Tubular carcinomas
Tubular carcinomas are a specific subtype of invasive ductal carcinoma, recognized for their well-differentiated structure characterized by small epithelial tubules invading the surrounding tissue. This type of breast cancer typically arises in women aged 40 to 60 and accounts for a small percentage (1 to 5 percent) of all breast cancer cases. Tubular carcinomas can be classified into pure and mixed types, with pure tubular carcinomas exhibiting over 70 percent tubularity, while mixed forms incorporate ductal components and tend to be more aggressive. The tumors are estrogen-dependent and HER2/neu negative, which influences treatment options.
Patients may first notice tubular carcinoma as a palpable mass, often detectable through mammography, where it may appear as microcalcifications or small masses. The prognosis for patients with pure tubular carcinoma is generally favorable, with a nearly 100 percent survival rate over fifteen years, attributed to its slower progression and low metastasis potential. Treatment options often mirror those for other estrogen-responsive breast cancers, including mastectomy and hormone-related therapies. Understanding the characteristics of tubular carcinomas is crucial for determining appropriate treatment and predicting patient outcomes.
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Subject Terms
Tubular carcinomas
ALSO KNOWN AS: Pure or mixed tubular carcinomas, tubulolobular carcinomas
RELATED CONDITIONS: Infiltrating ductal carcinomas
DEFINITION: Tubular carcinomas are a type of invasive ductal carcinoma, a well-differentiated form of breast cancer characterized by invasion of the stroma by small epithelial tubules.
Risk factors: The risk factors for the development of tubular carcinoma may be the presence of a radial scar, lobular proliferative lesions, and ductal carcinoma.
Etiology and the disease process: Tubular breast carcinoma is estrogen-dependent and human epidermal growth factor receptor 2/neu (HER2/neu) negative. The tumor varies in size and cell division time. Tubular carcinomas are a genetically distinct group of breast cancers. In particular, pure tubular carcinomas are a separate morphologic entity and have more than 70 percent tubularity. Carcinomas with less than 70 percent tubularity are often ductal and aggressive and are referred to as mixed tubular carcinomas. Another type of tubular carcinoma is tubulolobular carcinoma, which consists of tubular and infiltrating lobular elements. Tubular carcinoma is usually an unicentric lesion, but in about 20 percent of the cases, it exhibits multifocality. Multifocality is found in more than 30 percent of mixed tubular or tubulolobular carcinomas. Contralateral development of cancers, such as infiltrating ductal tumors, has been reported in 10 percent of patients with tubular carcinoma.
Incidence: Although invasive cancers containing tubular elements are common, tubular carcinoma is rare and accounts for between 1 and 5 percent of all breast cancers. It occurs most frequently in women between the ages of forty and sixty.
Symptoms: Tubular carcinoma often manifests as a palpable mass. Infiltrating ductal carcinoma is characterized by a hard lump with irregular borders, and the skin over the area or the nipple may retract.
Screening and diagnosis: Tubular carcinoma is usually detected by mammography, appearing as a small mass and spicules or microcalcifications when the mass is less than 1 centimeter (cm) in diameter. The spicules are often due to malignant cells and fibrous stroma. Under a microscope, the cancer cells in tubular carcinoma resemble tiny tubes that are well differentiated.
Treatment and therapy: Treatment for tubular carcinoma resembles that for estrogen-responsive breast cancer, and it may include mastectomy. Hormone-related and targeted therapies may also be used.
Prognosis, prevention, and outcomes: Pure tubular carcinoma typically does not metastasize, and patients with this disease have an excellent survival rate. Patients with tubular carcinomas have an almost 100 percent fifteen-year survival rate. Tubular carcinoma is less aggressive, has a slower progression rate, and responds well to treatment. Tubular carcinoma also has a low recurrence rate. However, the differentiation between the types of tubular carcinomas is important for more precise prognosis. With the increase of nontubular elements in a tumor, the likelihood of metastatic spread and multifocality also increase.
Bibliography
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Limaiem, Fatam. “Tubular Breast Carcinoma - StatPearls.” NCBI, 1 Jan. 2023, www.ncbi.nlm.nih.gov/books/NBK542223. Accessed 17 June 2024.
Schnitt, Stuart, and Sandra J. Shin. Breast Pathology: Diagnosis and Insights. Philadelphia: Saunders, 2012.
Yap, Joshua. “Tubular Carcinoma of the Breast - Radiology Reference Article.” Radiopaedia, 13 May 2023, radiopaedia.org/articles/tubular-carcinoma-of-the-breast. Accessed 17 June 2024.