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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Tubular Adenoma of the Breast

Definition

  • A benign breast lesion composed of a circumscribed mass of densely packed regular round tubules

Diagnostic Criteria

  • Circumscribed mass
    • Sharply demarcated but no true capsule
  • Densely packed, uniform, round tubules
    • Two cell layers throughout
      • Lumenal cells epithelial
      • Ablumenal cells myoepithelial
    • No cytologic atypia
      • Occasional nucleoli or mitotic figures may be seen
    • Cytoplasmic vacuoles not prominent
    • Lumenal eosinophilic secretion may be present
  • Scant stroma
    • No compression of ducts
  • Lactating adenoma may represent the same lesion under different physiologic conditions
    • Tubular adenoma has been identified in postpartum biopsies of masses that first presented during pregnancy

    Richard L Kempson MD
    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting: May 15, 2006

 

Supplemental studies

Immunohistology

  • Lumenal cells ER positive
  • Ablumenal cells positive for myoepithelial markers
    • Calponin, p63, smooth muscle actin positive
    • S100 positive

Differential Diagnosis

Lactating Adenoma Tubular Adenoma
Prominent lactational change Lumenal secretion may be present, but cytoplasmic vacuoles lacking
These may represent the same lesion under different physiologic conditions

Microglandular Adenosis Tubular Adenoma
Poorly circumscribed pattern Circumscribed
Surrounds normal elements Mass displaces normal elements
No myoepithelial cell layer Myoepithelial cell layer present
Haphazardly scattered tubules Densely packed tubules
Abundant fibrous or fatty stroma Scant stroma

Sclerosing Adenosis Tubular Adenoma
Localized but not sharply circumscribed Sharply circumscribed
Distorted, compressed ducts Uniform patent ducts
Cellular stroma Scant stroma

Adenomatous Transformation of Fibroadenoma Tubular Adenoma
Areas of typical fibroadenoma stroma Scant stroma
Variable tubules Uniform tubules
Areas typical of tubular adenoma may be found within fibroadenomas

Ductal Adenoma Tubular Adenoma
Frequent prominent sclerosing stroma Scant stroma
Fibrous capsule No capsule
Localized but not completely circumscribed Completely sharply circumscribed
Papillomatosis or adenomatosis with variable small glands Uniform glands

Nipple Adenoma Tubular Adenoma
Frequent prominent sclerosing stroma Scant stroma
Localized but not completely circumscribed Completely sharply circumscribed
Papillomatosis or adenomatosis with variable small glands Uniform glands

Tubular Carcinoma Tubular Adenoma
Stellate infiltrative pattern Circumscribed
No myoepithelial layer Myoepithelial cells present
These are similar in name only

Tubular Adenosis Tubular Adenoma
Diffuse, infiltrative Circumscribed
Surrounds normal elements Mass displaces normal elements
Haphazardly scattered tubules Densely packed tubules
Abundant fibrous or fatty stroma Scant stroma
These are similar in name only

Clinical

  • Most cases occur between 15-49 years of age
  • Rare lesion
  • No association with pregnancy or oral contraceptive use
    • Lactating adenoma may represent the same lesion under different physiologic conditions
  • No recurrences reported
  • No evidence for increased risk of carcinoma

Lists

Breast Adenomas (not all are true adenomas)

Bibliography

  • Maiorano E, Albrizio M. Tubular adenoma of the breast: an immunohistochemical study of ten cases. Pathol Res Pract. 1995 Dec;191(12):1222-30.
  • O'Hara MF, Page DL. Adenomas of the breast and ectopic breast under lactational influences. Hum Pathol. 1985 Jul;16(7):707-12.
  • Hertel BF, Zaloudek C, Kempson RL. Breast adenomas. Cancer. 1976 Jun;37(6):2891-905.
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© 2005  Stanford University School of Medicine