Invasive breast carcinoma - IARC

The tubular variant is distinguished from
focal, florid and diffuse hyperplasia of
mesonephric remnants by the presence
of cytologic atypia, mitotic activity and
the focal presence of intraluminal nuclear
debris instead of the colloid-like secretion
typical of mesonephric re m n a n t s
{2679}.
Mesonephric adenocarcinomas are
i m m u n o reactive for epithelial markers
(AE1/3, cytokeratin 1, Cam5.2, cytokeratin
7 and epithelial membrane antigen)
in 100% of cases, for calre t i n i n
(88%), and vimentin (70%). The
absence of immunoreactivity with
e s t rogen and pro g e s t e rone re c e p t o r
helps to distinguish the endometrioid
variant from endometrioid adenocarc i-
noma {2679}. Positive immunore a c t i v i t y
for CD10 may be another helpful feat
u re {2110}. The behaviour of the
lesions and prognosis are stage
d e p e n d e n t .
Early invasive adenocarcinoma
Definition
Early invasive adenocarcinoma refers to
a glandular neoplasm in which the extent
of stromal invasion is so minimal that the
risk of local lymph node metastasis is
negligible.
Synonym
"Microinvasive" adenocarcinoma.
Fig. 5.24 Early invasive adenocarcinoma, mounted
section.
Tumour spread and staging
Adenocarcinomas of the cervix exist in
early and frankly invasive forms {1611,
2139}. The entity of "early invasive" or
"microinvasive" carcinoma is controversial.
The current, 1995 FIGO staging,
omits specific re f e rence to glandular
lesions in stage IA {1300}. In addition,
there are practical problems in identifying
microinvasive adenocarcinoma histologically
(see below). Nevertheless, it is
recommended that the FIGO classification
be adopted.
Histopathology
The sine qua non of microinvasive aden
o c a rcinoma is stromal invasion. There
may be marked glandular irregularity with
e ffacement of the normal glandular arc h i-
t e c t u re, the tumour extending beyond the
deepest normal crypt. Cribri-form, papill
a ry or solid patterns may be pre s e n t .
T h e re may be a stromal response in the
f o rm of oedema, chronic inflammatory
infiltrate or a desmoplastic re a c t i o n .
Lymphatic capillary-like space involvement
is helpful in confirming invasion.
Having established the presence of invasion,
the depth of invasion and the width of
the tumour must be measured. In most
cases the depth is measured from the surface
rather than the point of origin, which
is hard to establish in some cases. Thus,
tumour thickness, rather than "depth of
invasion", is measured. The width is the
g reatest diameter of the neoplasm measu
red parallel to the surface; the measurement
should be done by calibrated optics.
Prognosis and predictive factors
The prognosis of microinvasive adenocarcinoma
(FIGO Stage 1A), as defined
above, is excellent and essentially the
same as that of its squamous counterpart
{768,2143,2573,2732,3076}.
Adenocarcinoma in situ
Definition
A lesion in which normally situated glands
a re partly or wholly replaced by cytologically
malignant epithelium; in the form e r
case the border is characteristically sharp.
Histopathology
The epithelium is usually devoid of intracellular
mucin and may resemble endo-
Fig. 5.25 Early invasive adenocarcinoma. Mounted
section shows that its horizontal spread is much
greater than the depth of invasion.
Fig. 5.26 Extensive adenocarcinoma in situ. Note that the neoplastic glands conform to the configuration of
normal crypts and do not extend beyond them, and there is no stromal reaction.
Epithelial tumours 275