Invasive breast carcinoma - IARC

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