Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre?...

Lesioni a cellule colonnariCON atipie (FEA/DIN1A)

Lesioni a rischio evolutivo?

Escissione sempre?

SI

?

The limited available data suggest that when atypia is encountered in a core needle biopsy

specimen, subsequent excision shows a more advanced lesion

in about 1/3 of cases.

This is sufficiently frequent to recommend excision

in such cases as a matter of routine

Breast Cancer Res 2003; 5:263-268

Clinical problems:to excise or not to excise CCC?

Margin evaluation: CCL with atypia should not be taken into consideration

even when they are composed of cells that are cytologically similar to those in the diagnostic areas of clinging DCIS.

Advances in Anatomic Pathology 2003; 10: 113-124

FEA/ADH/CDIS/DIN??????????????????????????????

Virchows Arch (2007) 451:883–891

The term “flat” refers to the overall architecture of theproliferation, which lacks any intraluminal protrusions in theform of arcades, bridges, or micropapillae and is essential indistinguishing this lesion from ADH.

ADHDIN1B

FEADIN1A

Modern Pathology (2009) 1–8

Modern Pathology (2009) 1–8

Modern Pathology (2009) 1–8

Histology at surgery RX-FU (months)

N°Benign

Atypia(LIN/ADH/FEA)

Mal(DCIS/IC)

mean38 ± 6.8

B2 CCL without atypia 68 5(7%) 63 (93%)

B3 FEA 38 13 (34%) 20 (53%) 5 (13%)

CCL without atypia and Papilloma

1 1 (100%)

CCL without atypia or FEA with LIN

11 2 (18%) 5 (45%) 1 (9%) 3 (27%)

CCL without atypia or FEA with ADH

2 1 (50%) 1 (50%)

B4 Extensive FEA 3 1 (33%) 2 (67%)

2. Multidisciplinary approach for FEA managing

3. Surgery recommended when CCL without atypia or FEA are associated with other risk lesions (ADH/LIN) on VACB;

4. Excision biopsy not mandatory only when histopathological findings are concordant with the radiological features and flat epithelial atypia is found on VACB as the most advanced lesion.

Management CCL/FEA

1. CCL without atypia BENIGN

FOLLOW UP?

close followup is advised with repeat mammogram every 6 months for 2–3 years for early detection of any such invasive carcinomas in the vicinity of flat DIN 1.

Virchows Arch (2007) 451:883–891

1. Multidisciplinary approach

2. Surgery recommended when CCL without atypia or FEA are associated with other risk lesions (ADH/LIN) on VACB;

3. Excision biopsy not mandatory only when histopathological findings are concordant with the radiological features and flat epithelial atypia is found on VACB as the most advanced lesion.

4. women should be advised of the possible hormone dependency of CCLs.

Management CCL/FEA

3D reconstruction of an atypical cystic lobuleER(red) and Ki67(green)in CCL

Laboratory Investigation (2008) 88, 938–948

CCL Not CCL