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Breast malignant, males, children

Carcinoma subtypes

Tubulolobular carcinoma


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 21 April 2014, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Definition
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● Rare, first described in 1977 (Hum Pathol 1977;8:679)
● Also occurs in anogenital region (Am J Surg Pathol 2006;30:1193)
● May be a well-differentiated ductal carcinoma with a lobular growth pattern, or a tubular variant of lobular carcinoma (Virchows Arch 2006;448:500)

Terminology
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● Not part of WHO breast classification

Epidemiology
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● Median age 60 years, range 43-79 years

Prognostic features
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● Intermediate prognostic features between lobular and ductal carcinoma
● Best prognosis if unilateral and < 2 cm
● 25% present with greater than stage I disease, compared to 0% with tubular and 60% with lobular carcinoma (Mod Pathol 2007;20:130)
● Axillary nodal metastases in 13-43%

Case reports
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● 69 year old woman with tubulobular carcinoma of the breast with grooved and cerebriform nuclei (Diagn Cytopathol 2011;39:54)

Gross description
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● 0.5 to 2.5 cm, usually unilateral and 19-30% multifocal

Micro description
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● Typical areas of invasive lobular carcinoma with cords of single file cells, which merge with small, round to angulated tubules with minute or undetectable lumina
● Usually accompanied by DCIS, LCIS or both
● Tumors are usually well differentiated with small, round nuclei and indistinct nucleoli
● Stroma is densely collagenous with prominent elastosis

Micro images
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Mixed tubular and lobular components      Fig a-d

                
Axillary nodal metastasis           Involving complex sclerosing lesion


Contributed by: Dr. Semir Vranic, University of Sarajevo (Bosnia)

                
E-cadherin (Fig 3a)              34betaE12 (negative in Fig 4a although usually positive)

       
Beta-catenin+ (Fig 6a) p120 catenin+ (Fig 7a) Tubulolobular breast immunophenotype

       
Small infiltrative glands

AFIP images:
   
             Arrow at tubules

Mixed tubular and lobular components #1;   #2;   #3;   #4

Virtual slides
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Tubulolobular carcinoma

Cytology description
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● Single filing of cells and tubular structures
● Tumor cells have intracytoplasmic vacuoles, low nuclear grade and low mitotic activity
● Relatively clean background
● Variable apocrine cells (Acta Cytol 1996;40:465)

Positive stains
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● E-cadherin (75-100%), 34betaE12 (93%) and Catenins (alpha, beta or gamma-membranous staining in 100%)
● Usually ER+ and PR+
● Aberrant overexpression of CD133 / Prominin-1, collagen IV (basement membrane like pattern, Breast Care (Basel) 2008;3:423)

Differential diagnosis
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Mixed ductal and lobular carcinoma: may lack small, round to angulated tubules with minute or undetectable lumina; may lack prominent elastosis

Additional references
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Am J Surg Pathol 2004;28:1587, Am J Surg Pathol 1997;21:653, Stanford University

End of Breast malignant, males, children > Carcinoma subtypes > Tubulolobular carcinoma


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