Invasive breast carcinoma - IARC

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Table 2.06 Grading of ovarian immature teratomas. Three-tiered grading system {2060} Grade 1 Tumours with rare foci of immature neuroepithelial tissue that occupy less than one low power field (40x) in any slide. Grade 2 Tumours with similar elements, occupying 1 to 3 low power fields (40x) in any slide. Grade 3 Tumours with large amount of immature neuroepithelial tissue occupying more than 3 low power fields (40x) in any slide. Table 2.07 Management of immature teratomas according to grade of primary tumours and/or implants. Three-tiered grading {2060} Two-tiered grading {2072} S t a g e Combination chemotherapy Grade 1 ovarian tumour Low grade Ia Not required Grade 2 or 3 ovarian tumour High grade Ia Required Grade 2 or 3 implants High grade ≥ II Required Grade 0 implants* regardless ≥ II Not required of ovarian tumour grade * Those extraovarian implants that are composed of mature tissue, essentially glia. ICD-O codes Immature teratoma 9080/3 Mature teratoma 9080/0 Cystic teratoma 9080/0 Dermoid cyst 9084/0 Immature teratoma Definition A teratoma containing a variable amount of immature, embryonal-type (generally immature neuroectodermal) tissue. Epidemiology Immature teratoma represents 3% of teratomas, 1% of all ovarian cancers and 20% of malignant ovarian germ cell tumours and is found either in pure form or as a component of a mixed germ cell tumour {989}. It occurs essentially during the two first decade of life (from 1-46 years; average 18) {989,1174,2060}. Macroscopy Immature teratoma is typically unilateral, large, variegated (6-35 cm; average, 18.5), predominantly solid, fleshy, and grey-tan and may be cystic with haemorrhage and necrosis {989,2060}. Histopathology Immature teratoma is composed of variable amounts of immature embryonaltype tissues, mostly in the form of neuro e c t o d e rmal rosettes and tubules, admixed with mature tissue. N e u roepithelial rosettes are lined by crowded basophilic cells with numerous mitoses {2060} and may be pigmented. Immature mesenchyme in the form of loose, myxoid stroma with focal differentiation into immature cartilage, fat, osteoid and rhabdomyoblasts is often present as well {2060}. Immature endodermal structures including hepatic tissue, intestinal-type epithelium with basal vacuolization and embryonic renal tissue resembling Wilms tumour are encountered less frequently. Immature vascular structures may occur and are sometimes prominent. Grading Based on the quantity of the immature neuroepithelial component, primary and metastatic ovarian immature teratomas (including peritoneal implants and lymph nodes metastases) are separately graded from 1 to 3 {2060}. More recently the possibility of using a two-tiered (low grade and high grade) grading system was suggested {2072}. Adequate sampling of the primary tumour (one block per 1 or 2 cm of tumour) and of all resected implants is crucial, as the tumour grade may vary in different implants. Somatic genetics I m m a t u re teratomas grades 1-2 are A Fig. 2.98 A Immature teratoma, high grade. Neuroectodermal rosettes lie in a background of glial tissue. B Mitotic figures are evident within the immature neuroectodemal tissue. B Germ cell tumours 169
Fig. 2.99 Mature cystic teratoma. T1-weighted precontrast magnetic resonance image. A fat-fluid level is seen (arrow). Fig. 2.100 Mature cystic teratoma with dark hair. The Rokitansky protuberance is composed of fatty tissue, bone, and teeth protuding into the lumen. Fig. 2.101 Fetiform teratoma (homunculus). Limb buds are apparent, and there is abundant hair over the cephalic portion. diploid in 90% of cases, whereas most (66%) of grade 3 tumours are aneuploid {165,2684}. Similarly, karyotypic abnormalities are most often seen in grade 3 tumours {165}. Immature teratomas show fewer DNA copy number changes detected by comparative genomic hybridization than other ovarian germ cell tumours and do not usually exhibit a gain of 12p or i(12p) {1518,2378}. Prognosis and predictive factors The stage and grade of the primary tumour and the grade of its metastases are important predictive factors. Prior to the chemotherapy era, the overall survival rate of patients with grade 1, 2 and 3 neoplasms was 82%, 63% and 30%, respectively {2060}. The use of cisplatin-based combination chemotherapy has dramatically improved the survival rate of patients; 90- 100% of those receiving this regimen remain disease-free {989}. The tumour grade is a crucial feature that determines behaviour and type of therapy. Patients with grade 1 tumours that are stage IA and those with mature (grade 0) implants do not re q u i re adjuvant chemotherapy. Those with grade 2 or 3 tumours, including stage IA, as well as those with immature implants re q u i re combination chemotherapy. The management of patients with grade 1 implants/metastases is not well established. A recent re p o rt from the Pediatric Oncology Group concludes that surgery alone is curative in children and adolescents with immature teratoma of any grade, reserving chemotherapy for cases with relapse {600}. Also, in immature teratomas occurring in childhood, the presence of histological foci of yolk sac tumour rather than the grade of the immature component, per se, is the only predictor of recurrence {1174}. Mature teratoma Definition A cystic or, more rarely, a solid tumour composed exclusively of mature, adulttype tissues. A cyst lined by mature tissue resembling the epidermis with its appendages is clinically designated as "dermoid cyst". Homunculus or fetiform teratoma is a rare type of mature, solid teratoma containing highly organized structures resembling a malformed fetus ("homunculus" = little man). Epidemiology Age Although most mature cystic teratomas occur during the reproductive years, they have a wide age distribution, from 2-80 years (mean, 32), and 5% occur in postmenopausal women {564}. Mature solid teratoma occurs mainly in the first two decades of life {199,2922}. Incidence M a t u re cystic teratoma accounts for 27- 44% of all ovarian tumours and up to 58% of the benign tumours {1502}. In addition to their pure form, derm o i d cysts are found macroscopically within 25% of immature teratomas and in the o v a ry contralateral to a malignant primitrive germ cell tumour in 10-15% of the cases. Clinical features Signs and symptoms Most mature cystic teratomas present with a mass, but at least 25% (up to 60% in some series) are discovered incidentally {546}. Symptoms such as a pelvic mass or pain are more common when the mature teratoma is solid {199,2922}. The following complications have been d e s c r i b e d : (1) Torsion of the pedicle occurs in 10- 16% of the cases, is responsible for acute abdominal pain and may be complicated by infarction, perforation or intra-abdominal haemorrhage. (2) Tumour rupture occurs in 1% of cases and can be spontaneous or traumatic. The spillage of the cyst contents into the peritoneum produces chemical peritonitis with granulomatous nodules mimicking t u b e rculosis or <strong>carcinoma</strong>tosis. Rupture of m a t u re teratoma containing neuro g l i a l elements is thought to be responsible for gliomatosis peritonei characterized by peritoneal “implants” composed of mature glial tissue and does not affect the pro g- nosis {2389}. However, a recent molecular study has demonstrated that these glial implants were heterozygous, whereas the associated mature ovarian teratomas w e re homozygous at the same micro s a t e l- lite loci. This finding suggests that glial implants may arise from metaplasia of pluripotent müllerian stem cells rather than from implantation of the associated ovarian teratomas {845}. Similarly, peritoneal melanosis characterized by pigmentation of the peritoneum has been re p o rted in cases of dermoid cysts. (3) Infection of the tumour occurs in 1% of c a s e s . 170 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,
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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
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aged women (average age of presenta
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lished data suggests a 21% rate of
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A Fig. 1.157 Syringomatous adenoma
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Malignant lymphoma and metastatic t
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used. Inflammatory conditions in th
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male population both in the USA and
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CHAPTER 2 Tumours of the Ovary and
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Polyembryoma 9072/3 Non-gestational
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Surface epithelial-stromal tumours
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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
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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
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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
Page 202 and 203: whelmingly poor {1038,1547,2310}. H
Page 204 and 205: CHAPTER 3 Tumours of the Fallopian
Page 206 and 207: TNM and FIGO classification of carc
Page 208 and 209: Endometrioid adenocarcinoma Endomet
Page 210 and 211: Two examples of adenofibroma of bor
Page 212 and 213: A Fig. 3.11 Adenomatoid tumour. A T
Page 214 and 215: Clinical features Patients range in
Page 216 and 217: Fig. 3.16 Uterus-like mass. The cys
Page 218 and 219: 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
Page 428 and 429:
MPNST, see Malignant peripheral ner
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Small cell / oat cell carcinoma, 32
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Invasive breast carcinoma - IARC

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