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Background

Tubular carcinoma of the breast is a well-differentiated variant of invasive ductal carcinoma and has been shown to have an exceptionally favorable prognosis.

OUTLINE

Pathogenesis  
Gross Appearance and Clinical Variants  
Histopathological Features and Variants  
Prognosis  
Treatment  
Commonly Used Terms  
Internet Links  

PATHOGENESIS CHARACTERIZATION
Genomic alterations in tubular breast carcinomas

Hum Pathol 2001;32:222-226

Analysis of 18 pure tubular carcinomas of the breast using comparative genomic hybridization to evaluate the chromosomal changes in these tumors. An average of 3.6 chromosomal alterations of the genome were identified per case

The most frequent change involved loss of 16q (in 78% of tumors) and gain of 1q (in 50% of tumors)

All but one case with 1q gain also exhibited a concomitant 16q loss
Other frequent changes involved 16p gain in 7 of 18 cases (39%) and distal 8p loss in 5 of 18 cases (28%)

Comparison with known genomic alterations in a mixed group of invasive cancers shows tubular cancer to have fewer overall chromosomal changes per tumor (P <.01), higher frequency of 16q loss (P <.001), and lower frequency of 17p loss (P = .007)

Conclusion:
Suggest that tubular carcinomas are a genetically distinct group of breast cancers

 

GROSS APPEARANCE/CLINICAL VARIANTS CHARACTERIZATION
General  
VARIANTS  
Tubular carcinoma of the breast: Association with multicentricity, bilaterality, and family history of mammary carcinoma Am J Clin Pathol 73:25-30, 1980

 

HISTOLOGICAL TYPES CHARACTERIZATION
GENERAL  
Refined morphologic criteria for tubular carcinoma to retain its favorable outcome status in contemporary breast carcinoma patients.

Goldstein NS, Kestin LL, Vicini FA.

Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, MI.
Am J Clin Pathol. 2004 Nov;122(5):728-39. Abstract quote

We studied outcomes of 147 patients with stage I/II grade 1 (32 pure tubular, 115 ductal) carcinoma treated with breast-conserving therapy to evaluate the prognostic usefulness of standard and recently proposed revised criteria for tubular (tubularity percentage [proportion of neoplastic cells adjacent to open lumens], nuclear grade, and mitoses) and ductal carcinoma.

Carcinomas with less than 70% tubularity were ductal. Carcinomas with 70% or more tubularity were divided into those with occasional grade 2 nuclei and mitoses and those with pure grade 1 nuclei and rare or no mitoses. The 10-year disease-free survival for patients with pure ductal vs pure tubular carcinoma was 91% vs 96% (P = .036). Overall survival rates were similar (85% vs 89%; P = .161). With the recently proposed criteria, neoplasms with less than 70% tubularity; 70% or more tubularity and occasional grade 2 nuclei and mitoses; and 70% or more tubularity, pure grade 1 nuclei, and rare mitoses had 10-year disease-free survival rates of 88%, 93%, and 100% (P < .001) and 10-year overall survival rates of 85%, 88%, and 94%, respectively (P < .001).

Tubular carcinoma as a distinct morphologic entity should be restricted to neoplasms with 70% or more tubularity, pure grade 1 nuclei, and rare mitoses. Other definitions of tubular carcinoma do not guarantee the excellent prognosis.
 

Am J Clin Pathol 58:231-238, 1972

A highly differentiated invasive carcinoma whose cells are regular and arranged in well-defined tubules, typically 1-layer thick, and surrounded by an abundant fibrous stroma

Pure tubular carcinomas are defined by a greater than 75% tubular pattern although restricting the diagnosis to tumors with a greater than 90% tubular pattern has also been suggested

VARIANTS  

Cancerization of small ectatic ducts of the breast by ductal carcinoma in situ cells with apocrine snouts: a lesion associated with tubular carcinoma.

Goldstein NS, O'Malley BA.

Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.

Am J Clin Pathol 1997 May;107(5):561-6 Abstract quote

Small ectatic ducts lined by atypical ductal cells with apocrine snouts occasionally have been observed in association with tubular carcinoma; some pathologists have considered these carcinomas to be a form of ductal carcinoma in situ (DCIS).

Thirty-two cases of tubular carcinoma, 41 of invasive grade 1 ductal carcinoma with DCIS, 40 of invasive grade 1 ductal carcinoma without DCIS, 40 of invasive grade 3 ductal carcinoma, 40 of invasive lobular carcinoma, 20 of well-differentiated DCIS, and 80 of fibrocystic changes were examined to determine the relationship between the lesion formed by atypical ductal cells with apocrine snouts and invasive carcinoma, DCIS, and benign breast changes.

Seventeen cases contained lesions formed by atypical ductal cells with apocrine snouts: 14 were associated with tubular carcinoma (43.7%), and 3 with invasive grade 1 ductal carcinoma (3.7%). In six invasive carcinomas, the associated DCIS was formed by cells identical to those within the lesion. These lesions were found at the periphery of the invasive carcinoma and adjacent to the DCIS. The lesions were probably composed of low-grade intraductal malignant epithelial cells, which partially involve small ectatic ducts and are often adjacent structures as a form of cancerization.

This cytologic and architectural form of DCIS appears to be related to an invasive carcinoma that is usually of tubular subtype. Attention to this form of cancerization by malignant intraductal cells, especially with regard to specimen surgical margins, is imperative when a tubular carcinoma is encountered.

If a pathologist encounters only this lesion in a partially sampled breast biopsy specimen, additional (or all) tissue should be submitted for histologic evaluation to ensure that an invasive carcinoma is not missed. This lesion needs to be distinguished from the frequent, benign, columnar alteration within lobules and small ectatic ducts.

TUBULOLOBULAR CARCINOMA  
Tubulolobular Carcinoma of the Breast: An Analysis of 27 Cases of a Tumor With a Hybrid Morphology and Immunoprofile.

Wheeler DT, Tai LH, Bratthauer GL, Waldner DL, Tavassoli FA.

From the *Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC; daggerDepartment of Pathology, Potomac Hospital, Woodbridge, VA; double daggerDepartment of Pathology, Madigan Army Medical Center, Tacoma, WA; and section signDepartment of Pathology, Yale University School of Medicine, New Haven, CT.
Am J Surg Pathol. 2004 Dec;28(12):1587-1593. Abstract quote  

Tubulolobular carcinoma (TLC) is a rare subtype of mammary carcinoma that has eluded precise classification, exhibiting features of both ductal and lobular differentiation.

The clinicopathologic features of 27 cases of TLC were analyzed by both hematoxylin and eosin and immunohistochemical stains for E-cadherin and 34betaE12 (high molecular weight cytokeratin). Five cases of both pure tubular and classic lobular carcinoma were included as controls. Patients with TLC ranged in age from 43 to 79 years (median, 60 years). Tumor characteristics were as follows: size, 0.5 cm to 2.5 cm (median, 1.4 cm); bilaterality, 1 of 27 (4%); and multifocality, 5 of 27 (19%). Twenty-two of the 27 cases (81%) contained an in situ component: 8 (36%) lobular (LIN); 4 (18%) ductal (DIN); and 10 (46%) mixed. All 27 cases were intensely positive (3+) for E-cadherin, a feature of ductal differentiation, while 25 of 27 (93%) cases showed variable positivity for 34betaE12 (1 to 3+), a feature far more common in tumors with lobular differentiation.

Clinical follow-up was available on 25 of 27 (93%) patients. Three of 24 (13%) patients developed axillary lymph node metastases and 1 of 25 (4%) patients developed a local recurrence over a follow-up period of 2 to 91 months (median, 39 months). In conclusion, TLCs are a distinct subtype of mammary carcinoma with overlapping morphologic features that are mirrored by a hybrid immunohistochemical profile. The uniform 3+ expression of E-cadherin in TLC supports the ductal differentiation of these tumors, despite a dominant lobular growth pattern.

The prognosis of these tumors appears to be excellent, especially in those cases that are unilateral and less than 2 cm in size.

 

TREATMENT AND PROGNOSIS  
PROGNOSIS  

Well-differentiated (tubular) carcinoma of the breast. A clinicopathologic study of 145 pure and mixed cases.

Deos PH, Norris HJ.

Am J Clin Pathol 1982 Jul;78(1):1-7 Abstract quote

In this study, 145 well-differentiated (tubular) carcinomas were divided into two groups: 90 pure tubular carcinomas and 55 which were mixtures in that they contained a component of infiltrating duct carcinoma occupying less than half the tumor.

Axillary lymph node metastases developed in 29% of women in the mixed group, but occurred in only 6% of the pure group. The prognosis was good in both groups, with five-year-actuarial survival rates in the pure and mixed groups of 100% and 93%, respectively. Residual carcinoma was present in the mastectomy specimen in 28% of the pure group, and in 40% of the mixed carcinomas. In addition, there was a recurrence rate of 50% in patients with pure tubular carcinoma treated by excisional biopsy.

These features indicate simple excision of tubular carcinoma is likely to be inadequate therapy and that a mastectomy is warranted. Axillary node dissections should be done when there is a component of infiltrating duct carcinoma because of the increased risk of axillary lymph node metastasis.

Tubular carcinoma of the breast. Clinical and pathological observations concerning 135 cases.

McDivitt RW, Boyce W, Gersell D.

Am J Surg Pathol 1982 Jul;6(5):401-11 Abstract quote

Clinical and pathological features of 135 tubular carcinomas are discussed.

Tumor size varied from 0.2 to 2.5 cm with a mean diameter of 0.9 cm. In situ carcinoma was found associated with tubular cancer in 86 cases (63.6%). In 82 of 86 (95.3%) it was of micropapillary/cribriform intraductal type. Twelve of 109 patients in whom axillary dissection was performed were found to have axillary metastases. Six patients (4%) developed recurrent or disseminated metastatic carcinoma during a mean follow-up period of 7.2 years. Two of these patients are dead of disease.

Tubular carcinoma should be distinguished from microglandular adenosis, an uncommon form of sclerosing adenosis.

Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Sixth Edition. WB Saunders 1999.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.


Commonly Used Terms

Breast Cancer

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Last Updated December 9, 2004

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