Breast – Malignant, Males, Children

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Breast-malignant, males, children

Tubular carcinoma

Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.

Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)

Revised: 27 September 2009

Last major update: September 2009

Definition

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● 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

Clinical

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● 2-6% of all malignant breast tumors

● Often multifocal/multicentric (20-55%), family history of breast carcinoma (40%)

● Usually presents with pT1 and pN0 disease (Int J Radiat Oncol Biol Phys 2009 Apr 20 [Epub ahead of print])

Treatment and prognosis

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● 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 (AJCP 2004;122:728)

● Mixture with ordinary ductal carcinoma has worse prognosis (Hum Path 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 includes surgery, long term followup for local recurrence, possibly radiation therapy (Breast Cancer Res Treat 2005;93:199, Breast J 2005;11:129)

Gross description

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● Poorly circumscribed margins, hard consistency, mean size 1 cm

Gross images

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Yellow-white sclerotic mass

Microscopic description

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● 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 (AJSP 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, no basement membrane after PAS or type IV collagen staining

Micro images

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Angular glands with cytoplasmic snouts With cribriform DCIS

Core biopsy Blue: malignant Tumor is CK5/6 Normal myoepithelial cells

red: benign negative are CK5/6 positive

p63 negative (fig e)

AFIP images:

Angular glands with With collagenous and elastotic With <90% tubular component

cytoplasmic snouts stroma and micropapillary DCIS Arrows point to ductal-type

Perineural Axillary nodal metastasis Reticulin stains stromal fibers, but fibers do not

Invasion completely surround neoplastic glands

Other images: cells in tubules have same morphology as lobular carcinoma cells

Cytology description

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● Increased cellularity, somewhat angular epithelial clusters, single epithelial cells

● Cells are bland and orderly with variable atypia, variable number of prominent myoepithelial cells (Acta Cytol 1997;41:1139, AJCP 1994;101:488)

Virtual slides

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● Tubular carcinoma

Positive stains

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● ER, PR, E-cadherin (but reduced)

Negative stains

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● HER2 (AJCP 2006;126:55), p53, EGFR

● Myoepithelial markers - p63, CD10, smooth muscle actin, CK5/6

Molecular / cytogenetics

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● Usually diploid

● 16q- (78% of tumors), 1q+ (50%), but fewer overall chromosomal changes than ductal NOS (Hum Path 2001;32:222)

● Clonally related to flat epithelial atypia and low grade DCIS (Am J Surg Pathol 2009 Aug 11 [Epub ahead of print])

Electron microscopy

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● Ductal differentiation, no myoepithelial cells, no basement membrane

Differential diagnosis

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● Benign sclerosing lesion - overall lobular architecture, compression of glandular structures, positive for myoepithelial markers p63, CD10 or smooth muscle actin (Appl Immunohistochem Mol Morphol 2006;14:71)

● Fibroadenoma

● Microglandular adenosis - more rounded tubules, often with colloid-like secretory material

● Grade 1 ductal carcinoma

Additional references

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● AJSP 1982;6:401, AJSP 1997;21:653, Stanford University

End of Breast – Malignant, Males, Children > Tubular carcinoma

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