Breast
Fibroepithelial tumors
Tubular adenoma


Topic Completed: 1 April 2021

Minor changes: 1 April 2021

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PubMed Search: Tubular adenoma [TIAB] breast

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Cite this page: Li JJX, Tse GM. Tubular adenoma . PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breasttubularadenoma.html. Accessed May 12th, 2021.
Definition / general
  • Benign fibroepithelial tumor of the breast composed of compact bilayered tubules with sparse intervening stroma
Essential features
  • Circumscribed / nodular benign tumor of the breast
  • Closely packed tubules with sparse intervening stroma
Terminology
  • Fibroadenomas variant (pericanalicular subtype), not recommended by WHO
ICD coding
  • ICD-O: 8211/0 - tubular adenoma, NOS
  • ICD-11: 2F30.0 - tubular adenoma of breast
  • ICD-11: XH7SY6 - tubular adenoma, NOS
Epidemiology
Sites
Pathophysiology
  • Arises from terminal duct lobular units
Etiology
  • Unknown
  • May be associated with reproductive hormones due to high incidence in women of reproductive age
Clinical features
Diagnosis
  • Histology recommended for definitive diagnosis (N Am J Med Sci 2014;6:219)
    • Radiology and cytology usually allow identification of the benign nature of lesion but may not be sufficient in excluding differential diagnoses
Radiology description
  • Well defined and well circumscribed lesion (AJR Am J Roentgenol 2000;174:757)
  • Hypoechoic on ultrasound
    • Posterior acoustic enhancement sometimes seen
  • Tiny, punctate and irregular microcalcifications may be present on mammography in older patients
Radiology images

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Ultrasound

Ultrasound

Prognostic factors
Case reports
Treatment
  • Curable by complete surgical excision
  • Observation acceptable for asymptomatic, low risk patients
Clinical images

Images hosted on other servers:
Lesion in accessory breast

Lesion in accessory breast

Gross description
Gross images

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Well defined borders

Well defined borders

Tan cut surface

Tan cut surface

Microscopic (histologic) description
  • Well defined borders
  • Sparse fibrovascular stroma intervening tubules
  • Small, uniform, closely packed round tubules (Clin Med Insights Pathol 2018;11:1179555718757499)
    • Lined by an inner layer of luminal epithelial cells and an outer layer of myoepithelial cells
      • Rare mild atypia and mitotic figures does not exclude diagnosis
    • Occasional luminal eosinophilic secretion
Microscopic (histologic) images

Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Well defined borders

Well defined borders

Closely packed tubules

Closely packed tubules

CK5/6

CK5/6

p63

p63

Eosinophilic luminal secretions

Eosinophilic luminal secretions

Sparse intervening stroma

Sparse intervening stroma



Contributed by Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Missing Image

Well defined lesion

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Mimicking invasion

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Myoepithelial layer on CD10

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Breast tubular adenoma immunoprofile

Virtual slides

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Biopsy

Biopsy of tubular adenoma

Cytology description
Cytology images

Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Background naked nuclei

Background naked nuclei

3 dimensional cell balls

3 dimensional cell balls

Bland nuclear features

Bland nuclear features

Positive stains
Negative stains
Molecular / cytogenetics description
  • Recently, next generation sequencing demonstrated that tubular adenomas and fibroadenomas show different mutation profiles (J Cell Biochem 2019;120:182)
Sample pathology report
  • Left breast, excisional biopsy:
    • Tubular adenoma (see comment)
    • Comment: Sections show a proliferation of small, crowded tubules with minimal intervening stroma, composed of bland epithelial cells with an intact myoepithelial cell layer. Occasional eosinophilic luminal secretions are noted.
Differential diagnosis
  • Fibroadenoma:
    • Expanded stromal component in between ducts
    • Ducts distorted and compressed by stroma (intracanalicular pattern)
    • Presence of MED12 mutations
  • Lactating adenoma:
    • Luminal epithelium shows secretory changes (hobnail changes, granular or vacuolated cytoplasm)
    • Luminal secretions positive for α-lactalbumin
  • Nipple adenoma:
    • Haphazardly distributed tubular ducts
    • Lacks circumscription
    • Located at the superficial aspect of nipple, often with epidermal connection
  • Adenomyoepithelioma:
    • Biphasic lesion with multilayered or solid nests of myoepithelial cells
    • Mixed nontubular patterns, including lobular and spindle patterns
  • Sclerosing adenosis:
    • Hyalinized and occasionally expanded stroma
    • Ducts compressed and distorted by stroma
  • Collagenous spherulosis:
    • Intraductal proliferation with cribriform pattern
    • Spherules containing basement membrane material enclosed by myoepithelial cells
    • Usually associated with benign proliferative lesions
  • Microglandular adenosis:
    • Infiltrative, haphazardly distributed small round glands
    • Lacks myoepithelial cells
    • Lacks circumscription
  • Tubular carcinoma:
    • Infiltrative angulated tubules with tapering ends
    • Lacks myoepithelial cells
    • Stroma shows desmoplastic reaction
Board review style question #1

Which of the following is a common clinical feature of tubular adenoma?

  1. Attachment to the nipple
  2. Irregular and fixed on palpation
  3. Located at upper outer quadrant of the breast
  4. Presence of axillary lymphadenopathy
  5. Presenting in a postmenopausal woman
Board review style answer #1
C. Tubular adenoma is most commonly but not exclusively located at the upper outer quadrant of the breast and presents in young women. Attachment to the nipple is a feature of nipple adenoma. Axillary lymphadenopathy, an irregular border and fixation are malignant features not commonly associated with tubular adenomas.

Comment Here

Reference: Tubular adenoma
Board review style question #2
Which of the following features favors the diagnosis of tubular adenoma over fibroadenoma?

  1. Detection of MED12 mutation
  2. Minimal intervening fibrous stroma between tubules
  3. Presence of myoepithelial layer
  4. Presence of rare mitotic figures
  5. Tubules arranged in an intracanalicular pattern
Board review style answer #2
B. Minimal intervening fibrous stroma between tubules. Fibroadenomas often demonstrate expansion of fibrous stroma, which compresses tubules and produces an intracanalicular pattern. MED12 mutation is associated with fibroepithelial lesions of the breast, in particular fibroadenomas. Myoepithelial layer is present in both lesions and rare mitotic figures are allowed in both lesions.

Comment Here

Reference: Tubular adenoma
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