Image of the Quarter (2015-1)

A good example of a tubulo-lobular carcinoma

50 year old woman - core biopsy-confirmed carcinoma - excision.

The tumour shows a low power pattern typical of lobular carcinoma however in some areas (a minority) there is evidence of tubular differentiation and the cytological detail of the tubular cells is also 'lobular'. 'Mouse-over' for closer view.

tubulo-lobular carcinoma

These further H&Es show areas of tubular differentiation. The 'Mouse-over' shows a focus of LCIS.

tubulo-lobular carcinoma

These views are of E cadherin immunostaining showing negative staining of the classical pattern lobular carcinoma and weak membrane staining of the tubular foci ('Mouse-over'). Contrast this with the strong crisp membrane staining of the cluster of ducts on the right of the image.

tubulo-lobular carcinoma - e cadherin staining

These final views are of beta catenin immunostaining of the two patterns of lobular carcinoma and the focus of LCIS ('Mouse-over'). The staining in the lobular areas is one of granular cytoplasmic staining. Again contrast this with the strong crisp membrane staining of the cluster of ducts top right and at the top of the mouse-over image.

tubulo-lobular carcinoma - beta catenin staining

The distinction between tubulo-lobular carcinoma and the mixed special type tubular and lobular causes difficulties for practitioners. In a truly mixed carcinoma the lobular & tubular elements will be true to their types morphologically and phenotypically i.e. the tubular element will be strongly membrane positive for e cadherin while the lobular element will be negative. Tubulo-lobular carcinoma, in contrast will show a uniform (if aberrant sometimes) staining pattern with E cadherin (negative of only weakly positive)and also with beta catenin (cytoplasmic dot positivity). Tragically, there will always be imperfect examples!

See also Lobular Carcinoma Variants.

See also... Special types of carcinoma and E cadherin/beta catenin staining on this site.

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