Tubular Adenoma

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 various 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 more up-to-date list of posts including tubular adenoma – However, this one is still pretty good, too!

Histologically (microscopically), the tubular and acinar cell formations, that 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 frequently show abundant, punctate, irregular calcifications.

Breast Tubular adenomas have a distinctive pattern of Microcalcifications

Microcalcifications raise concerns about a possible malignant process (breast cancer). However, the calcifications, in this case, tend to be fairly distinctive. So, a percutaneous core biopsy for confirmation will usually lay any fears to rest.

The X-ray 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 alone, there is really no way to predict that it is tubular adenoma, as it resembles any number of solid nodules.

Tubular adenomas of the breast are completely benign

Tubular breast adenomas are rare. Furthermore, these type of tumors are more common in younger women. However, when they occur in older women, it is more likely that they will present with microcalcifications.

So ladies, here is the main point tubular adenomas are benign and do not evolve into malignant carcinoma. In addition they do not metastasize.

There is a very small concern with breast adenomas, that an undetected epithelial malignancy may be simultaneously growing within the tumor. However, there is little evidence of this phenomenon in tubular adenomas.

In terms of treatment and 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 require surgical excision. Routine followup screenings would be a prudent measure.

Below are a couple common Q&A’s …

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 tubular structures that can vary a little in size. In addition, these tumors are 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 is the treatment for tubular adenoma?

Tubular adenomas are often left alone but if the symptoms cause problems then surgical excision may be necessary. However, after resection tubular adenomas do not tend to recur.

What causes adenoma?

Although scientists do not agree on the exact cause of tubular adenomas, hormones are possibly a factor.

References

Moross T, Lang AP, Mahoney L. (1983) Tubular adenoma of breast. Arch Pathol Lab
Med 1983;107:84-86 https://www.ncbi.nlm.nih.gov/pubmed/6687425
Stavros TA, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. (1995) Solid
breast nodules: use of sonography to distinguish between benign and malignant
lesions. Radiology 1995;196:123-134 https://www.ncbi.nlm.nih.gov/pubmed/7784555
Soo MS, Dash N, Bentley R, Lee LH, Nathan G. (2000) Tubular Adenomas
of the Breast
Imaging Findings with Histologic Correlation. American Journal of Roentgenology, https://www.ncbi.nlm.nih.gov/pubmed/10701621 2000; 174:757-761 https://www.ncbi.nlm.nih.gov/pubmed/10701621