Invasive breast carcinoma - IARC

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CHAPTER 1 Tumours of the Breast Cancer of the breast is one of the most common human neoplasms, accounting for approximately one quarter of all cancers in females. It is associated with the Western lifestyle, and incidence rates are, there f o re, highest in countries with advanced economies. Additional risk factors include early menarche and late childbirth. Breast cancer is further characterized by a marked genetic susceptibility. Early detection and advances in treatment have begun to reduce mortality rates in several countries. Through the use of cDNA expression profiles, it may become possible to predict clinical outcome in individual patients. The typing of invasive breast cancer and its histological variants is well established. More difficult is the classification of pre-invasive breast lesions which are now increasingly detected by mammography. The WHO Working Group agreed that more clinical follow-up and genetic data are needed for a better understanding of the natural history of these lesions.
WHO histological classification of tumours of the breast Epithelial tumours Invasive ductal carcinoma, not otherwise specified 8500/3 Mixed type carcinoma Pleomorphic carcinoma 8022/3 Carcinoma with osteoclastic giant cells 8035/3 Carcinoma with choriocarcinomatous features Carcinoma with melanotic features Invasive lobular carcinoma 8520/3 Tubular carcinoma 8211/3 Invasive cribriform carcinoma 8201/3 Medullary carcinoma 8510/3 Mucinous carcinoma and other tumours with abundant mucin Mucinous carcinoma 8480/3 Cystadenocarcinoma and columnar cell mucinous carcinoma 8480/3 Signet ring cell carcinoma 8490/3 Neuroendocrine tumours Solid neuroendocrine carcinoma Atypical carcinoid tumour 8249/3 Small cell / oat cell carcinoma 8041/3 Large cell neuroendocrine carcinoma 8013/3 Invasive papillary carcinoma 8503/3 Invasive micropapillary carcinoma 8507/3 Apocrine carcinoma 8401/3 Metaplastic carcinomas 8575/3 Pure epithelial metaplastic carcinomas 8575/3 Squamous cell carcinoma 8070/3 Adenocarcinoma with spindle cell metaplasia 8572/3 Adenosquamous carcinoma 8560/3 Mucoepidermoid carcinoma 8430/3 Mixed epithelial/mesenchymal metaplastic carcinomas 8575/3 Lipid-rich carcinoma 8314/3 Secretory carcinoma 8502/3 Oncocytic carcinoma 8290/3 Adenoid cystic carcinoma 8200/3 Acinic cell carcinoma 8550/3 Glycogen-rich clear cell carcinoma 8315/3 Sebaceous carcinoma 8410/3 Inflammatory carcinoma 8530/3 Lobular neoplasia Lobular carcinoma in situ 8520/2 Intraductal proliferative lesions Usual ductal hyperplasia Flat epithelial atypia Atypical ductal hyperplasia Ductal carcinoma in situ 8500/2 Microinvasive carcinoma Intraductal papillary neoplasms Central papilloma 8503/0 Peripheral papilloma 8503/0 Atypical papilloma Intraductal papillary carcinoma 8503/2 Intracystic papillary carcinoma 8504/2 Benign epithelial proliferations Adenosis including variants Sclerosing adenosis Apocrine adenosis Blunt duct adenosis Microglandular adenosis Adenomyoepithelial adenosis Radial scar / complex sclerosing lesion Adenomas Tubular adenoma 8211/0 Lactating adenoma 8204/0 Apocrine adenoma 8401/0 Pleomorphic adenoma 8940/0 Ductal adenoma 8503/0 Myoepithelial lesions Myoepitheliosis Adenomyoepithelial adenosis Adenomyoepithelioma 8983/0 Malignant myoepithelioma 8982/3 Mesenchymal tumours Haemangioma 9120/0 Angiomatosis Haemangiopericytoma 9150/1 Pseudoangiomatous stromal hyperplasia Myofibroblastoma 8825/0 Fibromatosis (aggressive) 8821/1 Inflammatory myofibroblastic tumour 8825/1 Lipoma 8850/0 Angiolipoma 8861/0 Granular cell tumour 9580/0 Neurofibroma 9540/0 Schwannoma 9560/0 Angiosarcoma 9120/3 Liposarcoma 8850/3 Rhabdomyosarcoma 8900/3 Osteosarcoma 9180/3 Leiomyoma 8890/0 Leiomyosarcoma 8890/3 Fibroepithelial tumours Fibroadenoma 9010/0 Phyllodes tumour 9020/1 Benign 9020/0 Borderline 9020/1 Malignant 9020/3 Periductal stromal sarcoma, low grade 9020 / 3 Mammary hamartoma Tumours of the nipple Nipple adenoma 8506/0 Syringomatous adenoma 8407/0 Paget disease of the nipple 8540/3 Malignant lymphoma Diffuse large B-cell lymphoma 9680/3 Burkitt lymphoma 9687/3 Extranodal marginal-zone B-cell lymphoma of MALT type 9699/3 Follicular lymphoma 9690/3 Metastatic tumours Tumours of the male breast Gynaecomastia Carcinoma Invasive 8500/3 In situ 8500/2 _ _ _ _ _ _ _ _ _ _ 1 Morphology code of the International Classification of Diseases for Oncology (ICD-O) {921} and the Systematized Nomenclature of Medicine (http://snomed.org). Behaviour is coded /0 for benign tumours, /2 for in situ carcinomas and grade 3 intraepithelial neoplasia, /3 for malignant tumours, and /1 for borderline or uncertain behaviour. 10 Tumours of the breast
Page 2: Previous volumes in this series Kle
Page 6 and 7: World Health Organization Classific
Page 8 and 9: Published by IARC Press, Internatio
Page 12 and 13: TNM classification of carcinomas of
Page 14 and 15: Invasive breast carcinoma I.O. Elli
Page 16 and 17: Rapid growth and greater adult heig
Page 18 and 19: tives, administrative and clerical
Page 20 and 21: Grade 1 - well differentiated: 3-5
Page 22 and 23: ent and this is occasionally extens
Page 24 and 25: Most melanotic tumours of the breas
Page 26 and 27: A Fig. 1.22 A Classic invasive lobu
Page 28 and 29: yet others at 90% {97,2147}. For pr
Page 30 and 31: Fig. 1.27 Medullary carcinoma. The
Page 32 and 33: myoepithelial cells in fibro a d e
Page 34 and 35: A Fig. 1.33 Neuroendocrine carcinom
Page 36 and 37: Macroscopy Fisher et al. reported t
Page 38 and 39: Fig. 1.39 Apocrine carcinoma. Note
Page 40 and 41: cells contain intracytoplasmic lume
Page 42 and 43: A Fig. 1.50 Carcinosarcoma. A Two a
Page 44 and 45: A B C Fig. 1.75 Lobular neoplasia.
Page 46 and 47: Intraductal proliferative lesions F
Page 48 and 49: A B absence of either microcalcific
Page 50 and 51: Fig. 1.83 Atypical ductal hyperplas
Page 52 and 53: A B Fig. 1.88 Large excision biopsy
Page 54 and 55: unusual variants as well. Using thi
Page 56 and 57: esemble those identified in invasiv
Page 58 and 59: A B Fig. 1.97 Microinvasive carcino
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A Papilloma may be subject to morph
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A B C Fig. 1.103 Papillary intraduc
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colour measuring from 0.5 to 12 cm.
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Immunoprofile The cases studied by
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Glycogen-rich, clear cell carcinoma
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Differential diagnosis There may be
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quality metaphase spreads from an i
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Fig. 1.67 Lobular carcinoma of brea
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detectable distant metastasis displ
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detected at a late stage as small t
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Extent of ductal carcinoma in situ
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Benign epithelial proliferations G.
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Fig. 1.112 Microglandular adenosis.
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A Apocrine adenoma ICD-O code 8401/
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A B Fig. 1.128 Adenomyoepithelioma,
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Mesenchymal tumours M. Drijkoningen
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1113,1275}. There is a complex patt
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A B Fig. 1.137 A Lipoma. Intraparen
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Fig. 1.141 Angiosarcoma after breas
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A Fig. 1.144 Mammary osteosarcoma.
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Fibroepithelial tumours J.P. Belloc
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aged women (average age of presenta
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lished data suggests a 21% rate of
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A Fig. 1.157 Syringomatous adenoma
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Malignant lymphoma and metastatic t
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used. Inflammatory conditions in th
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male population both in the USA and
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CHAPTER 2 Tumours of the Ovary and
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Polyembryoma 9072/3 Non-gestational
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Surface epithelial-stromal tumours
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A Fig. 2.04 A Serous borderline tum
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A Fig. 2.06 Serous borderline tumou
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A Fig. 2.10 Invasive peritoneal imp
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Fig. 2.15 Mucinous carcinoma with i
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Fig. 2.20 Mucinous endocervical-lik
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A Fig. 2.28 Mucinous cystic tumour
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early secretory endometrium {2605}.
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IV, 6% {2233}. Patients with grade
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A Fig. 2.37 A This polypoid intracy
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Fig. 2.40 Endometrioid cyst with at
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1 tumours are extremely rare. Almos
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Fig. 2.50 Borderline Brenner tumour
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express thrombomodulin and have bee
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serous and transitional cell carcin
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is yellow to tan with a variable ad
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Genetic susceptibility JGCTs may pr
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Clinical features F i b romas may b
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distinguishes this tumour from the
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A Fig. 2.77 A Retiform Sertoli-Leyd
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Mean ages of 21 and 38 years and me
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Tumours unassociated with PJS form
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mal origin without crystals of Rein
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Germ cell tumours F. Nogales A. Tal
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cases, anisokaryosis has no prognos
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ation may coexist in the same neopl
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Table 2.06 Grading of ovarian immat
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A B Fig. 2.102 A Mature cystic tera
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Diagnostic procedures Elevated urin
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associated with mature teratomas sh
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atives intimately admixed. The germ
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Fig. 2.113 Mixed germ cell-sex cord
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A Fig. 2.116 A Adenomatous hyperpla
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Fig. 2.117 Small cell carcinoma, hy
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Clinical features Adenoid cystic-li
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Histopathology This epithelial tumo
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sis. Corpus luteum of pregnancy has
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Lymphomas and leukaemias L.M. Roth
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Secondary tumours of the ovary J. P
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Occasionally, the colonic adenocarc
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Peritoneal tumours S.C. Mok J.O. Sc
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A B Fig. 2.140 Cystic adenomatoid m
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whelmingly poor {1038,1547,2310}. H
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CHAPTER 3 Tumours of the Fallopian
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TNM and FIGO classification of carc
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Endometrioid adenocarcinoma Endomet
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Two examples of adenofibroma of bor
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A Fig. 3.11 Adenomatoid tumour. A T
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Clinical features Patients range in
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Fig. 3.16 Uterus-like mass. The cys
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CHAPTER 4 Tumours of the Uterine Co
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TNM and FIGO classification of non-
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Epithelial tumours and related lesi
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endometrioid adenocarcinoma fro m a
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fers from the prototypical type I e
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the ovary and bladder. Unlike prima
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schema {1535,2602}. Although this c
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Table 4.03 Altered gene function in
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Mesenchymal tumours and related les
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areas are limited to less than 30%
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A B C Fig. 4.30 Leiomyosarcoma. A T
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e used sparingly and is reserved fo
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A B Fig. 4.38 Leiomyoma with perino
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cytological atypia, tumour cell nec
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Mixed epithelial and mesenchymal tu
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Prognosis and predictive factors Th
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tumours may superficially invade th
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A Fig. 4.46 A Gestational choriocar
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A Fig. 4.49 A Classic complete hyda
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Sex cord-like, neuroectodermal and
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Secondary tumours of the uterine co
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WHO histological classification of
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Epithelial tumours M. Wells J.M. Ne
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Fig. 5.04 Mechanisms of human papil
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Fig. 5.08 Keratinizing squamous cel
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in their Asian population {2957}. I
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have a strong association with high
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e red by squamous epithelium {380}.
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endometrioid adenocarcinoma of the
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metrial epithelium. In some cases t
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with distinct cell borders and a gr
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Mesenchymal tumours M.L. Carcangiu
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{781}, liposarcoma {2840,3016}, ost
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Mixed epithelial and mesenchymal tu
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Fig. 5.44 Wilms tumour. The tumour
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A Fig. 5.47 Implant of endometrial
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CHAPTER 6 Tumours of the Vagina Alt
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Epithelial tumours E.S. Andersen A.
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Aetiology The fact that both VAIN a
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Fig. 6.10 Fibroepithelial polyp.A m
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er of mitoses varies but is usually
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ICD-O codes Adenosquamous carcinoma
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A C Fig. 6.17 Sarcoma botryoides. A
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1-11 cm. They may arise anywhere in
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elsewhere in the female genital tra
Page 308 and 309:
A Fig. 6.24 Yolk sac tumour. A The
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g rowing in sheets. Some may have s
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WHO histological classification of
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Epithelial tumours E.J. Wilkinson M
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even with additional sectioning, it
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type) is a highly diff e rentiated
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Clinical features Bartholin gland c
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glandular elements surrounded by fi
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Mesenchymal tumours R.L. Kempson M.
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Table 7.03 Differential diagnosis o
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Prognosis and predictive factors A
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Table 7.04 Clark levels of cutaneou
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A Fig. 7.23 Vulvar peripheral primi
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Familial aggregation of cancers of
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BRCA1 syndrome Definition Inherited
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dispose individuals to the developm
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Fig. 8.05 To assess whether wild-ty
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Fig. 8.07 Factors that modify risk
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BRCA2 syndrome R. Eeles S. Piver S.
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tubal or ovarian carcinomas. Howeve
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in typical nuclear foci that may re
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Breast tumours Frequency Breast can
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Fig. 8.14 Codon distribution of som
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Breast tumours Age distribution and
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Hereditary non-polyposis colon canc
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essary in the evaluation of the pat
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Age distribution and penetrance Mos
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Contributors Dr Vera M. ABELER** De
Page 364 and 365:
Dr Carlo LA VECCHIA Laboratory of E
Page 366 and 367:
Dr Manuel TEIXEIRA Department of Ge
Page 368 and 369:
02.100 Dr. A. Ostor 02.101 Dr. F.A.
Page 370 and 371:
52. Akhtar M, Robinson C, Ashraf Al
Page 372 and 373:
180. Bapat K, Brustein S (1989). Ut
Page 374 and 375:
307. Bolis GB, Maccio T (2000). Cle
Page 376 and 377:
436. Chang J, Sharpe JC, A'Hern RP,
Page 378 and 379:
562. Costa MJ, Ames PF, Walls J, Ro
Page 380 and 381:
689. Di Domenico A, Stangl F, Benni
Page 382 and 383:
820. Falck J, Petrini JH, Williams
Page 384 and 385:
943. Gad A, Azzopardi JG (1975). Lo
Page 386 and 387:
1067. Grimes MM (1992). Cystosarcom
Page 388 and 389:
1197. Herod JJ, Shafi MI, Rollason
Page 390 and 391:
1323. Jacques SM, Qureshi F, Ramire
Page 392 and 393:
1449. Khalifa MA, Mannel RS, Harawa
Page 394 and 395:
1564. Lagios MD (1977). Multicentri
Page 396 and 397:
1687. Loman N, Johannsson O, Kristo
Page 398 and 399:
1807. McCluggage G, McBride H, Maxw
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1937. Mukai M, Torikata C, Iri H (1
Page 402 and 403:
2056. Norris HJ, Taylor HB (1967).
Page 404 and 405:
2180. Park JS, Jones RW, McLean MR,
Page 406 and 407:
2304. Puls LE, Hamous J, Morrow MS,
Page 408 and 409:
2 4 3 4 . Rosen PP, Groshen S, Saig
Page 410 and 411:
2559. Schlesinger C, Silverberg SG
Page 412 and 413:
2686. Silverberg SG (1999). Protoco
Page 414 and 415:
2806. Stutz JA, Evans AJ, Pinder S,
Page 416 and 417:
2942. Tornos C, Silva EG, Ordonez N
Page 418 and 419:
3061. Wargotz ES, Norris HJ (1990).
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3189. Yoshioka T, Tanaka T (2000).
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References 425
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Biphasic teratomas, 168 BLM, 341, 3
Page 426 and 427:
G GADD45, 343, 353 GCDFP-15, 25, 33
Page 428 and 429:
MPNST, see Malignant peripheral ner
Page 430:
Small cell / oat cell carcinoma, 32
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Invasive breast carcinoma - IARC

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