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Breast malignant, males, children

Carcinoma subtypes

Tubular carcinoma


Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 7 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

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
● Not actually tubular - pattern is better described as a necklace formed by a string of beads (Stanford University)

Clinical features
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● 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 features
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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 (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
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● 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
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● Poorly circumscribed margins, hard consistency, mean size 1 cm

Gross images
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Yellow-white sclerotic mass

Micro 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 (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

Micro images
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Various images


           
Angular glands with cytoplasmic snouts         With cribriform DCIS

           
Core biopsy     Blue: malignant  Tumor is CK5/6-; normal myoepithelial cells are CK5/6+
          Red: benign


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 invasion      Axillary nodal metastasis         Reticulin stains stromal fibers, but fibers do not completely
                                   surround neoplastic glands

Cells in tubules have same morphology as lobular carcinoma cells

Virtual slides
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Tubular carcinoma

Cytology description
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● 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
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● ER, PR and E-cadherin (but reduced)

Negative stains
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● HER2 (Am J Clin Pathol 2006;126:55), p53 and EGFR
● Myoepithelial markers (p63, CD10, smooth muscle actin, CK5/6)

Molecular description
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● 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)

Electron microscopy description
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● Ductal differentiation, no myoepithelial cells and no basement membrane

Differential diagnosis
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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

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


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