Invasive breast carcinoma - IARC

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Clinical features Adenoid cystic-like carcinoma presents typically as a pelvic mass or abdominal distension in postmenopausal women {758}. On the other hand, the two cases of adenoid cystic carcinoma occurred in the reproductive age group {837,3248}. Cases of basal cell carcinoma of the ovary also typically present as a pelvic mass but occur over a wide age range {758}. Histopathology These neoplasms histologically re s e m b l e adenoid cystic carcinoma, basal cell tumours of salivary gland or cutaneous basal cell carcinoma and occur in several f o rms. The adenoid cystic-like carc i n o- mas resemble adenoid cystic carc i n o m a of salivary gland but lack a myoepithelial component {758}. On the other hand a myoepithelial component has been demonstrated in the cases of adenoid cystic carcinoma {837,3248}. Cribriform p a t t e rns composed of uniform small cells s u r rounding round lumens and cysts were typical, and luminal mucin and hyaline cylinders were common to both forms. A s u rface epithelial-stromal component was p resent in the great majority of cases of adenoid cystic-like carcinoma {758} but was absent in the cases of adenoid cystic c a rcinoma {837,3248}. The cases of basal cell tumour consisted of aggregates of basaloid cells with peripheral palisading {758}. Several tumours of this type had foci of squamous diff e rentiation or gland f o rmation, and some showed an ameloblastoma-like pattern. A case of a monomorphic adenoma of salivary gland type described as a cribriform variant of basal cell adenoma has been re p o rt e d {2492}. In none of the re p o rted cases in this group was there evidence of a teratoma or other germ cell tumour. Immunoprofile Actin and S-100 protein stains were both positive in the two cases of adenoid cystic carcinoma {837,3248}; however, these stains were negative in the cases of adenoid cystic-like carcinoma {758}. Fig. 2.120 Ovarian papillary mesothelioma. Note the papillary tumour growth on the surface and a haemorrhagic corpus luteum within the ovary. cystic carcinoma have an excellent prognosis with relatively limited follow up. Ovarian malignant mesothelioma Definition Ovarian malignant mesotheliomas (OMMs) are mesothelial tumours confined mostly or entirely to the ovarian surface and/or the ovarian hilus. Aetiology In the largest series there was no history of asbestos exposure {526}. Clinical features The clinical presentation was usually abdominal or pelvic pain or abdominal swelling and an adnexal mass on pelvic examination {526}. Macroscopy The tumours were typically solid and varied from 3-15 cm in maximum dimension. Most were bilateral. Histopathology The tumours usually involved both the serosa and the parenchyma of the ovary. The histological and immunohistochemical characteristics of the OMM are analogous to those observed in peritoneal mesotheliomas. The pro l i f e r a t i n g mesothelial tumour cells may invade and partly replace ovarian tissue and/or the hilar soft tissue. Differential diagnosis Just like diffuse peritoneal malignant mesotheliomas, OMMs can extensively involve one or both ovaries in a macroscopically and histologically carcinomatous growth pattern and may thus be confused with ovarian epithelial neoplasms. In this context immunohistochemical detection of thrombomodulin, calretinin, Ber-EP4 and cytokeratin 5/6 provide the most useful markers {2113}. Prognosis and predictive factors In the absence of sufficient follow-up data for this rare neoplasm, OMM can be assumed to have a prognosis similar to its disseminated peritoneal analogue. Prognosis and predictive factors The prognosis of adenoid cystic-like carcinoma is generally unfavourable and appears to depend on the degree of malignancy of the surface epithelial-stromal component. On the other hand, cases of basal cell tumour and adenoid Fig. 2.121 Papillary mesothelioma of the ovary. Well differentiated papillary fronds of tumour grow from the surface of the ovary. Miscellaneous tumours and tumour-like conditions of the ovary 185
hydropic chorionic villi with cistern formation and trophoblastic proliferation. Prognosis and predictive factors The prognosis of gestational choriocarcinoma is more favourable than that of the nongestational type. Single agent chemotherapy with methotrexate or actinomycin D is highly effective. Hydatidiform mole Definition Hydatidiform mole is an ectopic ovarian molar pregnancy. Ovarian hydatidiform moles have hydropic chorionic villi with cistern formation and trophoblastic proliferation. A Clinical features Patients with hydatidiform mole have symptoms related to large haemorrhagic masses that may rupture causing haematoperitoneum. Macrosopy Hydatiform mole typically consists of a haemorrhagic mass; chorionic vesicles may be identified. Histopathology Hydatidiform moles show characteristic hydropic chorionic villi with cistern formation and trophoblastic pro l i f e r a t i o n {2821,3212}. Ovarian wolffian tumour B Fig. 2.122 Wolffian tumour. A The microcysts containing an eosinophilic material result in a sieve-like appearance. B The tumour cells may be spindle-shaped and form irregularly-shaped tubules simulating a retiform pattern. Gestational choriocarcinoma Definition A rare tumour composed of both cytotrophoblast and syncytiotrophoblast that arises as a result of an ectopic ovarian pregnancy. No germ cell or common epithelial component is present. Clinical features Patients with choriocarcinoma have symptoms related to a large haemorrhagic mass that may rupture causing haematoperitoneum. Macrosopy Choriocarcinoma consists typically of a haemorrhagic mass. Histopathology The typical appearance is an admixture of syncytiotrophoblast and cytotrophoblast often arranged in a plexiform pattern {142,1317}. The specimens must be sampled extensively to rule out a germ cell, or in the older age group, a surface epithelial component. They must be distinguished from rarely re p o rt e d ovarian hydatidiform moles, which have Definition A tumour of presumptive wolffian origin characterized by a variety of epithelial patterns. Synonyms Ovarian tumour of probable wolffian origin, retiform wolffian tumour. Localization Although more common in the broad ligament, this tumour also occurs in the ovary {1262,3212}. Clinical features Patients are in the re p roductive age g roup or beyond and present with abdominal swelling or a mass {3212}. P reoperative serum oestradiol levels may be elevated and re t u rn to norm a l postmenopausal levels after operation {1289}. 186 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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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
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
Page 142 and 143: Fig. 2.50 Borderline Brenner tumour
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Page 146 and 147: serous and transitional cell carcin
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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
Page 162 and 163: mal origin without crystals of Rein
Page 164 and 165: Germ cell tumours F. Nogales A. Tal
Page 166 and 167: cases, anisokaryosis has no prognos
Page 168 and 169: ation may coexist in the same neopl
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 188 and 189: Histopathology This epithelial tumo
Page 190 and 191: sis. Corpus luteum of pregnancy has
Page 192 and 193: Lymphomas and leukaemias L.M. Roth
Page 194 and 195: Secondary tumours of the ovary J. P
Page 196 and 197: Occasionally, the colonic adenocarc
Page 198 and 199: Peritoneal tumours S.C. Mok J.O. Sc
Page 200 and 201: A B Fig. 2.140 Cystic adenomatoid m
Page 202 and 203: whelmingly poor {1038,1547,2310}. H
Page 204 and 205: CHAPTER 3 Tumours of the Fallopian
Page 206 and 207: TNM and FIGO classification of carc
Page 208 and 209: Endometrioid adenocarcinoma Endomet
Page 210 and 211: Two examples of adenofibroma of bor
Page 212 and 213: A Fig. 3.11 Adenomatoid tumour. A T
Page 214 and 215: Clinical features Patients range in
Page 216 and 217: Fig. 3.16 Uterus-like mass. The cys
Page 218 and 219: CHAPTER 4 Tumours of the Uterine Co
Page 220 and 221: TNM and FIGO classification of non-
Page 222 and 223: Epithelial tumours and related lesi
Page 224 and 225: endometrioid adenocarcinoma fro m a
Page 226 and 227: fers from the prototypical type I e
Page 228 and 229: the ovary and bladder. Unlike prima
Page 230 and 231: schema {1535,2602}. Although this c
Page 232 and 233: Table 4.03 Altered gene function in
Page 234 and 235: 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
Page 366 and 367:
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,
Page 378 and 379:
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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