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Breast
Histopathologic Diagnoses
Malignant Lesions
Tubular and Tubulolobular Carcinoma
Tubular and Tubulolobular Carcinoma
Wendie A. Berg, MD, PhD, FACR, FSBI; Hayley Oligane, DO; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Tubular carcinoma (TC) = cribriform carcinoma: Well-differentiated invasive ductal carcinoma (IDC) composed of tubular structures with single epithelial layer (lacking myoepithelium) and open lumina
                • Pure TC: Proportion of tubular structures ≥ 90%
                • IDC with tubular features = IDC with ≥ 50-89% tubular pattern = "mixed" TC
              • Tubulolobular carcinoma (TLC): Morphologically distinct, rare type of IDC with ≥ 75% of tumor consisting of well-formed tubules and single-file, dyscohesive cells (retaining E-cadherin)
                • Variable proportions: Predominantly tubular in 27%; equal in 27%; predominantly lobular in 47%

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Chen JX et al: The effects of postoperative radiotherapy on survival outcomes in patients under 65 with estrogen receptor positive tubular breast carcinoma. Radiat Oncol. 13(1):226, 2018
                                            2. Lee SJ et al: Correlation of tumor uptake on breast-specific gamma imaging and fluorodeoxyglucose PET/CT with molecular subtypes of breast cancer. Medicine (Baltimore). 97(43):e12840, 2018
                                            3. Poirier É et al: Characteristics and long-term survival of patients diagnosed with pure tubular carcinoma of the breast. J Surg Oncol. 117(6):1137-43, 2018
                                            4. Sun JY et al: Tubular carcinomas of the breast: an epidemiologic study. Future Oncol. ePub, 2018
                                            5. Wu SG et al: Omission of postoperative radiotherapy in women aged 65 years or older with tubular carcinoma of the breast after breast-conserving surgery. Front Oncol. 8:190, 2018
                                            6. Zhang WW et al: Clinicopathologic characteristics and clinical outcomes of pure type and mixed type of tubular carcinoma of the breast: a single-institution cohort study. Cancer Manag Res. 10:4509-15, 2018
                                            7. Boyan W et al: Tubular carcinoma of the breast: a single institution's experience of a favorable prognosis. Am Surg. 82(6):505-9, 2016
                                            8. Stolnicu S et al: Even small pure tubular carcinoma of the breast (stage T1a and T1b) can be associated with lymph node metastases - The U T MD Anderson Cancer Center experience. Eur J Surg Oncol. 42(6):911-2, 2016
                                            9. Lea V et al: Tubular carcinoma of the breast: axillary involvement and prognostic factors. ANZ J Surg. 85(6):448-51, 2015
                                            10. Munzone E et al: Outcomes of special histotypes of breast cancer after adjuvant endocrine therapy with letrozole or tamoxifen in the monotherapy cohort of the BIG 1-98 trial. Ann Oncol. 26(12):2442-9, 2015
                                            11. Romano AM et al: Tubular carcinoma of the breast: institutional and SEER database analysis supporting a unique classification. Breast Dis. 35(2):103-11, 2015
                                            12. Fritz P et al: Tubular breast cancer. A retrospective study. Anticancer Res. 34(7):3647-56, 2014
                                            13. Jorns JM et al: Estrogen receptor expression is high but is of lower intensity in tubular carcinoma than in well-differentiated invasive ductal carcinoma. Arch Pathol Lab Med. 138(11):1507-13, 2014
                                            14. Dejode M et al: Pure tubular carcinoma of the breast and sentinel lymph node biopsy: a retrospective multi-institutional study of 234 cases. Eur J Surg Oncol. 39(3):248-54, 2013
                                            15. Min Y et al: Tubular carcinoma of the breast: clinicopathologic features and survival outcome compared with ductal carcinoma in situ. J Breast Cancer. 16(4):404-9, 2013
                                            16. Bargalló X et al: Mammographic features of screening detected pT1 (a-b) invasive breast cancer using BI-RADS lexicon. Eur J Radiol. 81(10):2620-6, 2012
                                            17. Groves AM et al: Defining the role of PET-CT in staging early breast cancer. Oncologist. 17(5):613-9, 2012
                                            18. Linda A et al: Unusual malignant tumors of the breast: MRI features and pathologic correlation. Eur J Radiol. 75(2):178-84, 2010
                                            19. Manfrin E et al: Cancer size, histotype, and cellular grade may limit the success of fine-needle aspiration cytology for screen-detected breast carcinoma. Cancer. 117(6):491-9, 2009
                                            20. Esposito NN et al: The ductal phenotypic expression of the E-cadherin/catenin complex in tubulolobular carcinoma of the breast: an immunohistochemical and clinicopathologic study. Mod Pathol. 20(1):130-8, 2007
                                            21. Leikola J et al: The prevalence of axillary lymph-node metastases in patients with pure tubular carcinoma of the breast and sentinel node biopsy. Eur J Surg Oncol. 32(5):488-91, 2006
                                            22. Marchiò C et al: A new vision of tubular and tubulo-lobular carcinomas of the breast, as revealed by 3-D modelling. Histopathology. 48(5):556-62, 2006
                                            23. Fernandez-Aguilar S et al: Is complete axillary lymph node dissection neccessary in T1 stage invasive pure tubular carcinomas of the breast? Breast. 14(4):325-8, 2005
                                            24. Khirwadkar N et al: Fine needle aspiration cytology of tubular carcinoma of the breast. Acta Cytol. 49(3):344-5, 2005
                                            25. Leonard CE et al: Excision only for tubular carcinoma of the breast. Breast J. 11(2):129-33, 2005
                                            26. Livi L et al: Tubular carcinoma of the breast: outcome and loco-regional recurrence in 307 patients. Eur J Surg Oncol. 31(1):9-12, 2005
                                            27. Sullivan T et al: Tubular carcinoma of the breast: a retrospective analysis and review of the literature. Breast Cancer Res Treat. 93(3):199-205, 2005
                                            28. Goldstein NS et al: Refined morphologic criteria for tubular carcinoma to retain its favorable outcome status in contemporary breast carcinoma patients. Am J Clin Pathol. 122(5):728-39, 2004
                                            29. Cabral AH et al: Tubular carcinoma of the breast: an institutional experience and review of the literature. Breast J. 9(4):298-301, 2003
                                            30. Holland DW et al: Tubular breast cancer experience at Washington University: a review of the literature. Clin Breast Cancer. 2(3):210-4, 2001
                                            31. Kader HA et al: Tubular carcinoma of the breast: a population-based study of nodal metastases at presentation and of patterns of relapse. Breast J. 7(1):8-13, 2001
                                            32. Wurdinger S et al: False-negative findings of malignant breast lesions on preoperative magnetic resonance mammography. Breast. 10(2):131-9, 2001
                                            33. Sheppard DG et al: Tubular carcinoma of the breast: mammographic and sonographic features. AJR Am J Roentgenol. 174(1):253-7, 2000
                                            34. Mitnick JS et al: Tubular carcinoma of the breast: sensitivity of diagnostic techniques and correlation with histopathology. AJR Am J Roentgenol. 172(2):319-23, 1999
                                            35. Green I et al: A comparative study of pure tubular and tubulolobular carcinoma of the breast. Am J Surg Pathol. 21:653-7, 1997
                                            36. Gupta RK et al: Fine needle aspiration cytology of tubular carcinoma of the breast. Acta Cytol. 41(4):1139-43, 1997
                                            37. McBoyle MF et al: Tubular carcinoma of the breast: an institutional review. Am Surg. 63(7):639-44; discussion 644-5, 1997
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Tubular carcinoma (TC) = cribriform carcinoma: Well-differentiated invasive ductal carcinoma (IDC) composed of tubular structures with single epithelial layer (lacking myoepithelium) and open lumina
                                                          • Pure TC: Proportion of tubular structures ≥ 90%
                                                          • IDC with tubular features = IDC with ≥ 50-89% tubular pattern = "mixed" TC
                                                        • Tubulolobular carcinoma (TLC): Morphologically distinct, rare type of IDC with ≥ 75% of tumor consisting of well-formed tubules and single-file, dyscohesive cells (retaining E-cadherin)
                                                          • Variable proportions: Predominantly tubular in 27%; equal in 27%; predominantly lobular in 47%

                                                      IMAGING

                                                      • General Features

                                                        • Mammographic Findings

                                                          • Ultrasonographic Findings

                                                            • MR Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Chen JX et al: The effects of postoperative radiotherapy on survival outcomes in patients under 65 with estrogen receptor positive tubular breast carcinoma. Radiat Oncol. 13(1):226, 2018
                                                                                      2. Lee SJ et al: Correlation of tumor uptake on breast-specific gamma imaging and fluorodeoxyglucose PET/CT with molecular subtypes of breast cancer. Medicine (Baltimore). 97(43):e12840, 2018
                                                                                      3. Poirier É et al: Characteristics and long-term survival of patients diagnosed with pure tubular carcinoma of the breast. J Surg Oncol. 117(6):1137-43, 2018
                                                                                      4. Sun JY et al: Tubular carcinomas of the breast: an epidemiologic study. Future Oncol. ePub, 2018
                                                                                      5. Wu SG et al: Omission of postoperative radiotherapy in women aged 65 years or older with tubular carcinoma of the breast after breast-conserving surgery. Front Oncol. 8:190, 2018
                                                                                      6. Zhang WW et al: Clinicopathologic characteristics and clinical outcomes of pure type and mixed type of tubular carcinoma of the breast: a single-institution cohort study. Cancer Manag Res. 10:4509-15, 2018
                                                                                      7. Boyan W et al: Tubular carcinoma of the breast: a single institution's experience of a favorable prognosis. Am Surg. 82(6):505-9, 2016
                                                                                      8. Stolnicu S et al: Even small pure tubular carcinoma of the breast (stage T1a and T1b) can be associated with lymph node metastases - The U T MD Anderson Cancer Center experience. Eur J Surg Oncol. 42(6):911-2, 2016
                                                                                      9. Lea V et al: Tubular carcinoma of the breast: axillary involvement and prognostic factors. ANZ J Surg. 85(6):448-51, 2015
                                                                                      10. Munzone E et al: Outcomes of special histotypes of breast cancer after adjuvant endocrine therapy with letrozole or tamoxifen in the monotherapy cohort of the BIG 1-98 trial. Ann Oncol. 26(12):2442-9, 2015
                                                                                      11. Romano AM et al: Tubular carcinoma of the breast: institutional and SEER database analysis supporting a unique classification. Breast Dis. 35(2):103-11, 2015
                                                                                      12. Fritz P et al: Tubular breast cancer. A retrospective study. Anticancer Res. 34(7):3647-56, 2014
                                                                                      13. Jorns JM et al: Estrogen receptor expression is high but is of lower intensity in tubular carcinoma than in well-differentiated invasive ductal carcinoma. Arch Pathol Lab Med. 138(11):1507-13, 2014
                                                                                      14. Dejode M et al: Pure tubular carcinoma of the breast and sentinel lymph node biopsy: a retrospective multi-institutional study of 234 cases. Eur J Surg Oncol. 39(3):248-54, 2013
                                                                                      15. Min Y et al: Tubular carcinoma of the breast: clinicopathologic features and survival outcome compared with ductal carcinoma in situ. J Breast Cancer. 16(4):404-9, 2013
                                                                                      16. Bargalló X et al: Mammographic features of screening detected pT1 (a-b) invasive breast cancer using BI-RADS lexicon. Eur J Radiol. 81(10):2620-6, 2012
                                                                                      17. Groves AM et al: Defining the role of PET-CT in staging early breast cancer. Oncologist. 17(5):613-9, 2012
                                                                                      18. Linda A et al: Unusual malignant tumors of the breast: MRI features and pathologic correlation. Eur J Radiol. 75(2):178-84, 2010
                                                                                      19. Manfrin E et al: Cancer size, histotype, and cellular grade may limit the success of fine-needle aspiration cytology for screen-detected breast carcinoma. Cancer. 117(6):491-9, 2009
                                                                                      20. Esposito NN et al: The ductal phenotypic expression of the E-cadherin/catenin complex in tubulolobular carcinoma of the breast: an immunohistochemical and clinicopathologic study. Mod Pathol. 20(1):130-8, 2007
                                                                                      21. Leikola J et al: The prevalence of axillary lymph-node metastases in patients with pure tubular carcinoma of the breast and sentinel node biopsy. Eur J Surg Oncol. 32(5):488-91, 2006
                                                                                      22. Marchiò C et al: A new vision of tubular and tubulo-lobular carcinomas of the breast, as revealed by 3-D modelling. Histopathology. 48(5):556-62, 2006
                                                                                      23. Fernandez-Aguilar S et al: Is complete axillary lymph node dissection neccessary in T1 stage invasive pure tubular carcinomas of the breast? Breast. 14(4):325-8, 2005
                                                                                      24. Khirwadkar N et al: Fine needle aspiration cytology of tubular carcinoma of the breast. Acta Cytol. 49(3):344-5, 2005
                                                                                      25. Leonard CE et al: Excision only for tubular carcinoma of the breast. Breast J. 11(2):129-33, 2005
                                                                                      26. Livi L et al: Tubular carcinoma of the breast: outcome and loco-regional recurrence in 307 patients. Eur J Surg Oncol. 31(1):9-12, 2005
                                                                                      27. Sullivan T et al: Tubular carcinoma of the breast: a retrospective analysis and review of the literature. Breast Cancer Res Treat. 93(3):199-205, 2005
                                                                                      28. Goldstein NS et al: Refined morphologic criteria for tubular carcinoma to retain its favorable outcome status in contemporary breast carcinoma patients. Am J Clin Pathol. 122(5):728-39, 2004
                                                                                      29. Cabral AH et al: Tubular carcinoma of the breast: an institutional experience and review of the literature. Breast J. 9(4):298-301, 2003
                                                                                      30. Holland DW et al: Tubular breast cancer experience at Washington University: a review of the literature. Clin Breast Cancer. 2(3):210-4, 2001
                                                                                      31. Kader HA et al: Tubular carcinoma of the breast: a population-based study of nodal metastases at presentation and of patterns of relapse. Breast J. 7(1):8-13, 2001
                                                                                      32. Wurdinger S et al: False-negative findings of malignant breast lesions on preoperative magnetic resonance mammography. Breast. 10(2):131-9, 2001
                                                                                      33. Sheppard DG et al: Tubular carcinoma of the breast: mammographic and sonographic features. AJR Am J Roentgenol. 174(1):253-7, 2000
                                                                                      34. Mitnick JS et al: Tubular carcinoma of the breast: sensitivity of diagnostic techniques and correlation with histopathology. AJR Am J Roentgenol. 172(2):319-23, 1999
                                                                                      35. Green I et al: A comparative study of pure tubular and tubulolobular carcinoma of the breast. Am J Surg Pathol. 21:653-7, 1997
                                                                                      36. Gupta RK et al: Fine needle aspiration cytology of tubular carcinoma of the breast. Acta Cytol. 41(4):1139-43, 1997
                                                                                      37. McBoyle MF et al: Tubular carcinoma of the breast: an institutional review. Am Surg. 63(7):639-44; discussion 644-5, 1997
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