|Year : 2021 | Volume
| Issue : 1 | Page : 40-41
Tubular adenoma of the breast: A rare entity
L Rashil Simon1, Moirangthem Henary Singh2, Angelica Laiphrakpam3, L Sushila Devi2
1 Department of Surgery, Jnims, Imphal, Manipur, India
2 Department of Pathology, Jnims, Imphal, Manipur, India
3 Department of Pastic and Reconstructive Surgery, Afmc, Pune, Maharashtra, India
|Date of Submission||05-Jan-2021|
|Date of Acceptance||19-Jun-2021|
|Date of Web Publication||04-Aug-2021|
Moirangthem Henary Singh
Department of Pathology, JNIMS, Imphal - 795 005, Manipur
Source of Support: None, Conflict of Interest: None
Tubular adenoma is a rare benign neoplasm of the breast. It is commonly seen in premenopausal women and has no association with an increased risk of breast cancer. It is difficult to diagnose tubular adenoma clinically, radiologically, and cytologically. Histopathological examination remains the gold standard in diagnosing tubular adenoma.
Keywords: Fibroadenoma, histopathology, tubular adenoma
|How to cite this article:|
Simon L R, Singh MH, Laiphrakpam A, Devi L S. Tubular adenoma of the breast: A rare entity. J Med Soc 2021;35:40-1
| Introduction|| |
Tubular adenoma is one of the rarest benign neoplasms of the breast, accounting for only 0.13%–1.7% of all benign breast neoplasms. It is typically seen in women of reproductive age group. It is difficult to diagnose and differentiate it from other benign lesions (fibroadenoma) and malignant breast cancer (tubular carcinoma) on the basis of physical examination, imaging studies, and aspiration cytology. A definite diagnosis can be established only after histopathological examination. Only a few cases are reported in the current literature, and as such, it is not a well-known entity among clinicians. Here, we report a case of tubular adenoma clinically diagnosed as fibroadenoma.
| Case Report|| |
A 16-year-old girl presented with a complaint of gradually enlarging painless lump in the (L) breast of 8-month duration. There is no history of any associated nipple discharge or skin changes. There was no history of breast malignancy in the family. No known comorbidities were present. Physical examination revealed a firm, nontender, freely mobile, well-defined lump of size 2 cm × 1.5 cm in the upper outer quadrant of the (L) breast. There were no palpable axillary or supraclavicular lymph nodes. Another systemic examination was unremarkable. A clinical diagnosis of fibroadenoma was made, supported by fine-needle aspiration cytology and sonographic findings, and the patient underwent excision biopsy. Histopathological examination revealed it to be a case of tubular adenoma [Figure 1] and [Figure 2]. The postoperative period was uneventful.
|Figure 1: Tubular adenoma showing tightly packed homogenous tubular and acinar epithelial components with sparse stroma (H and E, ×10)|
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|Figure 2: Tubular adenoma showing attenuated myoepithelial cell layer (H and E, ×40)|
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| Discussion|| |
Tubular adenomas are rare benign epithelial tumors of the breast, and in 90% of the cases, it occurs in women below 40 years of age, although there are reported cases of tubular adenoma occurring in postmenopausal women. Tubular adenoma resembles fibroadenoma clinically as well as on imaging studies and usually presents as a painless, freely mobile, well-defined breast mass with no skin or nipple alterations. A differentiation from fibroadenoma can only be made histologically. Tubular adenomas are characterized by the presence of tightly packed homogenous tubular and acinar epithelial components with sparse stroma while fibroadenomas show abundant stroma. The tubules are lined by a single layer of epithelial cells with an attenuated myoepithelial layer.
Preoperative diagnosis of tubular adenoma is extremely difficult because, in majority of the cases, the physical findings and imaging features are nonspecific. Radiologically, it resembles noncalcified fibroadenomas in younger women, while in older women, microcalcifications may be present resembling malignancy. The presence of both tubular adenoma and fibroadenoma has been reported suggesting a close relation of the two processes. Reports of tubular adenoma occurring in accessory breast have also been described in the literature.
However, tubular adenoma is a completely benign tumor and is not known to be associated with an increased risk of breast cancer. Even reported cases of association between carcinoma and tubular adenoma showed generally histologically demarcated lesions and seemed to be a collision between a separate tubular adenoma and an invasive carcinoma.
| Conclusion|| |
Tubular adenomas of the breast are rare benign epithelial tumors most commonly seen in young women of reproductive age. Preoperative diagnosis is difficult as physical findings and imaging studies are nonspecific. Surgical excision followed by histopathological examination is needed to arrive at a definite diagnosis and is the treatment of choice. Despite its rarity, it is important for surgeons to keep this entity in mind during diagnostic evaluation of breast lesions in order to avoid unnecessary aggressive treatment and the entailing morbidity and mortality.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]