Invasive breast carcinoma - IARC

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Fig. 2.50 Borderline Brenner tumour. A large, papillary, polypoid component protrudes into a cystic space. Macroscopy Transitional cell carcinomas are bilateral in approximately 15% of cases {139} and a re macroscopically indistinguishable f rom other surface epithelial-stro m a l tumours {139,2676}. Tumour spread and staging At the time of diagnosis transitional cell c a rcinomas have spread beyond the ovary in over two-thirds of cases {2676} Histopathology Transitional cell carcinomas re s e m b l e those occurring in the urinary tract and lack a benign or borderline Bre n n e r tumour component {139,2676}. Typically, they are papillary with multilayered transitional epithelium and a smooth luminal border ("papillary type"). A nested pattern characterized by malignant transitional cell nests irregularly distributed in fibrotic stroma ("malignant Brenner-like type") has been described {2464,2465}. As in urothelial carcinoma, foci of glandular and/or squamous diff e re n t i a t i o n may occur. Very commonly, transitional cell carcinoma is admixed with other epithelial cell types, primarily sero u s adenocarcinoma. Transitional cell carcinomas lack the prominent stromal calcification characteristic of some benign and malignant Brenner tumours. Grading Transitional cell carcinomas should be graded utilizing criteria for transitional cell carcinoma of the urinary tract. A Histogenesis The term transitional cell carcinoma is not uniformly accepted, and overlapping f e a t u res with other epithelial-stro m a l tumours, particularly serous carcinoma, are present. It is important that strict histological criteria be applied to establish the diagnosis {2465}. Not only an architectural but also a histological resemblance to transitional epithelium is required. The frequent association with epithelial-stromal tumours of other types strongly suggests a surface epithelial origin {2465}. In addition, several immunohistochemical studies have demonstrated that the tumour lacks a urothelial phenotype {2115,2371}. Thus, the ovarian neoplasm shows histological but not immunohistochemical similarities to transitional cell carcinoma of the urinary bladder. Prognosis and predictive factors The overall 5-year survival rate for transitional cell carcinoma is 35%. Some, but not all, investigators have re p o rt e d greater chemosensitivity and higher 5- year survival in patients whose metastases are composed purely or predominantly of transitional cell carcinoma {564, 1232,2676}. Immunoprofile Ovarian transitional cell carcinomas have an immunoprofile that differs from transitional cell carcinomas of the urinary tract and closely resembles that of ovarian s u rface epithelial-stromal tumours. Ovarian transitional cell carcinomas are consistently uroplakin, thrombomodulin and cyokeratin 13 and 20 negative and CA125 and cytokeratin 7 positive {2115, 2371}. B Fig. 2.51 Borderline Brenner tumour (proliferating Brenner tumour). A Complex undulating and papillary transitional cell epithelium protrudes into a cystic space. B The transitional epithelium is thick with low grade cytological features. Surface epithelial-stromal tumours 141
Malignant Brenner tumour Definition An ovarian tumour containing invasive transitional cell aggregates as well as benign nests of transitional epithelium set in a fibromatous stroma. Epidemiology The great majority of malignant Brenner tumours occur in women 50-70 years old {1110,1868,2676}. Only 5% of Brenner tumours are malignant {1110,1868}. Clinical features Most patients seek medical attention because of an abdominal mass or pain {139,2460,2461}. A few patients present with abnormal vaginal bleeding. Macroscopy Malignant Brenner tumours are typically large with a median diameter of 16-20 cm and typically have a solid component resembling benign Brenner tumour as well as cysts containing papillary or polypoid masses {2461}. Tumour spread and staging Malignant Brenner tumours are bilateral in 12% of cases {139,452}. About 80% of malignant Brenner tumours are stage 1 at the time of diagnosis. Histopathology In malignant Brenner tumours there is s t romal invasion associated with a benign or borderline Brenner tumour component {139}. The invasive element is usually high grade transitional cell carcinoma or squamous cell carc i n o m a , although occasional tumours are composed of crowded, irregular islands of malignant transitional cells with low grade features {2460}. Glandular elements may be admixed, but pure mucinous or serous carcinomas associated with a benign Brenner tumour component should not be diagnosed as a malignant Brenner tumour. Foci of calcification are occasionally prominent. Immunoprofile The very small number of malignant Brenner tumours studied have exhibited a benign Brenner tumour immunoprofile in that component with a variable pattern of antigen expression in the invasive component; uroplakin immunopositivity has occurred in some {2371}. Fig. 2.52 Benign Brenner tumour. Sectioned surface is firm, lobulated and fibroma-like with a small cystic component. Prognosis and predictive factors When confined to the ovary, malignant B renner tumours have an excellent pro g- nosis. Patients with stage IA tumours have an 88% 5-year survival, and those with high stage malignant Bre n n e r tumours have a better prognosis than stage matched transitional cell carc i n o- mas {139}. Borderline Brenner tumour Synonyms Brenner tumour of low malignant potential, proliferating Brenner tumour (for cases with low grade features). Definition An ovarian transitional cell tumour of low malignant potential with atypical or malignant features of the epithelium but lacking obvious stromal invasion. Epidemiology Only 3-5% of Brenner tumours are borderline {1110,1868}. Tumour spread and staging Borderline Brenner tumours are confined to the ovary and, with rare exceptions, have been unilateral {1110,1868,2461, 3144}. Clinical features Most patients seek medical attention because of an abdominal mass or pain {139,2460,2461}. A few patients present with abnormal vaginal bleeding. Macroscopy Borderline Brenner tumours are typically large with a median diameter of 16-20 cm. They usually have a solid component resembling benign Brenner tumour as well as a cystic component containing a papillary or polypoid mass {2461}. Histopathology B o rderline Brenner tumours show a greater degree of architectural complexity than benign Brenner tumours typified by branching fibrovascular papillae surfaced by transitional epithelium often protruding into cystic spaces. The transitional epithelium manifests the same spectrum of architectural and cytological features encountered in urothelial lesions of the urinary tract. By definition, there is no stromal invasion. A benign Brenner tumour component is typically present but may be small and easily overlooked. The mitotic rate is highly variable but may be brisk, and focal necrosis is common. Mucinous metaplasia may be a prominent feature. The diagnostic criteria and terminology applied to the intermediate g roup of transitional cell tumours is somewhat controversial {2461,2605}. Some have advocated categorizing tumours with low grade features as "proliferating" rather than borderline {2461}, and others designate those resembling grade 2 or 3 transitional cell carcinoma of the urinary tract as "borderline with intraepithelial carcinoma" {2605}. Prognosis and predictive factors No Brenner tumour in the intermediate category without stromal invasion has metastasized or caused the death of a patient {1110,2461}. Benign Brenner tumour Definition An ovarian transitional cell tumour composed of mature urothelial-like cells arranged in solid or cystic circumscribed aggregates within a predominantly fibromatous stroma. Epidemiology Benign Brenner tumours account for 4- 5% of benign ovarian epithelial tumours {1409,1502,1970,2865}. Most benign Brenner tumours (95%) are diagnosed in women 30-60 years old {753,905,1868, 2460,2461,2676,2685,3073,3186}. Clinical features The majority of patients with benign Brenner tumours are asymptomatic; over 50% of tumours are less than 2 cm and are typically discovered incidentally in ovaries removed for some other reason {753,905,2685,3073}. In only 10% of cases is the tumour larger than 10 cm; 142 Tumours of the ovary and peritoneum
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Previous volumes in this series Kle
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World Health Organization Classific
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Published by IARC Press, Internatio
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CHAPTER 1 Tumours of the Breast Can
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TNM classification of carcinomas of
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Invasive breast carcinoma I.O. Elli
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Rapid growth and greater adult heig
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tives, administrative and clerical
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Grade 1 - well differentiated: 3-5
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ent and this is occasionally extens
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Most melanotic tumours of the breas
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A Fig. 1.22 A Classic invasive lobu
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yet others at 90% {97,2147}. For pr
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Fig. 1.27 Medullary carcinoma. The
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myoepithelial cells in fibro a d e
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A Fig. 1.33 Neuroendocrine carcinom
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Macroscopy Fisher et al. reported t
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Fig. 1.39 Apocrine carcinoma. Note
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cells contain intracytoplasmic lume
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A Fig. 1.50 Carcinosarcoma. A Two a
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A B C Fig. 1.75 Lobular neoplasia.
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Intraductal proliferative lesions F
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A B absence of either microcalcific
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Fig. 1.83 Atypical ductal hyperplas
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A B Fig. 1.88 Large excision biopsy
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unusual variants as well. Using thi
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esemble those identified in invasiv
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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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Page 94 and 95: A B Fig. 1.137 A Lipoma. Intraparen
Page 96 and 97: Fig. 1.141 Angiosarcoma after breas
Page 98 and 99: A Fig. 1.144 Mammary osteosarcoma.
Page 100 and 101: Fibroepithelial tumours J.P. Belloc
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Page 106 and 107: A Fig. 1.157 Syringomatous adenoma
Page 108 and 109: Malignant lymphoma and metastatic t
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Page 114 and 115: CHAPTER 2 Tumours of the Ovary and
Page 116 and 117: Polyembryoma 9072/3 Non-gestational
Page 118 and 119: Surface epithelial-stromal tumours
Page 120 and 121: A Fig. 2.04 A Serous borderline tum
Page 122 and 123: A Fig. 2.06 Serous borderline tumou
Page 124 and 125: A Fig. 2.10 Invasive peritoneal imp
Page 126 and 127: Fig. 2.15 Mucinous carcinoma with i
Page 128 and 129: Fig. 2.20 Mucinous endocervical-lik
Page 130 and 131: A Fig. 2.28 Mucinous cystic tumour
Page 132 and 133: early secretory endometrium {2605}.
Page 134 and 135: IV, 6% {2233}. Patients with grade
Page 136 and 137: A Fig. 2.37 A This polypoid intracy
Page 138 and 139: Fig. 2.40 Endometrioid cyst with at
Page 140 and 141: 1 tumours are extremely rare. Almos
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Page 150 and 151: Genetic susceptibility JGCTs may pr
Page 152 and 153: Clinical features F i b romas may b
Page 154 and 155: distinguishes this tumour from the
Page 156 and 157: A Fig. 2.77 A Retiform Sertoli-Leyd
Page 158 and 159: Mean ages of 21 and 38 years and me
Page 160 and 161: Tumours unassociated with PJS form
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Page 164 and 165: Germ cell tumours F. Nogales A. Tal
Page 166 and 167: cases, anisokaryosis has no prognos
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Page 170 and 171: Table 2.06 Grading of ovarian immat
Page 172 and 173: A B Fig. 2.102 A Mature cystic tera
Page 174 and 175: Diagnostic procedures Elevated urin
Page 176 and 177: associated with mature teratomas sh
Page 178 and 179: atives intimately admixed. The germ
Page 180 and 181: Fig. 2.113 Mixed germ cell-sex cord
Page 182 and 183: A Fig. 2.116 A Adenomatous hyperpla
Page 184 and 185: Fig. 2.117 Small cell carcinoma, hy
Page 186 and 187: Clinical features Adenoid cystic-li
Page 188 and 189: Histopathology This epithelial tumo
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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
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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
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Dr Carlo LA VECCHIA Laboratory of E
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Dr Manuel TEIXEIRA Department of Ge
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02.100 Dr. A. Ostor 02.101 Dr. F.A.
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52. Akhtar M, Robinson C, Ashraf Al
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180. Bapat K, Brustein S (1989). Ut
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307. Bolis GB, Maccio T (2000). Cle
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436. Chang J, Sharpe JC, A'Hern RP,
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562. Costa MJ, Ames PF, Walls J, Ro
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689. Di Domenico A, Stangl F, Benni
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820. Falck J, Petrini JH, Williams
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943. Gad A, Azzopardi JG (1975). Lo
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1067. Grimes MM (1992). Cystosarcom
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1197. Herod JJ, Shafi MI, Rollason
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1323. Jacques SM, Qureshi F, Ramire
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1449. Khalifa MA, Mannel RS, Harawa
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1564. Lagios MD (1977). Multicentri
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1687. Loman N, Johannsson O, Kristo
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1807. McCluggage G, McBride H, Maxw
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1937. Mukai M, Torikata C, Iri H (1
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2056. Norris HJ, Taylor HB (1967).
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2180. Park JS, Jones RW, McLean MR,
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2304. Puls LE, Hamous J, Morrow MS,
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2 4 3 4 . Rosen PP, Groshen S, Saig
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2559. Schlesinger C, Silverberg SG
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2686. Silverberg SG (1999). Protoco
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2806. Stutz JA, Evans AJ, Pinder S,
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2942. Tornos C, Silva EG, Ordonez N
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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
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G GADD45, 343, 353 GCDFP-15, 25, 33
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MPNST, see Malignant peripheral ner
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Small cell / oat cell carcinoma, 32
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