Invasive tubular carcinoma of the breast is a very well differenciated tumor. Purely tubular carcinoma represents a mere 2% of all mammary carcinomas. As in most cases they present themselves as small, non palpable lesions, they are difficult to find. But with the help of new, improved detecting methods, it is possible that they would be more frequent than we first tought. Some sources say that tubular carcinoma could be a transition form towards a less differenciated form of ductal carcinoma. Mammography shows a stellate aspect, with ill-defined borders, mimicking a radial scar. They present themselves in small foci, most often in association with another carcinoma. Tubulolobular carcinoma is for instance, a tubular carcinoma in association with a lobular carcinoma.

It is a slow-growing tumor, of good prognosis, as lymph node metastases ar rare. Except when it is in association with another carcinoma. Intraductal carcinoma is found in most of the cases in papillary arrangement, cribriform or both. Cells are regular, forming tubules surrounded by abundant fibrous stroma. Typically, the glands consist of a single layer of clear cubic cells, without myoepithelial cells. Cytologically, the general image reminds that of a fibroadenoma. Cellularity is rich, and the cell groups are uniform with bland nuclei. In the tubular carcinoma, cell groups are rather ellongated and thin, but in fibroadenoma, they are larger with monolayer arrangement.

In many cases of tubular carcinoma, myoepithelial cells can be observed, scattered in the background of the smear, but not interspersed in the cell groups, like in the fibroadenoma. Cell atypias are very slight, sometimes moderate. Chromatin is finely distributed, sometimes with nuclear grooves, and occasionally with a small intracytoplasmic vacuole. Cytoplasmic vacuoles, especially with the "target" image, are rather typical of lobular carcinoma, but one can find them also in ductal carcinoma. There are small inconspicuous nucleoli. Tumor cells are found isolated or in angular, or bent tubules. A lumina can be observed in the tubules. The cells within the groups are rather cohesive, but some groups display a clear dyscohesion. Mitoses are rare and microcalcifications can be seen.

Microcalcifications can be found in other mammary carcinomas, and even in benign lesions, like sclerosing adenosis. Fibrous stroma is sometimes observed as elastoid material, long filaments, stained green with Papanicolaou staining, intermixed or not with isolated cells.

Tubular invasive carcinoma of the breast is a challenging diagnosis in cytology, as the typical criteria are not always present, or simply overlooked. At best can we mention some cellular irregularities and suggest a biopsy. In the case presented here, we were lucky to have all the classical aspects, and so we could tell the precise diagnosis, which was later confirmed by histology.

-Eighty-one year old woman.

 

  
  Numerous groups of tumor cells in sheets or forming "tubules" which are sometimes bent.  
       
  Tumour cells have a quite uniform aspect, without anisonucleosis. Chromatin is not coarse, there is no prominent nucleoli and nuclear borders are regular. A slignt dyscohesion of the cells can be noted.  
       
  Group with tubular arrangement with three mitoses.  
       
  Here, the nucleoli are a little more visible. There are many microcalcifications.  
       
  Group with gland lumina.  
       
  Elastoid fibres.  
       
  Many tubules which ar often angular.  
       
  Close-up of a gland. One can note the absence of myoepithelial cells. The gland seems to sit free in the stroma. Nuclei do not have prominent nucleoli. Chromatin is not very coarse. There is no marked anisonucleosis.  
       
 
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  Dernière mise à jour: le 31 janvier, 2004    
 

Pour en savoir plus:

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