The “Rosen Triad”: Tubular Carcinoma, Lobular Carcinoma In Situ, and Columnar Cell Lesions

Abstract

The histologic triad of tubular carcinoma (TC), columnar cell lesion (CCL), and lobular carcinoma in situ (LCIS) has been recognized, but has not yet been fully characterized. The "Rosen Triad"-named in tribute to its first categorical description by the eponymous pathologist-is a morphologic observation that may have important clinical and pathologic implications. To study these implications, the literature on the topic was reviewed. Our own institution's experience with this triad was also reviewed via a study of clinicopathologic material from all TCs diagnosed at excision during a 5-year period (2001 to 2006). The diagnosis of TC was confirmed in 86 of our cases, and relevant patient data were analyzed. TC was associated with some degree of CCL in all (100%, 86/86) cases and with LCIS in 53% (46/86) of cases. Although cases of TC that were associated with LCIS (vs. those not associated with LCIS) seemed to be slightly more likely to have multifocal TC, have another synchronous higher-grade invasive carcinoma and show nodal positivity, these differences were not found to be statistically significant (P<0.05). All 3 lesions (TC, CCL, and LCIS), whenever tested, were estrogen receptor positive, progesterone receptor-positive, and Her-2/neu negative. On the basis of our review of the literature and our own experience, until such time as the biologic explanation and clinical implication of this triad is further elucidated, we recommend that pathologists be aware of this triad and should proactively seek the other 2 lesions if any one of these elements of this triad is identified in any diagnostic breast tissue.

Clinicopathologic characteristics of carcinomas that develop after a biopsy containing columnar cell lesions

“…3 The association between columnar cell atypia and tubular cancer was first reported in 1997, 20 whereas the association between columnar cell atypia, ALH, and tubular cancer was reported in 1999 by Rosen,21 and later substantiated by Abdel-Fatah and several others. 3,22,23 This association between tubular carcinoma and a background of columnar cell atypia has been documented in as many as 90% of tubular carcinomas. It is often the case that ADH or DCIS appears to arise in a background of columnar cell atypia, in the same lobular unit or cluster of lobular units, rather than in 2 separate, unrelated foci.…”

“…24,25 This seems to at least suggest a link between columnar cell atypia and the family of low-grade breast cancers, either as a concomitant lesion, or as a nonobligate early precursor. 3,23 From a morphological standpoint, it is true that the constituting cells in columnar cell atypia and architecturally atypical lesions are identical and seamlessly merge into each other. Also, as far as tubular carcinoma is concerned, it is notable that cellular morphology is similar, and apical snouts are equally characteristic.…”

Pathologic Upgrade Rates on Subsequent Excision When Lobular Carcinoma In Situ Is the Primary Diagnosis in the Needle Core Biopsy With Special Attention to the Radiographic Target

“…The frequent association of columnar cell change with LCIS, invasive lobular carcinoma, and/or invasive tubular carcinoma has led to its recognition as a member of a family of low-grade neoplastic breast lesions. [19][20][21][22][23][24] Several studies 14,22,25 report the coexistence of columnar cell change with lobular neoplasia in needle core biopsy samples, with frequency rates ranging from 29% to 37%. However, no study has shown a correlation between the presence of a columnar cell lesion on core biopsy and pathologic upgrade.…”

Small Glandular Proliferations of the Breast With Absent or Attenuated Myoepithelial Reactivity by Immunohistochemistry: A Review Focusing on the Differential Diagnosis and Interpretative Pitfalls

“…20,21,26,[28][29][30]37,38 Tubular carcinoma is frequently associated with atypical lobular hyperplasia/lobular carcinoma in situ and columnar cell alterations. 23,30,32,37,39 Columnar cell lesions were seen in association with tubular carcinoma in 93% of cases in one study. 23 Lobular carcinoma in situ and/ or atypical lobular hyperplasia is associated with tubular carcinoma in approximately half of cases.…”

“…23 Lobular carcinoma in situ and/ or atypical lobular hyperplasia is associated with tubular carcinoma in approximately half of cases. 23,37,39 Virtually all tubular carcinomas express ER and PR and lack HER2/neu overexpression by immunohistochemistry. 20,23,26,40,41 Certain features are helpful in distinguishing tubular carcinoma from MGA.…”