Invasive breast carcinoma - IARC

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Table 7.03 Differential diagnosis of myxoid soft tissue lesions of the vulva. Sarcoma botryoides Deep Angiomyofibro- Superficial Fibroepithelial polyp angiomyxoma blastoma angiomyxoma Age at presentation Pre-pubertal Reproductive years Reproductive years Reproductive years Reproductive years Size, site and Polypoid, exophytic or mass Often larger than Subcutaneous, Small, dermal Small, subepithelial, macroscopic 5 cm, never exophytic less than 5 cm lobulated, exophytic configuration superficial Margins Infiltrative Infiltrative Compressive Poorly circumscribed Cellularity and cells Largely paucicellular with a Paucicellular More cellular than DA Bland spindle cells variably pronounced cambium Cytologically bland, Perivascular concen- in addition to enlarlayer stellate tration of cells is ged, pleomorphic Spindle shaped cells usual. stromal cells with including rhabdomyoblasts Cytologically bland smudged chromatin in the myxoid zones Plasmacytoid or epithelioid cells may be prominent. Vessels Inconspicuous Medium calibre, Smaller vessels Elongated thinthick-walled vessels; than DA walled vessels pinwheel collagen Perivascular concentration of stromal cells Matrix Paucicellular, myxoid Mitotic index Usually easily found Rare Rare Rare Rare Immunohistochemistry Actin and desmin Actin, desmin and Strongly desmin positive. Desmin negative Often desmin positive. Myogenin vimentin positive. Minority of cells in positive and myoD positive. occasional cases show positivity for either smooth muscle actin or panmuscle actin (HHF35). Negative for S-100 protein, keratin, fast myosin and myoglobin. Associated findings Stromal neutrophils Overlying epithelium When multiple, may demonstrate consider Carney intraepithelial syndrome neoplasia Clinical course Fully malignant neoplasm Local recurrence Does not recur Benign, Alveolar histology common; never Occasional no recurrences adverse prognostic metastasizes lesions have factor hybrid features of DA and AMFB and should be treated as DA Abbreviations: DA = Deep angiomyxoma; AMFB = Angiomyofibroblastoma 328 Tumours of the vulva
Deep angiomyxoma Definition A locally infiltrative tumour composed of fibroblasts, myofibroblasts and numerous, characteristically thick-walled, blood vessels embedded in an abundant myxoid matrix. Synonym Aggressive angiomyxoma. Clinical features Most patients present with a relatively large, often greater than 10 cm, slowly growing, painless mass in the pelviperineal region that may give rise to pressure effects on the adjacent urogenital or anorectal tracts. Imaging studies often show the mass to be substantially larger than clinically suspected. Macroscopy Macroscopically, the tumour is lobulated but poorly circumscribed due to fingerlike extensions into the surrounding tissue. The neoplasm is grey-pink or tan and rubbery or gelatinous. Tumour spread and staging Deep angiomyxoma is a locally infiltrative but non-metastasizing neoplasm that occurs during the re p roductive years {198,853,2779}. Histopathology The constituent cells of this paucicellular neoplasm are small, uniform, spindleshaped to stellate with poorly defined, pale eosinophilic cytoplasm and bland, often vesicular nuclei. The abundant myxoid matrix contains a variable number of rounded medium-sized to large vessels that possess thickened focally hyalinized walls. Multinucleated cells may be pre s e n t , and occasionally there is morphological overlap with angiomyo -fibroblastoma (see below). Actin and desmin stains are positive in almost all cases, whereas S-100 protein is consistently negative {1431,2082}. Differential diagnosis The diff e rential diagnosis includes a n g i o m y o f i b roblastoma, fibro e p i t h e l i a l polyp (so-called pseudosarcoma botryoides) and superficial angiomyxoma {1054,2063}. Other less common lesions that may enter the differential diagnosis are: (1) Myxoid neuro f i b roma, which has more buckled or wavy nuclei and whose cells are S-100 protein positive. (2) Low grade myxofibrosarcoma, which has thin–walled curvilinear vessels, shows more nuclear atypia and is essentially always desmin negative. (3) Myxoid liposarcoma, which contains delicate arborizing vessels and small lipoblasts. (4) Cellular angiofibroma, which is well circumscribed. Somatic genetics A single case of vulvar deep angiomyxoma showed a loss of one X chromosome as the only cytogenetic aberration, a chromosomal change that is uncommon in this neoplasm {1438}. Prognosis and predictive factors The treatment for this locally aggressive but non-metastasizing proliferation is primarily surgical with close attention to margins. Approximately 30% of patients develop one or more local recurrences. Superficial angiomyxoma Definition A multilobulated, dermal or subcutaneous lesion composed of fibroblasts and thin-walled vessels in a myxoid matrix that occurs in adults. Clinical features The tumour occurs as a subcutanous mass during the reproductive years. Histopathology S c a t t e red multinucleated fibroblasts are often seen {389,854}. There is no cytological atypia or pleomorphism, but scatt e red mitoses may be found. The stro m a generally contains an inconspicuous mixed inflammatory infiltrate that is notable for the presence of neutrophils despite the absence of ulceration or necrosis. Up to o n e - t h i rd contain an epithelial component, usually squamous epithelium. Prognosis and predictive factors Approximately one-third of the lesions recur locally in a non–destructive fashion, usually as a consequence of an incomplete or marginal excision. Less than 5% of cases recur repeatedly. Angiomyofibroblastoma Definition A benign, non-recurring, well circ u m- scribed, myofibroblastic lesion composed of spindle-shaped to round cells A B Fig. 7.18 Angiomyofibroblastoma. A Alternating hypercellular and hypocellular areas are associated with a prominent vascular pattern. B Binucleate and trinucleate tumour cells are common, and some cells have a plasmacytoid appearance. Mesenchymal tumours 329
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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
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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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Page 280 and 281: Mesenchymal tumours M.L. Carcangiu
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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
Page 322 and 323: glandular elements surrounded by fi
Page 324 and 325: Mesenchymal tumours R.L. Kempson M.
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
Page 334 and 335: Familial aggregation of cancers of
Page 336 and 337: BRCA1 syndrome Definition Inherited
Page 338 and 339: dispose individuals to the developm
Page 340 and 341: Fig. 8.05 To assess whether wild-ty
Page 342 and 343: Fig. 8.07 Factors that modify risk
Page 344 and 345: BRCA2 syndrome R. Eeles S. Piver S.
Page 346 and 347: tubal or ovarian carcinomas. Howeve
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Page 350 and 351: Breast tumours Frequency Breast can
Page 352 and 353: Fig. 8.14 Codon distribution of som
Page 354 and 355: Breast tumours Age distribution and
Page 356 and 357: Hereditary non-polyposis colon canc
Page 358 and 359: essary in the evaluation of the pat
Page 360 and 361: Age distribution and penetrance Mos
Page 362 and 363: Contributors Dr Vera M. ABELER** De
Page 364 and 365: Dr Carlo LA VECCHIA Laboratory of E
Page 366 and 367: Dr Manuel TEIXEIRA Department of Ge
Page 368 and 369: 02.100 Dr. A. Ostor 02.101 Dr. F.A.
Page 370 and 371: 52. Akhtar M, Robinson C, Ashraf Al
Page 372 and 373: 180. Bapat K, Brustein S (1989). Ut
Page 374 and 375: 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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