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Table of Contents
Definition / general | Clinical features | Prognostic factors | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Cytology description | Positive stains | Negative stains | Electron microscopy description | Molecular / cytogenetics description | Differential diagnosisCite this page: Tubular carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignanttubular.html. Accessed July 14th, 2017.
Definition / general
- Special type of breast carcinoma with favorable prognosis, composed of distinct, well differentiated angular tubular structures (90%+ according to WHO) with open lumina, lined by a single layer of epithelial cells
- Not actually tubular - pattern is better described as a necklace formed by a string of beads (Stanford University - Tubular Carcinoma of the Breast)
Clinical features
- 2 - 6% of all malignant breast tumors
- Often multifocal / multicentric (20 - 55%, Am J Surg Pathol 1997;21:653), family history of breast carcinoma (40%)
- Usually presents with pT1 and pN0 disease (Int J Radiat Oncol Biol Phys 2009;75:1304)
Prognostic factors
- A well differentiated variant with very favorable prognosis (low rate of recurrence or metastasis) and only rare deaths (Am J Surg 2009;197:674)
- Excellent prognosis is restricted to tumors with 70%+ tubules, pure grade 1 nuclei and no / rare mitoses (Am J Clin Pathol 2004;122:728)
- Mixture with ordinary ductal carcinoma has worse prognosis (Hum Pathol 1983;14:694)
- Cause specific survival is 97% at 10 years (Eur J Surg Oncol 2005;31:9)
- 10 - 27% have axillary metastases, often micrometastases (Eur J Surg Oncol 2006;32:488), but still have excellent prognosis (Breast J 2003;9:298)
Treatment
- Surgery, long term followup for local recurrence and possibly radiation therapy (Breast Cancer Res Treat 2005;93:199, Breast J 2005;11:129)
Gross description
- Poorly circumscribed margins, hard consistency, mean size 1 cm
Gross images
Images hosted on other servers:
Yellow-white sclerotic mass
Microscopic (histologic) description
- 90%+ tubules with low grade features, irregular angulated contours of glands ("teardrop-like"), open lumina with apocrine-like snouts and basophilic secretions / columnar cell lesions in almost all cases (Adv Anat Pathol 2008;15:140), usually with flat epithelial atypia (Am J Surg Pathol 2007;31:417, Pathol Int 2008;58:620)
- Also desmoplastic stroma
- May form trabecular bars
- Frequently invades fat at periphery
- Fibrous, cellular and elastotic stroma
- Associated with low grade DCIS in 40 - 65% (micropapillary or cribriform), less often LCIS
- Minimal pleomorphism
- No myoepithelial layer, no mitotic figures, no necrosis, no angiolymphatic or perineural invasion and no basement membrane after PAS or type IV collagen staining
Microscopic (histologic) images
Scroll to see all images.
Images hosted on PathOut server:
Contributed by Dr. Mark R. Wick:
AFIP images:
Angular glands with cytoplasmic snouts
With < 90% tubular component, arrows point to ductal-type
Perineural invasion completely
With collagenous and
elastotic stroma and
micropapillary DCIS
Axillary nodal metastasis
Reticulin stains stromal
fibers, fibers do no
surround neoplastic glands
Images hosted on other servers:
Angular glands with cytoplasmic snouts
With cribriform DCIS
Core biopsy
Blue: malignant, Red: benign
H&E
Well defined glands
Shares histologic features with radial scar
Irregular neoplastic glands
Tumor is CK5 / 6-; normal myoepithelial cells are CK5 / 6+
Virtual slides
Images hosted on other servers:
Tubular breast cancer
Cytology description
- Increased cellularity, somewhat angular epithelial clusters and single epithelial cells
- Cells are bland and orderly with variable atypia and variable number of prominent myoepithelial cells (Acta Cytol 1997;41:1139, Am J Clin Pathol 1994;101:488)
Positive stains
- ER, PR and E-cadherin (but reduced)
Negative stains
- HER2 (Am J Clin Pathol 2006;126:55), p53 and EGFR
- Myoepithelial markers (p63, CD10, smooth muscle actin, CK5 / 6)
Electron microscopy description
- Ductal differentiation, no myoepithelial cells and no basement membrane
Molecular / cytogenetics description
- Usually diploid
- 16q- (78% of tumors), 1q+ (50%), but fewer overall chromosomal changes than ductal NOS (Hum Pathol 2001;32:222)
- Clonally related to flat epithelial atypia and low grade DCIS (Am J Surg Pathol 2009;33:1646)
Differential diagnosis
- Benign sclerosing lesion: overall lobular architecture, compression of glandular structures, positive for myoepithelial markers p63 and CD10 or smooth muscle actin (Appl Immunohistochem Mol Morphol 2006;14:71)
- Fibroadenoma: biphasic tumor with overgrowth of epithelial and stromal tissue; no true angulated contours of cells (may be compressed by stroma), no desmoplastic stroma
- Microglandular adenosis: more rounded tubules, often with colloid-like secretory material (Am J Surg Pathol 1982;6:401)
- Ductal carcinoma, low grade: actual tubules, not angular; usually no apocrine-like snouts with basophilic secretions / columnar cell lesions
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