Invasive breast carcinoma - IARC

1 tumours are extremely rare. Almost
invariably high grade (grade 3) nuclei
are identified. In view of this finding as
well as the mixture of different architectural
patterns, clear cell adenocarcinoma
is not graded.
Prognosis and predictive factors
When controlled for stage, survival of
women with clear cell adenocarcinoma
may be slightly lower than that of patients
with serous carcinoma. The five year survival
is 69% for patients with stage I
tumours, 55% for stage II, 14% for stage
III and 4% for stage IV. There is no consensus
in the literature about the value of
pattern, cell type, mitotic index or grade
as a prognostic indicator {395}.
B
Fig. 2.45 MRI: T1-weighted image (left) and T2-weighted (right) of a borderline clear cell cystadenofibroma
of the left ovary. The huge multicystic tumour fills the pelvis almost completely. The uterus with endometrial
hyperplasia (arrow) is pushed to the right iliac bone, and the urinary bladder (B) is compressed.
Borderline clear cell
adenofibromatous tumour
Definition
An ovarian tumour of low malignant
potential composed of atypical or histologically
malignant glands or cysts lined
by clear or hobnail cells set in a dense
f i b rous stroma with an absence of stromal
invasion.
S y n o n y m s
Clear cell adenofibromatous tumour of
low malignant potential, clear cell aden
o f i b romatous tumour of bord e r l i n e
m a l i g n a n c y.
E p i d e m i o l o g y
Of approximately 30 cases of neoplasms
classified as borderline clear
cell adenofibromatous tumour, the mean
age of patients was 65 years.
M a c r o s c o p y
A d e n o f i b romas with increasing atypia
including intraepithelial carcinoma have
a similar appearance to adenofibro m a s
but in addition have areas that are softer
and fleshier.
H i s t o p a t h o l o g y
B o rderline clear cell adenofibro m a t o u s
tumours include those in which the
epithelium is atypical or carc i n o m a t o u s
without invasion. Adenofibromatous tumours
in which the glands are lined by
malignant epithelium are best designated
as "borderline clear cell adenofibromas
with intraepithelial carc i n o m a " .
They are similar to borderline adenofib
romas; however, nuclear atypia is more
marked with coarse chromatin clumping,
prominent nucleoli and incre a s e d
mitotic activity. Occasionally, minute foci
of invasion can be identified, and these
tumours are designated "micro i n v a s i v e " .
The epithelium often displays stratification
and budding, although true papill
a ry structures are uncommon. Small
solid masses of clear cells in the stro m a
raise the question of invasion.
Prognosis and predictive factors
With the exception of one case {202},
b o rderline clear cell adenofibro m a -
tous tumours including those with
intraepithelial carcinoma and microinvasion
have a benign course following
removal of the ovary {583,1285,1435,
1 8 9 7 , 2 0 5 2 } .
Clear cell adenofibroma
Definition
An ovarian tumour composed of histologically
benign glands or cysts lined by
Fig. 2.46 Borderline clear cell adenofibromatous
tumour. High power magnification shows simple
glands with nuclear enlargement, irregular nuclear
membranes and distinct nucleoli.
clear or hobnail cells set in a dense
fibrous stroma.
Epidemiology
Among approximately twelve reported
cases of benign clear cell adenofibroma,
the mean age of patients was 45.
Macroscopy
Adenofibromas have a median diameter
of 12 cm and display a smooth lobulated
external surface. The sectioned surface
has a fine honeycomb appearance with
minute cysts embedded in a rubbery
stroma.
Histopathology
Clear cell adenofibromas are characterized
by tubular glands lined by one or
two layers of epithelium that contains
polygonal, hobnail or flattened cells. The
cytoplasm may be clear, slightly granular
or eosinophilic. Nuclear atypia and mitotic
activity are minimal. The stroma is
densely fibrous.
Fig. 2.47 Borderline clear cell tumour with
microinvasion. Clear cell adenofibromatous
tumour is seen on the right with the area of
microinvasion on the left.
Surface epithelial-stromal tumours 139