Invasive breast carcinoma - IARC

Fig. 2.12 Serous surface papilloma. A portion of the
external surface of the ovary is covered by papillary
excrescences.
Fig. 2.13 Serous cystadenoma. Sectioned surface
shows a multiloculated cystic tumour with smooth
cyst walls.
to be associated with a poor prognosis
{652,2145}. Although rare, transformation
of a SBT into a bona fide frankly invasive
carcinoma may occur.
Benign serous tumours
Definition
Benign tumours composed of epithelium
resembling that of the fallopian tube or in
some cases the surface epithelium of the
ovary.
Epidemiology
Benign serous tumours of the ovary
account for approximately 16% of all
ovarian epithelial neoplasms. The majority
of benign serous tumours arise in
adults in the fourth to sixth decades,
although they may occur in patients
younger than twenty or older than eighty
y e a r s .
Localization
Benign serous tumours arise preferentially
in the cortex of the ovary or on its surface
(8%). They are usually bilateral,
especially in older women. Often the
tumours are metachronous with intervals
that range from three to fourteen years.
Similar tumours in extraovarian sites
occasionally accompany benign serous
tumours.
Clinical features
Signs and symptoms
The most common symptoms are pain,
vaginal bleeding and abdominal
enlargement, but usually the tumour is
asymptomatic and discovered incidentally
during ultrasound investigation of
another gynaecological disorder.
Macroscopy
Benign serous tumours are usually 1-10
cm in diameter but occasionally reach up
to 30 cm or more. They are typically
unilocular or multilocular cystic lesions,
the external surface is smooth, and the
inner surface may contain small papillary
projections. The cyst contents are watery
and very rarely opaque or bloody.
Adenofibromas are solid and have a
spongy sectioned surface with minute,
colourless fluid-containing cysts. Cystadenofibromas
contain both solid areas
and cysts. Surface papillomas appear as
warty excrescences of different sizes on
the surface of the ovary.
Histopathology
Benign serous tumours typically are lined
by an epithelium similar to that of the fallopian
tube with ciliated and less frequently
nonciliated secretory cells. Of
special diagnostic interest are the cysts
with flattened lining, some of which may
represent benign serous neoplasms with
a desquamated lining. The only effective
method to establish their nature is the
application of scanning electron microscopy,
which easily detects the ciliated
cells, allowing a definitive diagnosis to
be made.
Histogenesis
Benign serous tumours result from the
proliferation of the surface epithelium of
the ovary, {272,1403,2605} pro d u c i n g
s u rface papillary excrescences or
invaginating into the cortex of the ovary,
forming so called inclusion cysts. Some
morphological data support the possibility
that a number of benign sero u s
tumours arise from remnants in the hilar
region of the ovary, possibly from rete
cysts {726,1403,1823}.
Prognosis and predictive factors
Serous cystadenomas are benign.
Fig. 2.14 Mucinous adenocarcinoma. The sectioned
surface shows a multiloculated cystic tumour with
more solid areas containing small cysts.
Mucinous tumours
Definition
Ovarian tumours some or all of whose
epithelial cells contain intracytoplasmic
mucin. They may resemble those of the
endocervix, gastric pylorus or intestine.
In some tumours only scattered goblet
cells are present in an epithelium that is
otherwise non-mucinous.
ICD–O codes
Mucinous adenocarcinoma 8480/3
Mucinous
cystadenocarcinofibroma 9015/3
Mucinous borderline tumour 8472/1
Mucinous cystadenoma 8470/0
Mucinous adenofibroma 9015/0
Mucinous adenocarcinoma and
related tumours
Definition
A malignant epithelial tumour of the
o v a ry that in its better diff e re n t i a t e d
areas resembles intestinal or endocervical
epithelium. Ovarian mucinous adenoc
a rcinomas differ from bord e r l i n e
tumours by having evidence of ovarian
stromal invasion.
Macroscopy
Mucinous carcinomas are usually large,
unilateral, smooth surfaced, multilocular
or unilocular cystic masses containing
watery or viscous mucoid material. They
a re bilateral in approximately 5% of
cases. Haemorrhagic, necrotic, solid or
papillary areas are relatively frequent,
and some tumours may be predominantly
solid {1613,2605}. Because areas of
malignancy may be limited, generous
sampling of all mucinous cystic tumours
to include up to one histological section
per 1-2 cm of tumour diameter with sam-
124 Tumours of the ovary and peritoneum