Invasive breast carcinoma - IARC

Prognosis and predictive factors
The prognosis is excellent. Recurre n c e s
and metastases are rare. Even in the rare
case of an extraovarian tumour nodule
involving the colonic serosa {2737}, no
subsequent problems developed 9 years
after surgery, radiation and chemotherap
y. Since a few patients treated by unilateral
salpingo-oophorectomy developed
endometrioid carcinoma in the contralateral
ovary, and 1 died from it, bilateral
s a l p i n g o - o o p h o rectomy would be prudent
when retention of fertility is no longer
an issue. Unilateral salpingo-oophore c t o-
my along with follow-up for early detection
of any subsequent ovarian or endometrial
adenocarcinoma is acceptable for
women of childbearing age.
Benign endometrioid tumours
Definition
Ovarian tumours with histological features
of benign glands or cysts lined by
well differentiated cells of endometrial
type.
Fig. 2.38 Endometrioid borderline tumour of the ovary with microinvasion. Cystic tumour contains complex
papillae. A small area has densely packed glands indicative of microinvasion (arrow) .
predominantly unilateral, but rare bilateral
lesions occur.
Macroscopy
Tumours range in size from 2-40 cm,
have a tan to grey-white sectioned surface
that varies from solid to predominantly
solid with cysts ranging from a few
mm to 8 cm in diameter {201,2737}.
Haemorrhage and necrosis are present
mainly in larger tumours.
Histopathology
T h ree patterns have been described
{201,2737}. The most common is adenofibromatous.
Islands of crowded endometrioid
glands or cysts lined by cells
displaying grade 1 to, rarely, grade 3
cytological atypia proliferate in an adenofibromatous
stroma. Stromal invasion
is absent. Mitotic activity is usually low.
A
Squamous metaplasia is common, and
necrosis may develop in the metaplastic
epithelium. The second pattern is villoglandular
or papillary with an atypical cell
lining similar to atypical hyperplasia of
the endometrium again in a fibromatous
b a c k g round. The third form shows a
combination of villoglandular and adenofibromatous
patterns. Anywhere from
15% to over half of the patients have
endometriosis in the same ovary as well
as at extraovarian sites {201,2737}.
Fig. 2.39 A Endometrioid cystadenoma. The cystic neoplasm forms villiform structures lined by well differentiated
endometrioid type epithelium. B Endometroid adenofibroma. A squamous morule bridges two
endometrioid type glands lined by uniform cells set in a fibrous stroma.
B
Epidemiology
Because of the rarity of these neoplasms
no convincing epidemiological data can
be quoted. The reported patients are
mainly of the reproductive age.
Localization
Benign endometrioid tumours are usually
unilateral, though in rare cases involvement
of both ovaries is encountered.
Clinical features
Signs and symptoms
There are no specific clinical symptoms
of benign endometrioid tumours. Small
neoplasms are incidental findings, sometimes
in the wall of an ovarian endometriotic
cyst. Large tumours are manifested
by pain and abdominal swelling.
Imaging
Imaging techniques, including US, CT
and MRI, cannot effectively establish the
specific nosological character of the
process. They can visualize endometriotic
foci and thus indirectly indicate the
presumptive endometrioid nature of the
neoplasm; otherwise the results of imaging
technique show the formal characteristics,
i.e. cystic or cystic-fibrous architecture
of the lesion {234}.
Histopathology
The histological diagnosis of endometrioid
adenomas and cystadenomas is
based on the presence of well differentiated,
benign appearing glands or cysts
lined by endometrial type cells with or
without squamous differentiation. In the
adenofibromatous variant fibrous stroma
p redominates. Though adenofibro m a s
136 Tumours of the ovary and peritoneum