Invasive breast carcinoma - IARC

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with distinct cell borders and a gro u n d - glass cytoplasm. A prominent eosinophilic infiltration in the stroma helps to separate the tumour from non-keratinizing squamous cell carcinoma {1701}. Prognosis and predictive factors The prognosis of adenosquamous carcinoma remains uncertain {68}. A Fig. 5.32 Adenoid basal carcinoma. A Clusters of basaloid cells show mature central squamous differentiation. B Note small clusters of basaloid cells adjacent to cystic glands. B Adenoid cystic carcinoma Definition A carcinoma of the cervix that resembles adenoid cystic carcinoma of salivary gland origin. Epidemiology Most of the patients are over 60 years of age, and there is a high proportion of Black women {849}. Clinical features The majority of patients present with postmenopausal bleeding and have a mass on pelvic examination {849}. Fig. 5.33 Atypical carcinoid. Islands of tumour cells with moderate nuclear atypia are surrounded by fibrous stroma. Fig. 5.34 Small cell carcinoma. Note the loosely packed neoplastic cells with scant cytoplasm. Histopathology This rare tumour of the cervix has a histological appearance similar to its counterpart in salivary glands. The characteristic cystic spaces are filled with a slightly eosinophilic hyaline material or basophilic mucin and are surrounded by palisaded epithelial cells {849}. In contrast to adenoid cystic carcinoma of salivary gland, the cervical carcinomas show greater nuclear pleomorphism, a high mitotic rate and necrosis {849}. A solid variant has been described {65}. Immunostains for basement membrane components such as collagen type IV and laminin are strongly positive {1918}. In contrast to an earlier study {849}, the majority of the tumours stained for S-100 protein and HHF35 suggesting myoepithelial differentiation {1059}. The differential diagnosis includes small cell carcinoma, adenoid basal carcinoma and non-keratinizing squamous cell carcinoma. Histogenesis This tumour, basaloid squamous cell carcinoma and adenoid basal carcinoma are part of a morphological and biological spectrum of basaloid cervical neoplasms, and a putative reserve cell origin has been suggested {1059}. Circumstantial evidence suggests that adenoid 278 Tumours of the uterine cervix
A Fig. 5.35 Large cell neuroendocrine carcinoma. A The tumour is composed of large cells with pleomorphic nuclei and frequent mitotic figures. B Note the strong cytoplasmic immunoreactivity for chromogranin A. B basal carcinoma may be a precursor of adenoid cystic carcinoma {1059}. Prognosis and predictive factors The tumours frequently recur locally or metastasize to distant organs and have an unfavourable prognosis. Adenoid basal carcinoma Definition A cervical carcinoma in which rounded, generally well diff e rentiated nests of basaloid cells show focal gland formation or sometimes central squamous differentiation. Epidemiology Adenoid basal carcinoma is a rare tumour. The patients are usually more than 50 years old. Clinical findings Patients are usually asymptomatic and without a clinically detectable abnormality of the cervix. The tumour is often discovered as an incidental finding. Histopathology The histological appearance shows small nests of basaloid cells, almost always beneath and often arising from CIN or small invasive squamous cell carc i n o m a s {849}. The cells are small with scanty cytoplasm and are arranged in cords and nests with focal glandular or squamous diff e re n- tiation. There is frequently associated CIN {332,849}. The differential diagnosis includes other small cell tumours {2280}. Histogenesis This tumour, basaloid squamous cell carcinoma and adenoid cystic carcinoma are part of a morphological and biological spectrum of basaloid cervical neoplasms and a putative reserve cell origin has been suggested {1059}. Prognosis and predictive factors The tumour is low grade and rare l y metastasizes. Neuroendocrine tumours The group of neuroendocrine tumours includes carcinoid, atypical carc i n o i d , large cell neuroendocrine carcinoma and small cell carcinoma {63,2803}. Neuroendocrine differentiation is demonstrated with pan-neuroendocrine markers such as chromogranin A, synaptophysin and neuron specific enolase. A variety of peptides and hormones are also present, such as calcitonin, gastrin, serotonin, substance P, vasoactive intestinal peptide, pancreatic polypeptide, somatostatin and adre n o c o rt i c o t ro p h i c hormone {22}, but their clinical significance is limited {2612}. Carcinoid Generally benign, carcinoids have the same characteristic organoid appearance as observed in other sites. The d e g ree of nuclear atypia and mitotic activity are important in the differential diagnosis between typical and atypical carcinoids. Atypical carcinoid An atypical carcinoid is a carcinoid with cytologic atypia that exhibits increased mitotic activity (5-10 per high power field) and contains foci of necrosis {63}. Small cell carcinoma Small cell carcinomas account for 1-6% of cervical carcinomas {22}. Squamous or glandular diff e rentiation may be present {22,248, 830,1761,2219}. The 5-year survival rate is re p o rted to be 14-39% {22,248,2803}. Large cell neuroendocrine carcinoma Large cell neuroendocrine carcinoma is a r a re tumour that often has focal adenocarcinomatous diff e rentiation {592a, 1521a, 2361a}. The tumour cells have abundant cytoplasm, large nuclei and pro m i n e n t nucleoli. Mitoses are frequent. The diff e re n- tial diagnosis includes non-neuro e n d o c r i n e u n d i ff e rentiated carcinoma, adenocarc i n o- ma with neuroendocrine features, metastatic neuroendocrine carcinoma and undiff e r- entiated sarcoma. The tumours are aggre s- sive and appear to have a similar outcome to small cell carcinoma {1006}. Undifferentiated carcinoma U n d i ff e rentiated carcinoma is a carc i n o- ma lacking specific diff e rentiation. The diff e rential diagnosis includes poorly diff e r- entiated squamous cell carcinoma, aden o c a rcinoma, glassy cell carcinoma and large cell neuroendocrine carc i n o m a . Epithelial tumours 279
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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
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A Fig. 2.77 A Retiform Sertoli-Leyd
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Mean ages of 21 and 38 years and me
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Tumours unassociated with PJS form
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mal origin without crystals of Rein
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Germ cell tumours F. Nogales A. Tal
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cases, anisokaryosis has no prognos
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ation may coexist in the same neopl
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Table 2.06 Grading of ovarian immat
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A B Fig. 2.102 A Mature cystic tera
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Diagnostic procedures Elevated urin
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associated with mature teratomas sh
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atives intimately admixed. The germ
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Fig. 2.113 Mixed germ cell-sex cord
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A Fig. 2.116 A Adenomatous hyperpla
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Fig. 2.117 Small cell carcinoma, hy
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Clinical features Adenoid cystic-li
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Histopathology This epithelial tumo
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sis. Corpus luteum of pregnancy has
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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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Page 232 and 233: Table 4.03 Altered gene function in
Page 234 and 235: Mesenchymal tumours and related les
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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
Page 256 and 257: Sex cord-like, neuroectodermal and
Page 258 and 259: Secondary tumours of the uterine co
Page 260 and 261: WHO histological classification of
Page 262 and 263: Epithelial tumours M. Wells J.M. Ne
Page 264 and 265: Fig. 5.04 Mechanisms of human papil
Page 266 and 267: Fig. 5.08 Keratinizing squamous cel
Page 268 and 269: in their Asian population {2957}. I
Page 270 and 271: have a strong association with high
Page 272 and 273: e red by squamous epithelium {380}.
Page 274 and 275: endometrioid adenocarcinoma of the
Page 276 and 277: metrial epithelium. In some cases t
Page 280 and 281: Mesenchymal tumours M.L. Carcangiu
Page 282 and 283: {781}, liposarcoma {2840,3016}, ost
Page 284 and 285: Mixed epithelial and mesenchymal tu
Page 286 and 287: Fig. 5.44 Wilms tumour. The tumour
Page 288 and 289: A Fig. 5.47 Implant of endometrial
Page 290 and 291: CHAPTER 6 Tumours of the Vagina Alt
Page 292 and 293: Epithelial tumours E.S. Andersen A.
Page 294 and 295: Aetiology The fact that both VAIN a
Page 296 and 297: Fig. 6.10 Fibroepithelial polyp.A m
Page 298 and 299: er of mitoses varies but is usually
Page 300 and 301: ICD-O codes Adenosquamous carcinoma
Page 302 and 303: A C Fig. 6.17 Sarcoma botryoides. A
Page 304 and 305: 1-11 cm. They may arise anywhere in
Page 306 and 307: elsewhere in the female genital tra
Page 308 and 309: A Fig. 6.24 Yolk sac tumour. A The
Page 310 and 311: g rowing in sheets. Some may have s
Page 312 and 313: WHO histological classification of
Page 314 and 315: Epithelial tumours E.J. Wilkinson M
Page 316 and 317: even with additional sectioning, it
Page 318 and 319: type) is a highly diff e rentiated
Page 320 and 321: Clinical features Bartholin gland c
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Page 324 and 325: Mesenchymal tumours R.L. Kempson M.
Page 326 and 327: 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,
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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