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

Brandt, Suzanne M. MD; Young, Gloria Q. MD; Hoda, Syed A. MD

Advances in Anatomic Pathology: May 2008 - Volume 15 - Issue 3 - p 140-146
doi: 10.1097/PAP.0b013e31816ff313
Review Articles

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.

Weill Cornell Medical College and New York Presbyterian Hospital, New York Weill Cornell Medical Center, New York, NY

This is the authors' own work and has not been supported by any source.

Reprints: Syed A. Hoda, MD, Department of Pathology, Weill Cornell Medical College and New York Presbyterian Hospital-New York Weill Cornell Medical Center, 525 E 68th Street, Starr 1031C, Mail Unit 93, New York, NY 10021 (e-mail: sahoda@med.cornell.edu).

Presented, in part, at the 96th Annual Meeting of the United States and Canadian Academy of Pathologists' Meeting in San Diego in March 2007.

© 2008 Lippincott Williams & Wilkins, Inc.