© 2006 Blackwell Publishing, Inc., 1075-122X/06 The Breast Journal, Volume 12 Number 3, 2006 257–259 Address correspondence and reprint requests to: Francesca Rovera, MD, Department of Surgical Sciences, University of Insubria, Viale Borri, 57, 21100 Varese, Italy, or e-mail: francesca.rovera@uninsubria.it. Blackwell Publishing Inc CASE REPORT Tubular Adenoma of the Breast in an 84-Year-Old Woman: Report of a Case Simulating Breast Cancer Francesca Rovera, MD, Alberta Ferrari, MD, Giulio Carcano, MD, Gianlorenzo Dionigi, MD, Lorenza Cinquepalmi, MD, Luigi Boni, MD, Mario Diurni, MD, and Renzo Dionigi, MD Department of Surgical Sciences, University of Insubria, Varese, Italy  Abstract: Tubular adenomas of the breast are rare and they mainly occur in young women. They must be differentiated from other benign lesions and from malignant breast cancer. Preoperative diagnosis is difficult because both radiologic and cytohistologic examinations performed before surgery are often not diagnostic; therefore, in most cases, surgical excision is the only way to reach a precise diagnosis and a definitive treatment. This article describes a case of an 84-year-old woman suffering from tubular ade- noma of the breast. The authors underline the difficulty in preoperative differentiation between benign and malignant breast lesions.  Key Words: breast cancer, breast lesion, breast surgery, tubular adenoma T ubular adenomas, also called “pure adenomas,” are uncommon benign lesions of the breast, with a reported incidence of about 4% of all benign lesions (1,2). They mainly appear in young women, rarely occurring in the elderly (3). Tubular adenoma must be differentiated from other benign lesions (fibroadenoma) and from malignant breast cancer (tubular carcinoma). Preoperative diagnosis is often difficult: both radiologic and cytohisto- logic examinations performed before surgery are often not diagnostic and surgical excision is necessary in order to reach a precise diagnosis and a definitive treatment. We report a case of tubular adenoma of the breast in an 84-year-old woman preoperatively misdiagnosed as a breast cancer. CASE REPORT An 84-year-old white woman presented to our Depart- ment of Surgery in July 2004 for a palpable, painless nod- ule of her left breast, occasionally detected by the patient herself. Her family history was positive for breast cancer, developed by her mother at the age of 54 years. The patient had her first menses at the age of 12 years and reached meno- pausal status at 54 years; parity was positive for two sons. Personal pathologic anamnesis showed a mild bron- chopneumopathic chronic obstructive pulmonary disease (COPD) syndrome and a radically resected colorectal carcinoma. At the time of breast surgeon evaluation, the patient was 13 years disease free from colorectal cancer, asymptomatic, and in good general health. On physical examination, a 1.5 cm lump located in the internal inferior area of the left breast was detected. Neither skin or nipple-areola complex alterations were associated with the presence of the nodule. Diagnostic assessment of the breast lesion was per- formed, including breast ultrasound, mammography, and fine-needle aspiration cytology. Breast ultrasound showed a 15 mm solid hypoechoic lesion with inhomogeneous echo structure and expansive growth pattern, and mammo- graphic slides confirmed a high-density nodule in the left breast, with partially irregular edges (Fig. 1). All these clinical and radiologic data were highly suggestive for a malignant lesion. Fine-needle aspiration cytology showed a sample with a high number of cells revealing few atypical features (C-3 diagnostic class: doubtful if benign or malignant lesion). In an attempt to reach a correct preoperative diagnosis, the patient underwent a 16-gauge core biopsy of the nodule. The result of the histologic examination was again suspicious for cancer, but not completely diagnostic: in fact, it showed normal breast tissue with a focal area of atypical glandular cells suspicious for infiltrating ductal carcinoma. These atypical cells were further characterized Address correspondence and reprint requests to: Francesca Rovera, MD, Department of Surgical Sciences, University of Insubria, Viale Borri, 57, 21100 Varese, Italy, or e-mail: francesca.rovera@uninsubria.it.