Invasive breast carcinoma - IARC

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Mixed epithelial and mesenchymal tumours W.G. McCluggage R.A. Kubik-Huch Definition Tumours composed of an admixture of neoplastic epithelial and mesenchymal elements. Each of these components may be either benign or malignant. ICD-O codes Carcinosarcoma 8980/3 Adenosarcoma 8933/3 Wilms tumour 8960/3 Adenofibroma 9013/0 Adenomyoma 8932/0 Epidemiology These neoplasms are much less common than their counterparts in the uterine corpus. They may occur in any age group, but carcinosarcomas most commonly involve elderly postmenopausal women {527,1060}. Clinical features The presenting symptom is usually a b n o rmal uterine bleeding. In some cases, especially in cases of carcinosarcoma, a friable mass may extrude from the vaginal introitus. The tumour may be identified following an abnormal cervical smear. Carcinosarcoma Definition A neoplasm composed of an admixture of malignant epithelial and mesenchymal elements. prior radiation treatment. HPV infection, especially HPV 16, has been found in the epithelial and mesenchymal components suggesting a role in the evolution of these neoplasms {1060}. Histopathology The histological features are similar to its c o u n t e r p a rt in the uterine corpus. H o w e v e r, the epithelial elements are m o re commonly non-glandular in type and include squamous (keratinizing, non-keratinizing or basaloid), adenoid cystic, adenoid basal or undiff e re n t i a t e d c a rcinoma {527,1060,1757,1785,3177}. Adjacent severe dysplasia of the squamous epithelium has also been described. Mesonephric adenocarc i n o m a s of the cervix with a malignant spindle cell component have been re p o rt e d , re p resenting an unusual subtype of cervical carc i n o s a rcoma {521}. Before diagnosing a cervical carc i n o s a rcoma, extension from a primary uterine corpus neoplasm should be excluded {960, 3245}. Prognosis and predictive factors Cervical carcinosarcomas are aggressive neoplasms, and treatment is usually radical hysterectomy followed by chemotherapy and/or radiotherapy. The prognosis may be better in small tumours with a polypoid appearance. Although aggressive, these neoplasms appear to be more often confined to the uterus compared to their counterparts in the corpus and may have a better prognosis {527,1060}. Adenosarcoma Definition A neoplasm composed of an admixture of benign epithelial and malignant mesenchymal elements. Synonyms Malignant müllerian mixed tumour, malignant mesodemal mixed tumour, metaplastic <strong>carcinoma</strong>. Epidemiology C a rc i n o s a rcomas most commonly involve elderly postmenopausal women {527,1060}. These neoplasms are much less common than their counterparts in the uterine body. LM T T Aetiology An occasional case of cervical carcinosarcoma has been associated with Fig. 5.42 CT scans of malignant mullerian tumour (T) of the cervix, extensively involving uterine corpus. On the sagittal image (left) note a large leiomyoma (LM) of the uterine fundus. The coronal reconstruction (right) shows the large extension of the tumour (T). Note the hydronephrosis of the left kidney. 284 Tumours of the uterine cervix
Epidemiology Cervical adenosarcomas are much less common than their counterparts in the uterine corpus. Histopathology The histological features are similar to its counterpart in the corpus. However, the epithelium is more likely to be squamous or mucinous. Adenosarcomas may or may not invade the underlying cervical stroma. Prognosis and predictive factors Because these neoplasms are rare, management is individualized. The therapy is usually simple hysterectomy, and radiation may be considered for deeply invasive neoplasms. They may recur following conservative therapy by simple excision or polypectomy. The prognostic features are not well established The prognosis is much better than that of cervical carcinosarcoma {848}. Wilms tumour Definition A malignant tumor showing blastema and primitive glomerular and tubular differentiation resembling Wilms tumour of the kidney. Epidemiology Occasional cases of Wilms tumour arising within the cervix have been described, usually in adolescents {155, 215,1302}. Macroscopy Macroscopically, these neoplasms are composed of polypoid masses that protrude through the vagina. Histopathology Histologically, the classic triphasic patt e rn of epithelial, mesenchymal and blastemal elements may be present. Prognosis and predictive factors In two cases prolonged survival has been reported following local excision and chemotherapy {155,206,215,1302}. Adenofibroma Definition A mixed neoplasm composed of benign epithelial and mesenchymal components. Fig. 5.43 Adenosarcoma. Leaf-like glands are surrounded by a cuff of cellular mesenchyme. Epidemiology These are uncommon in the cervix and are more commonly found within the uterine body {3245}. Macroscopy Cervical adenofibromas are polypoid neoplasms that usually protrude into the endocervical canal. On sectioning small cystic spaces may be identified. Histopathology Histologically, adenofibroma is a benign papillary neoplasm composed of fronds lined by benign epithelium that is usually glandular in type. The epithelium may be cuboidal, columnar, attenuated, ciliated or mucinous. Occasionally, benign squamous epithelium may be present. The mesenchymal component shows little mitotic activity and is usually composed of non-specific fibrous tissue. The main differential diagnosis is a low grade adenosarcoma; the latter, however, exhibits malignant mesenchymal features including hypercellularity with condensation around glands, nuclear atypia and increased mitotic activity. Prognosis and predictive factors The therapy is usually local excision or simple hysterectomy. Local excision is usually curative, although re c u r rence may follow incomplete re m o - v a l . Adenomyoma Definition A tumour composed of a benign glandular component and a benign mesenchymal component composed exclusively or p redominantly of smooth muscle. These tumours are rare within the cervix. A variant is the atypical polypoid adenomyoma. Macroscopy Cervical adenomyomas are usually polypoid lesions with a firm sectioned surf a c e . In some cases small cystic areas may be seen that may contain abundant mucin. R a re tumours are entirely intramural. Histopathology Three variants of cervical adenomyoma have been described, the endocervical type, the endometrial type and atypical polypoid adenomyoma. Endocervical type The endocervical type, which may be confused with minimal deviation adeno<strong>carcinoma</strong>, is composed largely of endocervical mucinous glands surrounded by a mesenchymal component consisting predominantly of smooth muscle {1005}. The glands are lined by tall mucinsecreting cells and are typically irregularly shaped with papillary infoldings. O c c a s i o n a l l y, tubal-type epithelium or endometrial-type glands surrounded by endometrial-type stroma are focally pres- Mixed epithelial and mesenchymal tumours 285
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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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the ovary and bladder. Unlike prima
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schema {1535,2602}. Although this c
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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
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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 278 and 279: with distinct cell borders and a gr
Page 280 and 281: Mesenchymal tumours M.L. Carcangiu
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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
Page 328 and 329: Prognosis and predictive factors A
Page 330 and 331: Table 7.04 Clark levels of cutaneou
Page 332 and 333: 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,
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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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