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Papillomatous breast lesions with atypical columnar cell features
  1. Mirthe de Boer1,
  2. Anoek H J Verschuur-Maes2,
  3. Cathy Moelans1,
  4. Paul J van Diest3
  1. 1Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Pathology, Gelre Hospital, Apeldoorn, The Netherlands
  3. 3Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Professor Paul J van Diest, Department of Pathology, University Medical Centre Utrecht, Utrecht, 3584 CX, The Netherlands; p.j.vandiest{at}


Aims Columnar cell lesions (CCLs) are recognised breast cancer precursor lesions. Intraductal papillomas are usually lined by benign (polyclonal) cells. Although papillomas with monoclonal lesions (atypical ductal hyperplasia (ADH)/ductal carcinoma in situ (DCIS)) have been described, CCLs have not been described in papillomas.

Methods We present two papillary breast lesions lined by a single layer of luminal cells resembling atypical CCL/flat epithelial atypia (FEA). We compared these two lesions with 13 benign intraductal papillomas, and 2 papillomas with ADH/DCIS grade 1 features as controls were immunohistochemically stained for the oestrogen receptor alpha (oestrogen receptor) and progesterone receptors (PR), cytokeratin 5 (CK5) and cyclin D1.

Results Oestrogen receptor/PR expression was variable, with areas with ≥85% hormone receptor positivity in both morphologically normal papillomas and papillomas with ADH. In ADH areas, CK5 expression was seen in ≤5% of cells while cyclin D1 expression was high (>60%). The two papillary lesions with FEA were 100% oestrogen receptor and 90% cyclin D1 positive, and low on PR/CK5. There was only one morphologically normal papilloma with similar areas of low CK5 (5%) and high cyclin D1 expression; in all other morphologically benign papillomas CK5 expression varied between 10% and 50% and cyclin D1 expression was ≤50%. The papillary lesion with FEA that could be tested showed 16q losses, the hallmark genetic change in low nuclear grade breast neoplasias, in contrast to nine morphologically benign papillomas that could be tested.

Conclusion We present two papillomatous breast lesions with atypical CCL morphology and 16q loss, for which we propose the term papillary FEA.

  • Breast Neoplasms
  • Pathology, Molecular

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Runjan Chetty.

  • Contributors MB, AV, CM and PD participated in the conception and writing of the manuscript and reviewed the final version. PD is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.