Columnar cell change of the breast

by Vanessa Grace M. De Villa-Atienza, MD, DPSP
May 7, 2024

Columnar cell change (CCC) is a common non-cancerous condition in the breast. In this condition, normal cells are replaced by tall, thin columnar-shaped cells. A pathologist can only see this change when tissue from the breast is examined under the microscope. Columnar cell change often develops alongside another non-cancerous change in the breast called flat epithelial atypia. 

What are the symptoms of columnar cell change?

Columnar cell change typically does not produce any symptoms and is usually detected incidentally during biopsies performed for other reasons, such as abnormal mammograms.

What causes columnar cell change?

The exact cause of columnar cell change is not well understood. It is thought to be influenced by hormonal factors, as it is more commonly found in areas of the breast undergoing active hormonal changes. There may also be genetic components involved, although these are less clearly defined.

Is columnar cell change associated with an increased risk of developing breast cancer?

Columnar cell change is considered a marker of a slightly increased risk of developing breast cancer, especially when it occurs with another change called flat epithelial atypia (FEA). Depending on the presence and extent of accompanying atypical cells, the presence of these changes might lead to a recommendation for closer monitoring rather than immediate intervention.

How is this diagnosis made?

The diagnosis of columnar cell change 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. This change can also be discovered incidentally in tissue removed to diagnose or treat cancer or other non-cancerous conditions in the same breast.

Microscopic features

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 columnar cell change, 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).

The columnar-shaped epithelial cells produce a fluid 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.

Columnar cell change is closely related to columnar cell hyperplasia (CCH), another non-cancerous condition in the breast. Pathologists distinguish the two conditions based on the number of columnar epithelial cells lining the glands. In columnar cell change, the glands are lined by one or two layers of cells, while in CCH, they 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.

About this article

This article was written by doctors to help you read and understand your pathology report. Contact us if you have any questions about this article or your pathology report. Read this article for a more general introduction to the parts of a typical pathology report.

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