tubular adenoma

Mimickers of
breast malignancy: imaging findings, pathologic concordance and clinical management. Tubular adenoma. A 36-year-old woman presented with a palpable breast mass. Spot cradiocaudal and lateral mammogram (a, b) shows a high-density irregular mass (solid arrow), adjacent to an incidental oil cyst (dotted arrow). Grayscale (c) and power Doppler ultrasound (d) images show an irregular hypoechoic mass with increased vascularity (arrows). Core needle biopsy showed tubular adenoma. The mass remained stable sonographically for 30 months and mammographically for 9 years
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Tubular adenomas (TA) of the breast, also known as pure adenoma of the breast, are a rare benign breast lesion. It is a type of adenomatous breast lesion.

Epidemiology

They are typically found in young women and are usually palpated by the patient or her physician.

TA are rare tumors of the breast, that account for only 0.13–1.7% of benign breast lesions . The patient age ranges between 13-76 years; however, the lesions are seen most commonly in young females, with greater than 90% cases being discovered in females below the age of 40 years (mean age=31 years) . Rarely, they have also been reported in male patients. The lesion size ranges from 1.0 cm to more than 7.5 cm but is barely greater than 5 cm .

Pathology

On gross pathology, tubular adenomas appear as circumscribed masses. Microscopically, they contain closely-approximated tubular structures that vary little in size. These lesions are related to fibroadenomas but can be distinguished by the predominance of epithelium and relative lack of stromal components.

Radiographic features

Mammography

While they can a variable appearance, they are typically seen as non-calcified round or oval masses with either well-defined or obscure margin. Because the lesions are typically found in young women, primary imaging is almost always with ultrasound.

In young females, no calcifications are seen in the tubular adenomas and they closely resemble non-calcified fibroadenomas; however, calcifications (irregular or tightly packed punctate) may be seen in older patients, which need tissue diagnosis to rule out the possibility of malignancy. Rarely, the lesions may exhibit ill-defined margins .

Breast ultrasound

There is significant sonographic imaging overlap with fibroadenoma and differentiation can be impossible. They are typically seen as well defined hypoechoic lesions with relatively well-defined margins. There may be posterior acoustic enhancement.

Practical points

In practice, these lesions are exceptionally rare. Typically the lesion is expected to likely be a fibroadenoma on biopsy and the diagnosis comes as a bit of a surprise when you get back the histology report. These lesions very rarely show calcification and are almost unknown in postmenopausal women.

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