Invasive breast carcinoma - IARC

Clinical features
F i b romas may be found incidentally, but
when large, patients may present with
non-specific signs and symptoms of a
pelvic mass. Between 10-15% of fibromas
over 10 cm are associated with
ascites {2519}, and Meigs syndro m e
(ascites and pleural effusion with re s o l u-
tion after fibroma removal) occurs in
about 1% of cases {1839}.
M a c r o s c o p y
F i b romas are hard white tumours averaging
6 cm in diameter. Oedematous
tumours may be soft, and cyst form a t i o n
is common. Haemorrhage and necro s i s
a re rare outside the setting of torsion.
The majority of tumours are unilateral.
Only 8% are bilateral, and less than 10%
show focal or diffuse calcification.
H i s t o p a t h o l o g y
F i b romas are composed of spindleshaped
cells with uniform, bland nuclei
and scant cytoplasm that may contain
small amounts of lipid or occasionally
eosinophilic droplets. The cells are
arranged in fascicles or in a storiform
p a t t e rn. Mitoses are absent or rare .
F i b romas are generally sparsely to moderately
cellular with abundant interc e l l u-
lar collagen, hyalinized plaques and
variable degrees of oedema. The cellularity
may vary from area to area. About
10% of tumours are uniformly and
densely cellular (attaining the cellularity
of a diffuse granulosa cell tumour) and
a re re f e r red to as cellular fibro m a s
{2289}. Cellular fibromas exhibit no
m o re than mild cytological atypia and
an average of three or less mitoses per
10 high power fields. Fibromas expre s s
vimentin and may be immunore a c t i v e
for alpha-inhibin {1816, 2211}.
Fig. 2.69 Fibrosarcoma. Moderate to severe cytological atypia accompanied by numerous mitotic figures
characterize this fibrosarcoma.
generations of a kindred lacking other
stigmata of the syndrome {728,1635,
2 2 2 1 , 2 6 3 5 } .
Prognosis and predictive features
R a re l y, cellular fibromas recur in the
pelvis or upper abdomen, often after a
long interval, particularly if they were
a d h e rent or ruptured at the time of diagnosis
{2289}. Ve ry rare l y, fibro m a t o u s
tumours with no atypical features may
s p read beyond the ovary {1722}.
F i b r o s a r c o m a
D e f i n i t i o n
A rare fibroblastic tumour of the ovary
that typically has 4 or more mitotic figu
res per 10 high power fields as well as
significant nuclear atypia.
per 10 high power fields) with atypical
division figures, haemorrhage and
n e c rosis {90,145,2289}.
Somatic genetics
Trisomy 12 as well as trisomy 8 have
been re p o rted in an ovarian fibro s a rc o-
ma {2963}.
Genetic susceptibility
Ovarian fibro s a rcomas are rarely associated
with Maffucci syndrome {484}
and the nevoid basal cell carc i n o m a
s y n d rome {1517}.
Prognosis and predictive factors
The majority of ovarian fibro s a rc o m a s
have had a malignant course.
Genetic susceptibility
Ovarian fibromas are common in
females with the nevoid basal cell carc i-
noma syndrome, occurring in about
75% of patients having the syndro m e
re f e r red to gynaecologists. Syndro m e -
related tumours are usually bilateral
(75%), frequently multinodular, almost
always calcified, sometimes massively,
and tend to occur at a younger age,
usually in children, adolescents, or
young adults {1042,1354,2603}.
Additional tumours may arise after local
excision. The nevoid basal cell carc i n o-
ma syndrome has been re p o rted in four
E p i d e m i o l o g y
F i b ro s a rcomas are the most common
ovarian sarcoma, occurring at any age
but most often in older women.
M a c r o s c o p y
F i b ro s a rcomas are large, solid tumours,
commonly haemorrhagic and necro t i c ,
and are usually unilateral.
H i s t o p a t h o l o g y
F i b ro s a rcomas are densely cellular,
spindle cell neoplasms with moderate to
s e v e re cytological atypia, a high mitotic
rate (an average of 4 or more mitoses
Fig. 2.70 Stromal tumour with minor sex cord elements.
Rarely, fibrothecomas contain a few tubules
lined by cells resembling Sertoli cells.
Sex cord-stromal tumours 151