcalcifications located centrally (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates enlarged TDLUs containing calcifications. (d, e) High-power photomicrographs (H-E stain) demonstrate psammomatous calcifications (arrow in d) and ossifying calcifications (arrow in e). (f) High-power photomicrograph (H-E stain) demonstrates columnar cell stratification (arrow) with calcifications.
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Figure 4b. CCH. (a, b) Left mediolateral (a) and magnified craniocaudal (b) mammograms show dense parenchyma. There are clustered fine pleomorphic microcalcifications located centrally (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates enlarged TDLUs containing calcifications. (d, e) High-power photomicrographs (H-E stain) demonstrate psammomatous calcifications (arrow in d) and ossifying calcifications (arrow in e). (f) High-power photomicrograph (H-E stain) demonstrates columnar cell stratification (arrow) with calcifications.
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Figure 4c. CCH. (a, b) Left mediolateral (a) and magnified craniocaudal (b) mammograms show dense parenchyma. There are clustered fine pleomorphic microcalcifications located centrally (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates enlarged TDLUs containing calcifications. (d, e) High-power photomicrographs (H-E stain) demonstrate psammomatous calcifications (arrow in d) and ossifying calcifications (arrow in e). (f) High-power photomicrograph (H-E stain) demonstrates columnar cell stratification (arrow) with calcifications.
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Figure 4d. CCH. (a, b) Left mediolateral (a) and magnified craniocaudal (b) mammograms show dense parenchyma. There are clustered fine pleomorphic microcalcifications located centrally (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates enlarged TDLUs containing calcifications. (d, e) High-power photomicrographs (H-E stain) demonstrate psammomatous calcifications (arrow in d) and ossifying calcifications (arrow in e). (f) High-power photomicrograph (H-E stain) demonstrates columnar cell stratification (arrow) with calcifications.
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Figure 4e. CCH. (a, b) Left mediolateral (a) and magnified craniocaudal (b) mammograms show dense parenchyma. There are clustered fine pleomorphic microcalcifications located centrally (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates enlarged TDLUs containing calcifications. (d, e) High-power photomicrographs (H-E stain) demonstrate psammomatous calcifications (arrow in d) and ossifying calcifications (arrow in e). (f) High-power photomicrograph (H-E stain) demonstrates columnar cell stratification (arrow) with calcifications.
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Figure 4f. CCH. (a, b) Left mediolateral (a) and magnified craniocaudal (b) mammograms show dense parenchyma. There are clustered fine pleomorphic microcalcifications located centrally (arrow) that are suggestive of malignancy. (c) Low-power photomicrograph (H-E stain) demonstrates enlarged TDLUs containing calcifications. (d, e) High-power photomicrographs (H-E stain) demonstrate psammomatous calcifications (arrow in d) and ossifying calcifications (arrow in e). (f) High-power photomicrograph (H-E stain) demonstrates columnar cell stratification (arrow) with calcifications.
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Figure 5a. CCH. (a, b) Magnified right craniocaudal mammogram (a) and specimen radiograph (b) show scattered fibroglandular breast tissue with amorphous microcalcifications at the 10-o’clock position (arrow in a). (c) Low-power photomicrograph (H-E stain) demonstrates dilated TDLUs with variably dilated acini and fibrosis. (d) High-power photomicrograph (H-E stain) demonstrates thickened columnar epithelium with crowded columnar cells (arrow) having slender nuclei, most of which are oriented perpendicular to the basement membrane.
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Figure 5b. CCH. (a, b) Magnified right craniocaudal mammogram (a) and specimen radiograph (b) show scattered fibroglandular breast tissue with amorphous microcalcifications at the 10-o’clock position (arrow in a). (c) Low-power photomicrograph (H-E stain) demonstrates dilated TDLUs with variably dilated acini and fibrosis. (d) High-power photomicrograph (H-E stain) demonstrates thickened columnar epithelium with crowded columnar cells (arrow) having slender nuclei, most of which are oriented perpendicular to the basement membrane.
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Figure 5c. CCH. (a, b) Magnified right craniocaudal mammogram (a) and specimen radiograph (b) show scattered fibroglandular breast tissue with amorphous microcalcifications at the 10-o’clock position (arrow in a). (c) Low-power photomicrograph (H-E stain) demonstrates dilated TDLUs with variably dilated acini and fibrosis. (d) High-power photomicrograph (H-E stain) demonstrates thickened columnar epithelium with crowded columnar cells (arrow) having slender nuclei, most of which are oriented perpendicular to the basement membrane.
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Figure 5d. CCH. (a, b) Magnified right craniocaudal mammogram (a) and specimen radiograph (b) show scattered fibroglandular breast tissue with amorphous microcalcifications at the 10-o’clock position (arrow in a). (c) Low-power photomicrograph (H-E stain) demonstrates dilated TDLUs with variably dilated acini and fibrosis. (d) High-power photomicrograph (H-E stain) demonstrates thickened columnar epithelium with crowded columnar cells (arrow) having slender nuclei, most of which are oriented perpendicular to the basement membrane.
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Figure 6a. FEA. (a, b) Right craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are regional amorphous microcalcifications (arrowheads in a) as well as more clustered microcalcifications (arrow in b) that are suspect. (c) Specimen radiograph shows the calcifications (arrows) included in multiple core biopsy specimens. (d) High-power photomicrograph (H-E stain) demonstrates stratified layers of columnar epithelial cells (arrow). (e) High-power photomicrograph (H-E stain) demonstrates stratified atypical epithelial cells with distinct nucleoli (arrow).
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Figure 6b. FEA. (a, b) Right craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are regional amorphous microcalcifications (arrowheads in a) as well as more clustered microcalcifications (arrow in b) that are suspect. (c) Specimen radiograph shows the calcifications (arrows) included in multiple core biopsy specimens. (d) High-power photomicrograph (H-E stain) demonstrates stratified layers of columnar epithelial cells (arrow). (e) High-power photomicrograph (H-E stain) demonstrates stratified atypical epithelial cells with distinct nucleoli (arrow).
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Figure 6c. FEA. (a, b) Right craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are regional amorphous microcalcifications (arrowheads in a) as well as more clustered microcalcifications (arrow in b) that are suspect. (c) Specimen radiograph shows the calcifications (arrows) included in multiple core biopsy specimens. (d) High-power photomicrograph (H-E stain) demonstrates stratified layers of columnar epithelial cells (arrow). (e) High-power photomicrograph (H-E stain) demonstrates stratified atypical epithelial cells with distinct nucleoli (arrow).
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Figure 6d. FEA. (a, b) Right craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are regional amorphous microcalcifications (arrowheads in a) as well as more clustered microcalcifications (arrow in b) that are suspect. (c) Specimen radiograph shows the calcifications (arrows) included in multiple core biopsy specimens. (d) High-power photomicrograph (H-E stain) demonstrates stratified layers of columnar epithelial cells (arrow). (e) High-power photomicrograph (H-E stain) demonstrates stratified atypical epithelial cells with distinct nucleoli (arrow).
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Figure 6e. FEA. (a, b) Right craniocaudal (a) and magnified mediolateral (b) mammograms show heterogeneously dense tissue. There are regional amorphous microcalcifications (arrowheads in a) as well as more clustered microcalcifications (arrow in b) that are suspect. (c) Specimen radiograph shows the calcifications (arrows) included in multiple core biopsy specimens. (d) High-power photomicrograph (H-E stain) demonstrates stratified layers of columnar epithelial cells (arrow). (e) High-power photomicrograph (H-E stain) demonstrates stratified atypical epithelial cells with distinct nucleoli (arrow).
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Figure 7a. FEA. (a, b) Standard (a) and magnified (b) left craniocaudal mammograms show heterogeneously dense parenchyma. There are clustered amorphous microcalcifications (arrow) located laterally that are somewhat pleomorphic on the magnified image. (c) Low-power photomicrograph (H-E stain) demonstrates dilated basophilic TDLUs (arrow) containing prominent secretions within the duct lumina. (d) High-power photomicrograph (H-E stain) demonstrates multiple layers of epithelial cells with cytologic atypia lining the duct.
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Figure 7b. FEA. (a, b) Standard (a) and magnified (b) left craniocaudal mammograms show heterogeneously dense parenchyma. There are clustered amorphous microcalcifications (arrow) located laterally that are somewhat pleomorphic on the magnified image. (c) Low-power photomicrograph (H-E stain) demonstrates dilated basophilic TDLUs (arrow) containing prominent secretions within the duct lumina. (d) High-power photomicrograph (H-E stain) demonstrates multiple layers of epithelial cells with cytologic atypia lining the duct.
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Figure 7c. FEA. (a, b) Standard (a) and magnified (b) left craniocaudal mammograms show heterogeneously dense parenchyma. There are clustered amorphous microcalcifications (arrow) located laterally that are somewhat pleomorphic on the magnified image. (c) Low-power photomicrograph (H-E stain) demonstrates dilated basophilic TDLUs (arrow) containing prominent secretions within the duct lumina. (d) High-power photomicrograph (H-E stain) demonstrates multiple layers of epithelial cells with cytologic atypia lining the duct.
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Figure 7d. FEA. (a, b) Standard (a) and magnified (b) left craniocaudal mammograms show heterogeneously dense parenchyma. There are clustered amorphous microcalcifications (arrow) located laterally that are somewhat pleomorphic on the magnified image. (c) Low-power photomicrograph (H-E stain) demonstrates dilated basophilic TDLUs (arrow) containing prominent secretions within the duct lumina. (d) High-power photomicrograph (H-E stain) demonstrates multiple layers of epithelial cells with cytologic atypia lining the duct.
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Copyright © 2007 by the Radiological Society of North America.
