Invasive breast carcinoma - IARC

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TNM and FIGO classification of carcinomas of the fallopian tube TNM and FIGO classification 1,2 T – Primary Tumour TNM Categories FIGO Stages TX Primary tumour cannot be assessed T0 No evidence of primary tumour Tis 0 Carcinoma in situ (preinvasive carcinoma) T1 I Tumour confined to fallopian tube(s) T1a IA Tumour limited to one tube, without penetrating the serosal surface T1b IB Tumour limited to both tubes, without penetrating the serosal surface T1c IC Tumour limited to one or both tube(s) with extension onto or through the tubal serosa, or with malignant cells in ascites or peritoneal washings T2 II Tumour involves one or both fallopian tube(s) with pelvic extension T2a IIA Extension and/or metastasis to uterus and/or ovaries T2b IIB Extension to other pelvic structures T2c IIC Pelvic extension (2a or 2b) with malignant cells in ascites or peritoneal washings T3 and/or N1 III Tumour involves one or both fallopian tube(s) with peritoneal implants outside the pelvis and/or positive regional lymph nodes T3a IIIA Microscopic peritoneal metastasis outside the pelvis T3b IIIB Macroscopic peritoneal metastasis outside the pelvis 2 cm or less in greatest dimension T3c and/or N1 IIIC Peritoneal metastasis more than 2 cm in greatest dimension and/or positive regional lymph nodes M1 IV Distant metastasis (excludes peritoneal metastasis) Note: Liver capsule metastasis is T3/stage III, liver parenchymal metastasis, M1/stage IV. Pleural effusion must have positive cytology for M1/stage IV. N – Regional Lymph Nodes 3 NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis M – Distant Metastasis MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis Stage Grouping Stage 0 Tis N0 M0 Stage IA T1a N0 M0 Stage IB T1b N0 M0 Stage IC T1c N0 M0 Stage IIA T2a N0 M0 Stage IIB T2b N0 M0 Stage IIC T2c N0 M0 Stage IIIA T3a N0 M0 Stage IIIB T3b N0 M0 Stage IIIC T3c N0 M0 Any T N1 M0 Stage IV Any T Any N M1 _ _ _ _ _ _ _ _ _ _ 1 {51,2976}. 2 A help desk for specific questions about the TNM classification is available at http://tnm.uicc.org. 3 The regional lymph nodes are the hypogastric (obturator), common iliac, external iliac, lateral sacral, para-aortic, and inguinal nodes. 205
Tumours of the fallopian tube I. Alvarado-Cabrero A. Cheung R. Caduff Malignant epithelial tumours Definition A malignant epithelial tumour of the tubal mucosa, usually with glandular differentiation. In order to be considered a primary carcinoma of the fallopian tube, the tumour must be located macroscopically within the tube or its fimbriated end, and the uterus and ovary must either not contain carcinoma or, if they do, it must be clearly different from the fallopian tube lesion. ICD-O codes Serous adenocarcinoma 8441/3 Mucinous adenocarcinoma 8480/3 Endometrioid adenocarcinoma 8380/3 Clear cell adenocarcinoma 8310/3 Transitional cell carcinoma 8120/3 Undifferentiated carcinoma 8020/3 Epidemiology Primary fallopian tube carcinomas are rare, amounting to 0.3-1.1% of gynaecological malignancies {158}. The risk factors appear similar to those of epithelial ovarian cancer. Adenocarcinoma is the most frequent tumour of the fallopian tube {2566}. Macroscopy On macroscopic examination, the tube shows abnormal dilatation or nodular thickening resembling a hydrosalpinx or haematosalpinx and contains a dominant localized tumour mass. When found in the proximal part of the tube, the tumour may protrude through the fimbriated end. On the sectioned surface the adenocarcinoma usually consists of soft, grey-brown, villous or polypoid tissue. Tumour spread and staging The tumour spread is very similar to that of ovarian carcinoma and involves adjacent organs, the peritoneum and regional lymph nodes. Involvement of the adjacent ovary may make it difficult to determine whether the tumour is primary in the tube or ovary. When the origin remains unclear, the tumour is classified as tuboovarian carcinoma {1256}. Surgical staging is performed according to the FIGO classification system {51,2976}. Histopathology All carcinoma subtypes documented in the ovaries have been identified in the fallopian tube. Serous carcinoma is the most common cellular subtype. In one series of 151 cases, 80% of the tumours were serous {158}. In other large series, about half of these carcinomas were s e rous, one-fourth endometrioid, onefifth transitional cell or undifferentiated and the remainder of other cell types {75}. Serous adenocarcinoma Most serous carcinomas of the tube are invasive tumours with a high histological grade. In one series 50% of the cases were grade 3 {75}. Occasional serous Fig. 3.01 Carcinoma of the fallopian tube. The sec - tioned surface shows a dilated fallopian tube filled with papillary tumour exhibiting foci of haemorrhage. carcinomas have an extensive inflammatory cell infiltration that may simulate a salpingitis of non-tuberculous type {472}. Mucinous adenocarcinoma These tumours are extremely rare and often are associated with other mucinous neoplasms of the female genital tract {2617}. Reported cases have been predominantly in situ mucinous carcinomas {2450}. A case of synchronous, trifocal mucinous papillary adenocarc i n o m a involving the uterine cervix and both fallopian tubes has been reported {1316}. We are only aware of a single case of an invasive mucinous adenocarcinoma. The histological appearance of these tumours resembles that of ovarian mucinous carcinomas, and goblet cells may be prominent. A B Fig. 3.02 Serous papillary adenocarcinoma of the fallopian tube. A Pedunculated papillary tumour arises from the wall of the tube. There is no invasion of the muscular wall. B Note the well differentiated papillary fronds. C This papillary tumour shows prominent budding from the primary papillae. The nuclei show stratification and atypia. C 206 Tumours of the fallopian tube and uterine ligaments
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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
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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
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 186 and 187: Clinical features Adenoid cystic-li
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 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
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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
Page 236 and 237: areas are limited to less than 30%
Page 238 and 239: A B C Fig. 4.30 Leiomyosarcoma. A T
Page 240 and 241: e used sparingly and is reserved fo
Page 242 and 243: A B Fig. 4.38 Leiomyoma with perino
Page 244 and 245: cytological atypia, tumour cell nec
Page 246 and 247: Mixed epithelial and mesenchymal tu
Page 248 and 249: Prognosis and predictive factors Th
Page 250 and 251: tumours may superficially invade th
Page 252 and 253: A Fig. 4.46 A Gestational choriocar
Page 254 and 255: 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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