Invasive breast carcinoma - IARC

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Published by IARC Press, International Agency for Research on Cancer, 150 cours Albert Thomas, F-69008 Lyon, France © International Agency for Research on Cancer, 2003 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The International Agency for Research on Cancer welcomes requests for permission to reproduce or translate its publications, in part or in full. Requests for permission to reproduce figures or charts from this publication should be directed to the respective contributor (see section Source of Charts and Photographs). The designations used and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The authors alone are responsible for the views expressed in this publication. Enquiries should be addressed to the Communications Unit,International Agency for Research on Cancer, 69008 Lyon, France, which will provide the latest information on any changes made to the text and plans for new editions. Format for bibliographic citations: Tavassoli F.A., Devilee P. (Eds.): World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. IARC Press: Lyon 2003 IARC Library Cataloguing in Publication Data Pathology and genetics of tumours of the breast and female genital organs / editors, Fattaneh A. Tavassoli, Peter Devilee. (World Health Organization classification of tumours ; 5) 1. Breast Neoplasms—genetics. 2. Breast Neoplasms—pathology 3. Genital Neoplasms, Female—genetics 4. Genital Neoplasms, Female—pathology I. Tavassoli, Fattaneh A. II. Devilee, Peter III. Series ISBN 92 832 2412 4 (NLM Classification W 1)
Contents 1 Tumours of the breast 9 Invasive breast carcinoma 13 Invasive ductal carcinoma, NOS 19 Invasive lobular carcinoma 23 Tubular carcinoma 26 Invasive cribriform carcinoma 27 Medullary carcinoma 28 Mucin producing carcinomas 30 Neuroendocrine tumours 32 Invasive papillary carcinoma 34 Invasive micropapillary carcinoma 35 Apocrine carcinoma 36 Metaplastic carcinomas 37 Lipid-rich carcinoma 41 Secretory carcinoma 42 Oncocytic carcinoma 43 Adenoid cystic carcinoma 44 Acinic cell carcinoma 45 Glycogen-rich clear cell carcinoma 46 Sebaceous carcinoma 46 Inflammatory carcinoma 47 Bilateral breast carcinoma 48 Precursor lesions Lobular neoplasia 60 Intraductal proliferative lesions 63 Microinvasive carcinoma 74 Intraductal papillary neoplasms 76 Benign epithelial lesions 81 Myoepithelial lesions 86 Mesenchymal tumours 89 Fibroepithelial tumours 99 Tumours of the nipple 104 Malignant lymphoma and metastatic tumours 107 Tumours of the male breast 110 2 Tumours of the ovary and peritoneum 113 Surface epithelial-stromal tumours 117 Serous tumours 119 Mucinous tumours 124 Endometrioid tumours 130 Clear cell tumours 137 Transitional cell tumours 140 Squamous cell lesions 143 Mixed epithelial tumours 144 Undifferentiated carcinomas 145 Sex cord-stromal tumours 146 Granulosa-stromal cell tumours 146 Sertoli-stromal cell tumours 153 Mixed sex cord-stromal tumours 158 Steroid cell tumours 160 Germ cell tumours 163 Primitive germ cell tumours 163 Biphasic or triphasic teratomas 168 Monodermal teratomas 171 Mixed germ cell-sex cord-stromal tumours 176 Tumours and related lesions of the rete ovarii 180 Miscellaneous tumours and tumour-like lesions 182 Lymphomas and leukaemias 191 Secondary tumours of the ovary 193 Peritoneal tumours 197 3 Tumours of the fallopian tube and uterine ligaments 203 Tumours of the fallopian tube 206 Tumours of the uterine ligaments 212 4 Tumours of the uterine corpus 217 Epithelial tumours and related lesions 221 Endometrial carcinoma 221 Endometrial hyperplasia 228 Endometrial polyp 230 Mesenchymal tumours and related lesions 233 Endometrial stromal and related tumours 233 Smooth muscle tumours 236 Other mesenchymal tumours 242 Mixed epithelial and mesenchymal tumours 245 Gestational trophoblastic disease 250 Sex cord-like, neuroectodermal / neuroendocrine tumours, lymphomas and leukaemias 255 Secondary tumours of the uterine corpus 257 5 Tumours of the uterine cervix 259 Epithelial tumours 262 Squamous tumours and precursors 266 Glandular tumours and precursors 272 Uncommon carcinomas and neuroendocrine tumours 277 Mesenchymal tumours 280 Mixed epithelial and mesenchymal tumours 284 Melanotic, germ cell, lymphoid and secondary tumours of the cervix 287 6 Tumours of the vagina 291 Epithelial tumours 293 Squamous tumours 293 Glandular tumours 297 Tumours of skin appendage origin 324 Mesenchymal tumours 302 Mixed epithelial and mesenchymal tumours 306 Melanotic, neuroectodermal, lymphoid and secondary tumours 308 7 Tumours of the vulva 313 Epithelial tumours 316 Squamous tumours 316 Glandular tumours 321 Mesenchymal tumours 326 Melanocytic tumours 331 Germ cell, neuroectodermal, lymphoid and secondary tumours 333 8 Inherited tumour syndromes 335 Familial aggregation of cancers of the breast and female genital organs 336 BRCA1 syndrome 338 BRCA2 syndrome 346 Li-Fraumeni syndrome 351 Cowden syndrome 355 Hereditary non-polyposis colon cancer (HNPCC) 358 Ataxia telangiectasia syndrome 361 Contributors 365 Source of charts and photographs 370 References 372 Subject index 425
Page 2: Previous volumes in this series Kle
Page 6 and 7: World Health Organization Classific
Page 10 and 11: CHAPTER 1 Tumours of the Breast Can
Page 12 and 13: TNM classification of carcinomas of
Page 14 and 15: Invasive breast carcinoma I.O. Elli
Page 16 and 17: Rapid growth and greater adult heig
Page 18 and 19: tives, administrative and clerical
Page 20 and 21: Grade 1 - well differentiated: 3-5
Page 22 and 23: ent and this is occasionally extens
Page 24 and 25: Most melanotic tumours of the breas
Page 26 and 27: A Fig. 1.22 A Classic invasive lobu
Page 28 and 29: yet others at 90% {97,2147}. For pr
Page 30 and 31: Fig. 1.27 Medullary carcinoma. The
Page 32 and 33: myoepithelial cells in fibro a d e
Page 34 and 35: A Fig. 1.33 Neuroendocrine carcinom
Page 36 and 37: Macroscopy Fisher et al. reported t
Page 38 and 39: Fig. 1.39 Apocrine carcinoma. Note
Page 40 and 41: cells contain intracytoplasmic lume
Page 42 and 43: A Fig. 1.50 Carcinosarcoma. A Two a
Page 44 and 45: A B C Fig. 1.75 Lobular neoplasia.
Page 46 and 47: Intraductal proliferative lesions F
Page 48 and 49: A B absence of either microcalcific
Page 50 and 51: Fig. 1.83 Atypical ductal hyperplas
Page 52 and 53: A B Fig. 1.88 Large excision biopsy
Page 54 and 55: unusual variants as well. Using thi
Page 56 and 57: esemble those identified in invasiv
Page 58 and 59:
A B Fig. 1.97 Microinvasive carcino
Page 60 and 61:
A Papilloma may be subject to morph
Page 62 and 63:
A B C Fig. 1.103 Papillary intraduc
Page 64 and 65:
colour measuring from 0.5 to 12 cm.
Page 66 and 67:
Immunoprofile The cases studied by
Page 68 and 69:
Glycogen-rich, clear cell carcinoma
Page 70 and 71:
Differential diagnosis There may be
Page 72 and 73:
quality metaphase spreads from an i
Page 74 and 75:
Fig. 1.67 Lobular carcinoma of brea
Page 76 and 77:
detectable distant metastasis displ
Page 78 and 79:
detected at a late stage as small t
Page 80 and 81:
Extent of ductal carcinoma in situ
Page 82 and 83:
Benign epithelial proliferations G.
Page 84 and 85:
Fig. 1.112 Microglandular adenosis.
Page 86 and 87:
A Apocrine adenoma ICD-O code 8401/
Page 88 and 89:
A B Fig. 1.128 Adenomyoepithelioma,
Page 90 and 91:
Mesenchymal tumours M. Drijkoningen
Page 92 and 93:
1113,1275}. There is a complex patt
Page 94 and 95:
A B Fig. 1.137 A Lipoma. Intraparen
Page 96 and 97:
Fig. 1.141 Angiosarcoma after breas
Page 98 and 99:
A Fig. 1.144 Mammary osteosarcoma.
Page 100 and 101:
Fibroepithelial tumours J.P. Belloc
Page 102 and 103:
aged women (average age of presenta
Page 104 and 105:
lished data suggests a 21% rate of
Page 106 and 107:
A Fig. 1.157 Syringomatous adenoma
Page 108 and 109:
Malignant lymphoma and metastatic t
Page 110 and 111:
used. Inflammatory conditions in th
Page 112 and 113:
male population both in the USA and
Page 114 and 115:
CHAPTER 2 Tumours of the Ovary and
Page 116 and 117:
Polyembryoma 9072/3 Non-gestational
Page 118 and 119:
Surface epithelial-stromal tumours
Page 120 and 121:
A Fig. 2.04 A Serous borderline tum
Page 122 and 123:
A Fig. 2.06 Serous borderline tumou
Page 124 and 125:
A Fig. 2.10 Invasive peritoneal imp
Page 126 and 127:
Fig. 2.15 Mucinous carcinoma with i
Page 128 and 129:
Fig. 2.20 Mucinous endocervical-lik
Page 130 and 131:
A Fig. 2.28 Mucinous cystic tumour
Page 132 and 133:
early secretory endometrium {2605}.
Page 134 and 135:
IV, 6% {2233}. Patients with grade
Page 136 and 137:
A Fig. 2.37 A This polypoid intracy
Page 138 and 139:
Fig. 2.40 Endometrioid cyst with at
Page 140 and 141:
1 tumours are extremely rare. Almos
Page 142 and 143:
Fig. 2.50 Borderline Brenner tumour
Page 144 and 145:
express thrombomodulin and have bee
Page 146 and 147:
serous and transitional cell carcin
Page 148 and 149:
is yellow to tan with a variable ad
Page 150 and 151:
Genetic susceptibility JGCTs may pr
Page 152 and 153:
Clinical features F i b romas may b
Page 154 and 155:
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 206 and 207:
TNM and FIGO classification of carc
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
Page 224 and 225:
endometrioid adenocarcinoma fro m a
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
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
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
Page 322 and 323:
glandular elements surrounded by fi
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
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
Page 348 and 349:
in typical nuclear foci that may re
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
Page 376 and 377:
436. Chang J, Sharpe JC, A'Hern RP,
Page 378 and 379:
562. Costa MJ, Ames PF, Walls J, Ro
Page 380 and 381:
689. Di Domenico A, Stangl F, Benni
Page 382 and 383:
820. Falck J, Petrini JH, Williams
Page 384 and 385:
943. Gad A, Azzopardi JG (1975). Lo
Page 386 and 387:
1067. Grimes MM (1992). Cystosarcom
Page 388 and 389:
1197. Herod JJ, Shafi MI, Rollason
Page 390 and 391:
1323. Jacques SM, Qureshi F, Ramire
Page 392 and 393:
1449. Khalifa MA, Mannel RS, Harawa
Page 394 and 395:
1564. Lagios MD (1977). Multicentri
Page 396 and 397:
1687. Loman N, Johannsson O, Kristo
Page 398 and 399:
1807. McCluggage G, McBride H, Maxw
Page 400 and 401:
1937. Mukai M, Torikata C, Iri H (1
Page 402 and 403:
2056. Norris HJ, Taylor HB (1967).
Page 404 and 405:
2180. Park JS, Jones RW, McLean MR,
Page 406 and 407:
2304. Puls LE, Hamous J, Morrow MS,
Page 408 and 409:
2 4 3 4 . Rosen PP, Groshen S, Saig
Page 410 and 411:
2559. Schlesinger C, Silverberg SG
Page 412 and 413:
2686. Silverberg SG (1999). Protoco
Page 414 and 415:
2806. Stutz JA, Evans AJ, Pinder S,
Page 416 and 417:
2942. Tornos C, Silva EG, Ordonez N
Page 418 and 419:
3061. Wargotz ES, Norris HJ (1990).
Page 420 and 421:
3189. Yoshioka T, Tanaka T (2000).
Page 422 and 423:
References 425
Page 424 and 425:
Biphasic teratomas, 168 BLM, 341, 3
Page 426 and 427:
G GADD45, 343, 353 GCDFP-15, 25, 33
Page 428 and 429:
MPNST, see Malignant peripheral ner
Page 430:
Small cell / oat cell carcinoma, 32
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