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CASE REPORT
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 252-254  

Traits of tubular adenoma cytology


Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India

Date of Web Publication29-Jun-2018

Correspondence Address:
Manoj Gopal Madakshira
Department of Pathology, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_45_17

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  Abstract 


Tubular adenoma of breast is a rare benign pure epithelial tumor, which presents as a palpable mass. Clinical examination and imaging modalities are similar to that seen in a case of fibroadenoma. In such a situation, fine-needle aspiration can be a useful diagnostic tool. However, the cytopathologist has to be aware of the subtle cytology traits of tubular adenoma to make an informed assessment. We discuss a case diagnosed preoperatively as a case of tubular adenoma with histopathological confirmation.

Keywords: Adenoma, breast, cytology, tubular


How to cite this article:
Madakshira MG, Shelly D, Bharadwaj R. Traits of tubular adenoma cytology. Med J DY Patil Vidyapeeth 2018;11:252-4

How to cite this URL:
Madakshira MG, Shelly D, Bharadwaj R. Traits of tubular adenoma cytology. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Aug 25];11:252-4. Available from: http://www.mjdrdypv.org/text.asp?2018/11/3/252/235566




  Introduction Top


Tubular adenoma is an uncommon benign epithelial tumor of the breast. It constitutes about 1.7% of all benign lesions of the breast.[1] Persaud et al., in 1968, was the first to describe tubular adenoma as an exclusive subtype.[2] The initial cytological features of tubular adenoma were documented in 1983 by Moross et al.[3] As the clinical and radiological features of tubular adenoma overlap with those of fibroadenoma, establishing a preoperative diagnosis of tubular adenoma is often arduous.[4] Preoperative fine-needle aspiration can be a useful tool in arriving at a probable diagnosis of tubular adenoma.[5],[6] This is possible if the pathologist is aware of the subtle cytological traits of tubular adenoma to make an intuitive assessment. We describe a case of tubular adenoma which was diagnosed preoperatively with histopathological confirmation.


  Case Report Top


A 35-year-old female presented to our hospital with complaints of a gradually enlarging palpable right breast mass in the upper outer quadrant. She had no significant past history with a normal menstrual history. There was no family history of breast or ovarian cancer. On examination, there was a firm, nontender lump with normal appearing overlying skin and nipple–areola complex. The ipsilateral axilla was free of any palpable lymph nodes. Ultrasonography revealed a homogenous, well-circumscribed, hypoechoic mass, suggestive of a fibroadenoma. A fine-needle aspiration was attempted from the lump. The aspirate smears were cellular [Figure 1]a and composed of cells arranged in small, 3-dimensional cohesive clusters [Figure 1]c, straight tubules [Figure 1]b, and acini [Figure 1]d against a clean background. There was a paucity of bare nuclei, absence of stromal fragments, and staghorn pattern of cell clusters. The individual cells were uniform with a moderate amount of pale cytoplasm with regular nuclei and inconspicuous nucleoli [Figure 1]d. Myoepithelial cells with characteristic small dark oval nuclei were seen admixed within the epithelial cell clusters. No nuclear pleomorphism was seen. An opinion of benign breast lesion favoring tubular adenoma was offered on cytology. The patient was taken up for surgery for excision of the lesion. The excised tissue measured 7 cm × 6 cm × 5 cm with a white cut surface [Figure 2]a. Hematoxylin- and eosin-stained sections showed a well-circumscribed lesion with a thick fibrous capsule, enclosing closely approximated small tubules separated by scant loose fibrocollagenous stroma [Figure 2]b. The tubules are lined by cuboidal cells buttressed by a layer of myoepithelial cells [Figure 2]c. The patient had an uneventful postoperative course and is presently asymptomatic.
Figure 1: (a) May–Grunwald–Giemsa-stained aspirate smear (×40) is cellular with cohesive cell clusters, (b) May–Grunwald–Giemsa-stained aspirate smear (×400) shows a cohesive cell clusters in the form of straight tubules with rounded ends, (c) May–Grunwald–Giemsa-stained aspirate smear (×400) shows a ball-like 3-dimensional cell cluster, (d) Papanicolaou-stained aspirate smear (×1000) shows uniform ductal cells forming an acinus admixed with an occasional myoepithelial cell

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Figure 2: (a) Cut surface of lumpectomy specimen showing yellow-white well-circumscribed lesion, (b) a thick fibro-collagenous capsule enclosing the tumor mass (H and E, ×40), (c) closely packed small tubules with sparse loose fibrocollagenous stroma (H and E, ×400)

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  Discussion Top


The pure epithelial neoplasms of the breast are called adenomas.[7] As per the WHO classification of breast neoplasms, adenomas are classified into tubular adenoma, lactating adenoma, apocrine adenoma, pleomorphic adenoma, and ductal adenoma.[8] Tubular adenoma was considered as a variant of pericanalicular fibroadenoma with an unprecedented adenosis-like proliferation of epithelial elements.[1] Tubular adenoma presents in women during the reproductive age group of <40 years but has not been associated with pregnancy or contraceptive pills.[9] Tubular adenoma presents as a mobile, painless breast lump with the absence of skin and nipple changes.[1] Imaging is not specific for tubular adenoma and has a character similar to that of fibroadenoma. Ultrasonography shows a well-defined hypoechoic lesion having a posterior acoustic enhancement. Mammography of tubular adenoma may in some instances reveal the presence of microcalcifications, warranting a higher Breast Imaging, Reporting and Data system Score.[10] Grossly, tubular adenoma is well-circumscribed and is characterized by the presence of a thick capsule and a whitish cut surface. Histology of the tumor has a characteristic feature of closely arranged tubules and acini with scant interspersed stroma.[11] The tubules and acini are lined by benign ductal epithelial cells supported by a layer of myoepithelial cells. Literature [Table 1] on the cytological features of tubular adenoma is limited.[3],[4],[5],[6] Most authors agree that fine-needle aspiration of tubular adenoma is cellular and has compact clusters and 3-dimensional balls of cells arranged in straight tubules and acinar patterns.[5],[6] The aspirate usually shows the absence or paucity of classical staghorn pattern of cell clusters seen in cases of fibroadenoma. The smears also are conspicuous by the absence of the fibromyxoid stromal component, which is seen in most cases of fibroadenoma.[3],[6] The background in tubular adenoma has a lack of bare nuclei.[6] The individual cells have moderate cytoplasm, with some authors reporting the presence of cytoplasmic granularity on Romanowsky-stained smears.[5] The epithelial cells are uniform and have an oval-to-round nucleus with inconspicuous nucleoli. Presence of infarction in rare cases of tubular adenoma may lead to the presence of degenerative changes mimicking atypia which can be difficult to differentiate from carcinoma.[1] In such instances, definitive diagnosis can only be achieved following histopathological examination of the excised lesion. Rare instances of tubular adenoma occurring in elderly may be difficult to differentiate from a malignant lesion and mandates an excision biopsy for histopathological confirmation.[12] In conclusion, cytology can be instrumental in making an intelligent diagnosis of tubular adenoma, by identifying the characteristic cytological traits in the setting of a young female with the imaging suggestive of a benign lesion.
Table 1: Review of salient cytology traits of tubular adenoma over the years

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Salemis NS, Gemenetzis G, Karagkiouzis G, Seretis C, Sapounas K, Tsantilas V, et al. Tubular adenoma of the breast: A rare presentation and review of the literature. J Clin Med Res 2012;4:64-7.  Back to cited text no. 1
    
2.
Persaud V, Talerman A, Jordan R. Pure adenoma of the breast. Arch Pathol 1968;86:481-3.  Back to cited text no. 2
    
3.
Moross T, Lang AP, Mahoney L. Tubular adenoma of breast. Arch Pathol Lab Med 1983;107:84-6.  Back to cited text no. 3
    
4.
Sengupta S, Pal S, Biswas BK, Bose K, Phukan JP, Sinha A. Evaluation of clinico-radio-pathological features of tubular adenoma of breast: A study of ten cases with histopathological differential diagnosis. Iran J Pathol 2015;10:17-22.  Back to cited text no. 4
    
5.
Shet TM, Rege JD. Aspiration cytology of tubular adenomas of the breast. An analysis of eight cases. Acta Cytol 1998;42:657-62.  Back to cited text no. 5
    
6.
Kumar N, Kapila K, Verma K. Characterization of tubular adenoma of breast – Diagnostic problem in fine needle aspirates (FNAs). Cytopathology 1998;9:301-7.  Back to cited text no. 6
    
7.
Tavassoli FA, Devilee P. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. Lyon: IARC; 2003.  Back to cited text no. 7
    
8.
Irshad A, Ackerman SJ, Pope TL, Moses CK, Rumboldt T, Panzegrau B. Rare breast lesions: Correlation of imaging and histologic features with WHO classification. Radiographics 2008;28:1399-414.  Back to cited text no. 8
    
9.
Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am 2002;29:1-20.  Back to cited text no. 9
    
10.
Soo MS, Dash N, Bentley R, Lee LH, Nathan G. Tubular adenomas of the breast: Imaging findings with histologic correlation. AJR Am J Roentgenol 2000;174:757-61.  Back to cited text no. 10
    
11.
Dhaliwal C, Bashat GH, Miller ID, Graham AD. Rare benign lesions of the breast. Diagn Histopathol 2017;23:137-48.  Back to cited text no. 11
    
12.
Nishimori H, Sasaki M, Hirata K, Zembutsu H, Yasoshima T, Fukui R, et al. Tubular adenoma of the breast in a 73-year-old woman. Breast Cancer 2000;7:169-72.  Back to cited text no. 12
    


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