Tubular Carcinoma Of Breast Research Articles

An etiologic model proposing that sporadic adult-onset carcinoma is extramedullary hematopoiesis

This model proposes that primary carcinomatous tumors and almost all metastases are extramedullary hematopoietic tissue formed to compensate for reduced hematopoietic activity in the bone marrow. These marrow lesions are currently considered to be metastatic in origin, but as fibrosis and sclerosis are identifying features they are here equated to myelofibrosis. Myelofibrotic marrow is characterized by an increase in the number and size of vascular sinusoids. The increased blood flow suggested by this morphology, and observed in myelofibrosis patients, causes a rise in marrow pressure which may trigger the fibrosis. Specific carcinoma morphologies are equated to stages in endochondral bone and marrow formation and, as such, cancer cell identity varies with morphology. For example, infiltrating carcinomas of the breast consist of collagen and mucoid secreting cells in single file formation. This morphology is equated to the cartilagenous stage of marrow formation, when mesenchymal stem cells proliferate and differentiate into chondroblasts. In this model "infiltrating" cells arise in situ from stem cells located in the connective tissue. Tubular breast carcinoma, with its single layer of osteoblast-like carcinoma cells encircling small lumens and long branching tubules, is equated to the trabecular stage of marrow formation during which osteoblasts surround small pieces of calcified cartilage and begin secreting osteoid that will form the trabeculae. Lobular carcinoma in situ consists of cancer cell clusters separated by narrow clear spaces that, under high magnification, appear vascular. This morphology is equated to hematopoietic tissue in which primitive hematopoietic cells lie between anastomosing sinusoids. Similar cartilagenous, trabecular and hematopoietic morphologies can be found in carcinomatous tumors of most organs, but the nomenclature is variable. The hematopoietic carcinomas share numerous features with hematopoietic tissue including a structure composed of intermingled normoxic and hypoxic regions and a metabolism characterized by elevated levels of glycolysis. They also contain similar proportions of clonal cells. If this model is correct it necessitates a change in the treatment of carcinoma. If cancer cells are not the enemy, but desperately needed immature blood cells, and the medical problem is not the presence of tumors, but the inefficiency of this extramedullary hematopoietic tissue, then treatment should focus on increasing marrow hematopoiesis. As evidence suggests that the marrow lesion is the result of increased hydrostatic pressure this could be done by reducing blood volume. One way to accomplish this may be through the ingestion of ephedrine, as it is hypothesized to increase vascular tone.

骨芽腫を併発した純粋型乳腺管状癌の1例

骨芽腫を併発した純粋型乳腺管状癌の1例

397 PUBLICATION Outcome of node-negative mucinous, medullary and tubular breast carcinoma

397 PUBLICATION Outcome of node-negative mucinous, medullary and tubular breast carcinoma

Pure tubular breast carcinoma: A study of outcomes from 1971–2004

674 Background: Pure tubular breast carcinoma (ca) is widely thought to have a favorable prognosis, but questions remain regarding extent of treatment required. This study assessed the long term outcome for women with this rare histologic subtype. Methods & Materials: Between 1971 & 2004, 8832 patients (pts) were treated for breast cancer at our institution, and 27 (0.3%) were diagnosed with pure tubular ca. Tumors were considered tubular only if the pathology report explicitly identified the histology as tubular ca, and did not include any other histologic subtypes. All data for tubular ca pts were analyzed. Results: Median pt age was 55.4 years (range, 44–85). All patients were Caucasian. Twenty-one pts had stage I disease (78%), 5 pts stage IIA (19%), and 1 pt stage IIB disease. Eleven (41%) patients had a first-degree relative with breast or ovarian cancer. Median tumor diameter was 0.8 cm (range, 0.2–4.2 cm). Three pts (11%) had positive axillary lymph nodes. Fifteen pts were tested for estrogen rece...

Tubular carcinoma of the breast: outcome and loco-regional recurrence in 307 patients

Purpose The aim of this study is to describe the University of Florence experience in evaluating clinical, pathologic and treatment factors as they are related to the outcome and loco-regional recurrence in patients with tubular breast carcinoma. Material and methods Three hundred and seven patients (median age 56.4 years, range 26–91 years) with histological verified tubular carcinoma of the breast were consecutively treated at University of Florence from 1976 to 2001. All patients were followed for a median of 8.4 years (range 3 months to 20 years). Thirty-seven women underwent mastectomy and 270 underwent breast conserving surgery. Positive axillary nodes were found in 15% of patients. Fifty-two patients did not undergo radiotherapy to whole breast after having breast conserving surgery. Tamoxifen was prescribed in 108 patients and chemotherapy in 21 patients, 15 out of 21 had positive axillary nodes. Results Cause specific survival was 99.6, 99.2 and 97.2% at 3, 5 and 10 years. Local recurrence rate was 1.9, 3.6 and 4.7% at 3, 5 and 10 years. Univariate statistical analysis was significant for specific survival and local recurrence for angiolymphatic invasion only ( p=0.0004). Conclusions In the absence of axillary disease and angiolymphatic invasion, conserving surgery with adjuvant radiotherapy is effective treatment of disease.

Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinoma

Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinoma

Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinoma

Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinoma

Outcome after breast-conserving therapy for patients with stage I or II mucinous, medullary, or tubular breast carcinoma

Purpose To evaluate the site of first failure of patients with early-stage tubular, mucinous, and medullary breast carcinoma after breast-conserving therapy and compare their results with those of patients with infiltrating ductal carcinoma (IDC). Methods and materials Twenty clinical Stage I and II patients with mucinous carcinoma, 27 with medullary carcinoma, 28 with tubular carcinoma, and 1055 with IDC were identified. The minimal potential follow-up was 10 years. Results No statistically significant difference ( p = 0.15) was seen in the site of first failure between the four histologic types within the first 10 years after treatment. When the IDC tumors were omitted from the comparison, the failure patterns of the remaining three histologic types were not significantly different ( p = 0.31). In a polychotomous logistic model, histologic type was not significantly associated with the site of first failure (all p >0.17). Local failure was significantly associated with age <50 years ( p = 0.04), positive surgical margins ( p = 0.007), lymphovascular invasion ( p = 0.04), and tumors with an extensive intraductal component ( p <0.001). Regional/distant/opposite breast failure was significantly associated with clinical Stage T2 tumors ( p <0.001), four or more positive lymph nodes ( p = 0.004), and lymphovascular invasion-positive tumors ( p <0.001). Second malignancy or death was significantly associated with age at diagnosis >60 years ( p <0.001) and lymphovascular invasion-positive tumors ( p = 0.03). Conclusion No statistically significant difference was noted in the site of first failure between patients with medullary, mucinous, or tubular carcinoma and patients with IDC. Although not statistically significant, we did note a trend toward a lower long-term rate of disease-free survival in patients with IDC.

乳腺管状癌の1例

乳腺管状癌の1例

Mammographic and sonographic features of tubular breast carcinoma.

This study aimed to describe the mammographic and sonographic features of tubular carcinoma of the breast. A retrospective review of 198 consecutive cases of surgically proven breast cancer revealed ten cases of tubular carcinoma of the breast. Only tumors with a tubular component of at least 75% were included in the study. Mean patient age was 56 +/- 9 years, range 35 to 70 years. The mean size of the tumors was 11 +/- 4 mm. On mammography, all tubular carcinomas appeared as an irregularly shaped mass with a central density in 6/10 cases. Eight tubular carcinomas were described as having spiculated margins. Microcalcifications were present in 4/10 cases. On ultrasound the tumor presented as a hypoechoic mass with irregular margins and posterior acoustic shadowing in 7/10 cases. In three cases the tumor presented as a hypoechoic mass with ill-defined margins and posterior acoustic shadowing. Although some specific mammographic and sonographic features may suggest the presence of a tubular carcinoma, the final differential diagnosis from other spiculated lesions of the breast should rely on histologic evidence only. Therefore, surgical biopsy should be recommended in all cases of stellate lesions of the breast detected at mammography or ultrasonogram.

Evaluation of outcome after breast conservation therapy (BCT) in patients with stage I and II tubular, mucinous and medullary breast carcinoma

Evaluation of outcome after breast conservation therapy (BCT) in patients with stage I and II tubular, mucinous and medullary breast carcinoma

Tubular carcinoma of the breast: Is the long term survival insured?

Tubular carcinoma of the breast: Is the long term survival insured?

Genomic alterations in tubular breast carcinomas

Tubular carcinoma of the breast is a well-differentiated variant of invasive ductal carcinoma and has been shown to have an exceptionally favorable prognosis, as manifested by a low incidence of lymph node metastases and an excellent overall survival. It is unknown whether this subtype represents an early step along the continuum of development to a more aggressive, poorly differentiated ductal cancer, or whether these cancers are destined to remain well differentiated with limited metastatic potential. We undertook an analysis of 18 pure tubular carcinomas of the breast using comparative genomic hybridization to evaluate the chromosomal changes in these tumors. An average of 3.6 chromosomal alterations of the genome were identified per case. The most frequent change involved loss of 16q (in 78% of tumors) and gain of 1q (in 50% of tumors). All but one case with 1q gain also exhibited a concomitant 16q loss. Other frequent changes involved 16p gain in 7 of 18 cases (39%) and distal 8p loss in 5 of 18 cases (28%). Comparison with known genomic alterations in a mixed group of invasive cancers shows tubular cancer to have fewer overall chromosomal changes per tumor (P <.01), higher frequency of 16q loss (P <.001), and lower frequency of 17p loss (P =.007). These results strongly suggest that tubular carcinomas are a genetically distinct group of breast cancers. HUM PATHOL 32:222-226. Copyright © 2001 by W.B. Saunders Company

Tubular carcinoma of the breast: prognosis and response to adjuvant systemic therapy.

Tubular carcinoma of the breast is an uncommon and usually small tumour, and is thought to have a favourable prognosis. The present study examined the long-term prognosis of patients with tubular breast carcinoma and the roles of axillary dissection and adjuvant therapy. Eighty-six tubular cases were identified from a large worldwide database of 9520 breast carcinoma patients entered into randomized adjuvant therapy trials run by the International Breast Cancer Study Group from 1978 to 1999. These patients were followed for a median of 12 years. Forty-two (49%) cases were node-positive, of which 33 (79%) had 1-3 nodes involved. Ten (32%) of the 31 smaller tumours (< or = 1 cm in size) were node-positive. Patients with node-positive tubular carcinoma had a significantly better 10-year relapse-free survival (P = 0.006) and survival (P < 0.0001) compared with non-tubular node-positive cases. Overall survival was similar for node-positive and node-negative tubular carcinoma. Overall, 71 patients (83%) received some form of adjuvant systemic therapy. Of the 86 cases, 43 (50%) received more than one course of chemotherapy. There was an 85% decrease in the risk of death for patients who received more than one course of chemotherapy compared to those who did not (hazard ratio 0.15, 95% confidence interval (CI): 0.03-0.82; P = 0.03). Compared to other histological types of breast cancer, tubular carcinoma has a better long-term prognosis. Adjuvant chemotherapy may further improve prognosis and involvement of axillary nodes may not be an indicator for early death due to breast carcinoma.

Treatment of Pure Tubular Carcinoma of the Breast

Abstract: A retrospective study of 63 cases of tubular breast carcinoma was performed to address issues of optimum therapy; in particular, the extent of surgery, the need for axillary lymph node dissection, and the need for postoperative radiation therapy. The patient's mean age at presentation was 57 years. The primary lesions were treated by local excision in 61% of cases and by some form of mastectomy in the remainder. Twenty-one patients were treated with radiation therapy after local excision. Axillary lymph node dissection was performed on 39 patients. The primary lesions ranged in size from 3 to 21 mm (mean 8 mm). Fifteen lesions were larger than 10 mm. Two patients had axillary lymph node metastases (5% of those were treated by axillary lymphadenectomy). These patients were 2 of 15 that had lesions larger than 10 mm. Therefore 13.3% of patients with tumors 10 mm or larger metastasized to axillary lymph nodes. In those two cases, the size of the primary tumor was 11 mm and 14 mm. All patients were free of disease at last follow-up (mean follow-up 4 years, 9 months; median follow-up 4 years). The study demonstrates excellent prognosis for patients with tubular breast carcinoma, regardless of the extent of the surgery, performance of axillary lymph node dissection, or administration of postoperative radiation therapy. Local excision may be adequate to control the primary disease and axillary lymph node dissection may not be necessary in patients with small lesions.

Radial scar and tubular carcinoma of the breast

A case of tubular carcinoma within a radial scar pattern is reported. The aim of this study is to support the opinion of the authors who believe that there is a relationship between tubular carcinoma and radial scar. We think that surgical biopsy should be recommended in all cases of stellate lesions detected at mammography.

Localization of MR-detected breast cancer using a prototype stereotactic guidance MR system

Abstract We report the case of an invasive tubular breast carcinoma detected solely by MR imaging, and subsequently localized for excision biopsy with an MR-compatible, spring-hook wire positioning marker using a prototype MR-guided stereotactic localization system. This report emphasises the potential of interventional MR imaging in the management of breast cancer.

乳腺管状癌の１例

乳腺管状癌の１例

Localization of hyaluronan in normal breast tissue, radial scar, and tubular breast carcinoma

Hyaluronan (hyaluronic acid [HYA]) is one of the extracellular matrix components involved in normal cell physiology and is localized mainly in bodily fluids and connective tissues. Increased amounts of HYA in serum have been demonstrated in a number of neoplastic and inflammatory conditions, among them breast cancer. Tubular breast carcinoma (TC) and radial scar (RS) are two breast lesions that microscopically display characteristic stromal alterations and possess gross and microscopic similarities. Due to the importance of HYA as a component of the extracellular matrix, we investigated its presence in these lesions and in normal breast tissue. Using a biotinylated HYA-binding region for the in situ detection of HYA, we noted an increased amount of HYA in both TC and RS as compared with that in normal breast tissue specimens. A strong reactivity was observed predominantly around glandular structures and in the interlobular stroma of both TC and RS. Perivascular HYA staining also was distinctly observed in these lesions (TC and RS). Some HYA was observed in the connective tissue of the intralobular regions, around small blood vessels, and in the perivascular connective tissue of the normal breast. The distribution of HYA adjacent to the epithelium in the normal breast suggests a role for HYA in the interaction between epithelium and stroma of the normal breast. Its increase in the connective tissue of both TC and RS reflects the derangement of the stroma commonly observed in these conditions and supports the notion that these lesions may be associated.

乳腺管状癌の１例

乳腺のなかでもまれな管状癌で穿刺吸引細胞診が施行されたので, その細胞像について報告する. 症例は45歳女性, 主訴は右乳房腫瘤. 触診, 超音波画像, マンモグラフィーともに癌が疑われ, 腫瘤の穿刺吸引細胞診も陽性と判定された. 乳房切除術の迅速病理組織診断では乳頭腫症および硬化性腺症と診断されたが, その後の永久標本組織診断では管状癌と診断された.穿刺吸引細胞所見は (1) 腫瘍細胞は10-30個程度の細胞からなる小集団で出現し, 腺腔様配列や結合性が密な立体的管状構造配列を示す.(2) 腫瘍細胞はN/C比は大きいが大小不同が少なく均一で, 核は類円形でクロマチンは細類粒状で核小体はあまり大きくなく, 異型の乏しい癌細胞が多い.(3) 背景には間質由来の双極裸核様細胞も少なくきれいであることなどの特徴がみられた. 穿刺吸引材料においても上記の細胞学的特徴から管状癌の診断は可能と考えられた.