Columnar cell change

by Vanessa Grace M. De Villa-Atienza, MD, DPSP
April 4, 2022


What is columnar cell change in the breast?

Columnar cell change (CCC) is a common non-cancerous condition in the breast. CCC starts in glands normally found in the breast and it can only be seen after tissue from the breast is examined under the microscope by a pathologist. CCC is usually seen with another non-cancerous change called flat epithelial atypia. 

breast normal anatomy

 

How do pathologists make the diagnosis of columnar cell change?

The diagnosis of CCC can be made after a small sample of tissue is removed from the breast in a procedure called a core needle biopsy. The biopsy may be performed after calcifications were seen on mammography. CCC can also be discovered incidentally in tissue removed to diagnose or treat cancer or other non-cancerous condition in the same breast.

What does columnar cell change look like under the microscope?

In normal, healthy breast tissue, the ducts and glands are lined by a single layer of epithelial cells. Pathologists describe these cells as cuboidal because each cell is as tall as it is wide (like a square). In CCC, the normal cuboidal cells are replaced by columnar-shaped cells. Columnar is a word pathologists use to describe cells that are taller than they are wide (like a rectangle).

CCC is closely related to another non-cancerous condition in the breast called columnar cell hyperplasia (CCH). Pathologists make the distinction between the two conditions based on the number of columnar epithelial cells lining the glands. In CCC, the glands are lined by one or two layers of cells. While in CCH, the glands are lined by more than two layers of cells. Hyperplasia is a word pathologists use to describe an increased number of cells compared to normal.

The columnar-shaped epithelial cells produce a fluid that is rich in calcium. Over time, some of the calcium in the fluid is left in the tissue where it creates calcifications. These calcifications are denser than normal breast tissue which allows them to be seen on mammography.

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