A tubular adenoma is a kind of breast adenoma characterized by densely packed ‘tubular‘ and ‘acinar‘ (bud-like) cell formations. An adenoma is a disorganized neoplasm consisting of varied amounts of glandular, fibrous, and fat tissue that can result in a mass or pseudo-lesion. Tubular adenomas are sometimes called ‘pure‘ adenomas because they tend not to show excessive epithelial hyperplasia and connective tissue growth. But they do quite commonly appear mixed with the generic ‘fibroadenoma‘ as well.
Have a look at our new and improved page on tubular adenoma – it is more up-to-date. However, this one is still pretty good, too!
Histologically (microscopically), the tubular and acinar cell formations, which are actually small breast ducts, tend to be very small and regular in size. The surrounding fibrous stroma tends to be quite sparse. It typically presents on an X-ray or ultrasound as a well-circumscribed, solitary mass. However, tubular adenomas also frequenty show tightly packed, punctate, irregular calcifications.
Breast Tubular adenomas have a distinctive pattern of microcalcifications
Microcalcifications raise concerns about a possible malignant process (breast cancer), but the calcifications associated with tubular adenoma tend to be fairly distinctive, and a percutaneous core biopsy for confirmation will usually lay any fears to rest.
The xray image above is a close up of tubular breast adenoma with tightly clustered, dense, microcalcifications. A sonogram of the same lesion, shown below, shows a homogeneous, well circumscribed, oval, hypoechoic mass, with a mild degree of posterior acoustic enhancement. But from these images, there is really no way to predict that it is tubular adenoma, as it could resemble any number of solid nodules.
Tubular adenomas of the breast are completely benign
Tubular breast adenomas are rare, but are most common in younger women. When they occur in older women, it is more likely that they will have developed microcalcifications. They are benign and do not evolve into malignant carcinoma, and they do not metastasize. There is some concern with breast adenomas that undetected epithelial malignancy may be simultaneously growing within the neoplasm, but there is little evidence of this for tubular adenomas. In terms of management, tubular adenomas are typically just left alone. But if the adenoma grows to a size that causes pain or impairs breast function, it may be surgically excised. Routine followup screenings would be a prudent measure.
Below are a couple common Q&A …
- What does the tubular adenoma of breast look like? On gross pathology, tubular adenomas appear as small, round, oval, soft to firm, well-circumscribed masses. Microscopically, they contain closely-approximated tubular structures that vary little in size, and tan-yellow in color.
- At what age is tubular adenoma more common? It is more common in younger women and occasionally in older women.
- What treats tubular adenoma? Excision, it does not recur.
- What causes adenoma? The cause it not known, but it can be related to reproductive hormones.
- Moross T, Lang AP, Mahoney L. Tubular adenoma of breast. Arch Pathol Lab
- Stavros TA, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid
breast nodules: use of sonography to distinguish between benign and malignant
lesions. Radiology 1995;196:123-134
- Soo, MS., Dash, N., Bentley, R., Lee, LH., Nathan, G, Tubular Adenomas
of the Breast
Imaging Findings with Histologic Correlation. American Journal of Roentgenology,