Invasive breast carcinoma - IARC

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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
Transitional cell tumours Definition Ovarian tumours composed of epithelial elements histologically re s e m b l i n g urothelium and its neoplasms. A B Fig. 2.48 A Transitional cell carcinoma. This tumour is primarily cystic with prominent intracystic papillary proj e c t i o n s .B Papillary growth of malignant transitional epithelium with a smooth lumenal border predominates. Histopathology This group of tumours includes the following: (1) Benign Brenner tumours, distinguished by a prominent stromal component accompanying transitional cell nests. (2) Borderline and malignant Bre n n e r tumours in which a benign Bre n n e r tumour component is associated with exuberantly proliferative, variably atypical but non-invasive transitional epithelium in the former and unequivocal stromal invasion in the latter. (3) Transitional cell carcinoma in which a malignant transitional cell tumour is not associated with a benign or borderline Brenner component. ICD-O codes Transitional cell carcinoma (non-Brenner) 8120/3 Malignant Brenner tumour 9000/3 Borderline Brenner tumour 9000/1 Brenner tumour 9000/0 Epidemiology Transitional cell tumours account for 1- 2% of all ovarian tumours. Transitional cell carcinoma Definition An ovarian tumour that is composed of epithelial elements histologically resembling malignant urothelial neoplasms and does not have a component of benign or borderline Brenner tumour. Epidemiology Transitional cell carcinoma is the pure or predominant element in 6% of ovarian carcinomas {2676}. The great majority of transitional cell carcinomas occur in women 50-70 years old {1110}. Fig. 2.49 Malignant Brenner tumour. The malignant component consists of large, closely-packed, irregular aggregates of transitional epithelial cells infiltrating the stroma. There was also an area of benign Brenner tumour (not shown). Clinical features The presentation of women with transitional cell carcinoma is the same as with other malignant ovarian tumours, abdominal pain, swelling, weight loss, and bladder or bowel symptoms {139,2676}. 140 Tumours of the ovary and peritoneum
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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,
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 142 and 143: Fig. 2.50 Borderline Brenner tumour
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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
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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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metrial epithelium. In some cases t
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with distinct cell borders and a gr
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Mesenchymal tumours M.L. Carcangiu
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{781}, liposarcoma {2840,3016}, ost
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Mixed epithelial and mesenchymal tu
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Fig. 5.44 Wilms tumour. The tumour
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A Fig. 5.47 Implant of endometrial
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CHAPTER 6 Tumours of the Vagina Alt
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Epithelial tumours E.S. Andersen A.
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Aetiology The fact that both VAIN a
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Fig. 6.10 Fibroepithelial polyp.A m
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er of mitoses varies but is usually
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ICD-O codes Adenosquamous carcinoma
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A C Fig. 6.17 Sarcoma botryoides. A
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1-11 cm. They may arise anywhere in
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elsewhere in the female genital tra
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A Fig. 6.24 Yolk sac tumour. A The
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g rowing in sheets. Some may have s
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WHO histological classification of
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Epithelial tumours E.J. Wilkinson M
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even with additional sectioning, it
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type) is a highly diff e rentiated
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Clinical features Bartholin gland c
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glandular elements surrounded by fi
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Mesenchymal tumours R.L. Kempson M.
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Table 7.03 Differential diagnosis o
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Prognosis and predictive factors A
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Table 7.04 Clark levels of cutaneou
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A Fig. 7.23 Vulvar peripheral primi
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Familial aggregation of cancers of
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BRCA1 syndrome Definition Inherited
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dispose individuals to the developm
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Fig. 8.05 To assess whether wild-ty
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Fig. 8.07 Factors that modify risk
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BRCA2 syndrome R. Eeles S. Piver S.
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tubal or ovarian carcinomas. Howeve
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in typical nuclear foci that may re
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Breast tumours Frequency Breast can
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Fig. 8.14 Codon distribution of som
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Breast tumours Age distribution and
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Hereditary non-polyposis colon canc
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essary in the evaluation of the pat
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Age distribution and penetrance Mos
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Contributors Dr Vera M. ABELER** De
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Dr Carlo LA VECCHIA Laboratory of E
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Dr Manuel TEIXEIRA Department of Ge
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02.100 Dr. A. Ostor 02.101 Dr. F.A.
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52. Akhtar M, Robinson C, Ashraf Al
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180. Bapat K, Brustein S (1989). Ut
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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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