Invasive breast carcinoma - IARC

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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
f i b roblasts and round cells and separated by hypocellular, oedematous or collagenous tissue. E p i d e m i o l o g y This tumour accounts for 2-6% of ovarian stromal tumours, and more than 80% occur in young women in the second and third decades {433}. Clinical features P resenting symptoms include menstrual a b n o rmalities or abdominal discomfort {433,1280a,1409a,1695a}. Horm o n a l manifestations are rare {433}, although a few tumours have been shown to produce estrogens or androgens {614, 1222,1778,2315,2964}. Virilization may occur in pregnant women {419,738, 1308 }. Fig. 2.71 Signet-ring stromal tumour. There is a diffuse proliferation of round cells with eccentric nuclei and a single large cytoplasmic vacuole resembling signet-ring cells. Stromal tumour with minor sex cord elements D e f i n i t i o n S t romal tumour with minor sex cord elements is a rare, fibro t h e c o m a t o u s tumour containing scattered sex cord elements {2605,3211}. By definition, the sex cord element must account for
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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,
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Mesenchymal tumours M. Drijkoningen
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1113,1275}. There is a complex patt
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A B Fig. 1.137 A Lipoma. Intraparen
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Fig. 1.141 Angiosarcoma after breas
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A Fig. 1.144 Mammary osteosarcoma.
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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 140 and 141: 1 tumours are extremely rare. Almos
Page 142 and 143: Fig. 2.50 Borderline Brenner tumour
Page 144 and 145: express thrombomodulin and have bee
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 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
Page 190 and 191: sis. Corpus luteum of pregnancy has
Page 192 and 193: Lymphomas and leukaemias L.M. Roth
Page 194 and 195: Secondary tumours of the ovary J. P
Page 196 and 197: Occasionally, the colonic adenocarc
Page 198 and 199: Peritoneal tumours S.C. Mok J.O. Sc
Page 200 and 201: 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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