Home Uncategorized Tubular Adenoma of Breast

Tubular Adenoma of Breast

by Diksha Dadlani, Mohali, Punjab
Clinical History
Examination
Investigations
Diagnosis
Treatment
Discussion
References

17 year old female presented to the surgery department of Government Medical College and
Rajendra Hospital, Patiala, with a gradually enlarging palpable, asymptomatic mass in the
middle outer portion of the left breast. She had first noticed the mass 2 years ago and had then
undergone a sonography at another institution that revealed a well circumscribed, homogenous,
hypoechoic mass measuring approximately 2.2 x 2cm at that time. She had no history of
bronchial asthma, rheumatoid arthritis, diabetes, hypertension, hypothyroidism, any bleeding
disorder or any other previous surgery. She also had a negative family history of breast or
ovarian malignancies. The female had undergone menarche at the age of 14 and her menstrual
cycles were regular.

General and Systemic Examination- Normal.

Local physical examination:

  • Painless, non-tender, mobile, well circumscribed mass was palpated in the middle outer portion of left breast at 3 0’ clock position.
  • Skin overlying the swelling was normal and no nipple discharge or inflammatory changes were present.
  • No palpable supraclavicular or axillary lymph nodes.

Ultrasound: Well defined hypoechoic mass in the left breast with imaging features suggestive of non-calcified fibroadenoma.

FNAC: Cohesive clusters of dual population of ductal epithelial cells and myoepithelial cells along with naked, bipolar nuclei in the background – s/o fibroadenoma.

Histopathological examination of the surgically excised tumor: Closely packed small tubules lined with a bilayer of epithelial cells and myoepithelial cells were seen. Scanty connective tissue stroma was seen between the tubules. The mass was thus diagnosed as tubular breast adenoma.

Clinicoradiological differentials for tubular adenoma includes Fibroadenoma.

Histologically, the differential diagnosis of tubular adenoma includes fibroadenoma, ductal
carcinoma, microglandular adenosis, sclerosing adenosis, phyllodes tumour and tubular
carcinoma. It is important to rule out their diagnosis as some benign tumours may be associated
with the risk of invasive carcinoma.

Due to the history of progressive enlargement of the lump over the past two years, a surgical excision was carried out and a well circumscribed oval mass was resected.

Macroscopically, the excised tumour measuring 6×5.5×3 cm presented as a solid, yellowish-white elastic nodule with the surface showing slit-like areas, resembling a fibroadenoma. The patient had an
uncomplicated postoperative course and she is doing well after 6 months of surgery.

Tubular adenoma is a rare benign neoplasm seen predominantly in women of reproductive age group, occurring rarely in postmenopausal women [1,8]. It presents as a painless, freely mobile, well-circumscribed mass with size rarely exceeding 5cm [3,10]. However, cases of giant tubular adenomas measuring over 14cm have also been reported[11,12]. It can potentially be confused with fibroadenoma due to the high degree of similarity in their clinical, radiological and cytological characteristics, thus making preoperative diagnosis extremely difficult[ 3,6]. Surgical excision or biopsy followed by histopathological examination is necessary to obtain a definitive diagnosis[3,6]. Immunohistochemical analysis by myoepithelial cells markers, combined with stromal markers, allows to rule out the various differential diagnoses, either malignant or benign tumors[3,7,13]. Although it is not known to be associated with the risk of malignant transformation, a few cases of adenoma associated with carcinoma have been reported[14,15]. However, a clear cut histological demarcation between the two lesions was present in all the reported cases.

  1. Salemis. Tubular Adenoma of the Breast: A Rare Presentation and Review of the Literature. 2019.
  2. 2.Hanby A, walker C. Tavassoli FA, Devilee P: Pathology and Genetics: Tumours of the Breast and Female Genital Organs. WHO Classification of Tumours series – volume IV. Lyon, France: IARC Press. Breast Cancer Research. 2004;6(3).
  3. Rare Breast Lesions: Correlation of Imaging and Histologic Features with WHO Classification |
    RadioGraphics [Internet]. Pubs.rsna.org. 2019 [cited 28 December 2019]. Available from:
    https://pubs.rsna.org/doi/full/10.1148/rg.285075743
  4. Sanjay Sengupta A. Evaluation of Clinico-Radio-Pathological Features of Tubular Adenoma of Breast: a Study of Ten Cases with Histopathological Differential Diagnosis [Internet]. PubMed Central (PMC). 2019 [cited 27 December 2019]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539785/
  5. Tavassoli F, Devilee P. Pathology and genetics of tumours of the breast and female genitale organs.
    Lyon: IARC Press; 2003.
  6. Pal S, Biswas B, Phukan J, Sengupta S, Sinha A, Sinha R. Preoperative diagnosis of tubular adenoma
    of breast – 10 years of experience. 2019.
  7. Spruill L. Benign mimickers of malignant breast lesions. 2019.
  8. Rovera F, Ferrari A, Carcano G, Dionigi G, Cinquepalmi L, Boni L et al. Tubular Adenoma of the Breast
    in an 84-Year-Old Woman: Report of a Case Simulating Breast Cancer. 2019.
  9. Soo MS e. Tubular adenomas of the breast: imaging findings with histologic correlation. – PubMed –
    NCBI [Internet]. Ncbi.nlm.nih.gov. 2019 [cited 27 December 2019]. Available from:
    https://www.ncbi.nlm.nih.gov/pubmed/10701621
  10. Tubular Adenoma of the Breast: A Clinicopathologic Study of a Series of 9 Cases – Boubacar Efared,
    Ibrahim S Sidibé, Souley Abdoulaziz, Nawal Hammas, Laila Chbani, Hinde El Fatemi, 2018 [Internet]. SAGE Journals. 2019 [cited 27 December 2019]. Available from:
    https://journals.sagepub.com/doi/full/10.1177/1179555718757499
  11. Huang Y, Zhang H, Zhou Q, Ling L, Wang S. Giant tubular adenoma of the accessory breast in the
    anterior chest wall occurred in a pregnant woman. 2019.
  12. Düşünceli F, Manukyan M, Midi A, Deveci U, Yener N. Giant Tubular Adenoma of the Breast: A Rare
    Entity. The Breast Journal. 2011;18(1):79-80.
  13. Maiorano E, Albrizio M. Tubular adenoma of the breast. 2019.
  14. Domoto H, Tsuda H, Miyakawa K, Shinoda A, Nanasawa T. Invasive ductal carcinoma associated
    with tubular adenoma of the breast. Pathology International. 2002;52(3):244-248.
  15. Saimura M, Anan K, Mitsuyama S, Ono M, Toyoshima S. Ductal carcinoma in situ arising in tubular
    adenoma of the breast. 2019.

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