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

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

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Page 1: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

Lesioni a cellule colonnariCON atipie (FEA/DIN1A)

Lesioni a rischio evolutivo?

Escissione sempre?

SI

?

Page 2: Lesioni a cellule colonnari CON 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?

Page 3: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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

Page 4: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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

Page 5: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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.

Page 6: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?
Page 7: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

ADHDIN1B

FEADIN1A

Page 8: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?
Page 9: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

Modern Pathology (2009) 1–8

Page 10: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?
Page 11: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

Modern Pathology (2009) 1–8

Page 12: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

Modern Pathology (2009) 1–8

Page 13: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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%)

Page 14: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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

Page 15: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

FOLLOW UP?

Page 16: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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

Page 17: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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

Page 18: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

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

Page 19: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

Laboratory Investigation (2008) 88, 938–948

Page 20: Lesioni a cellule colonnari CON atipie (FEA/DIN1A) Lesioni a rischio evolutivo? Escissione sempre? SI ?

CCL Not CCL