Invasive breast carcinoma - IARC

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A B Fig. 2.102 A Mature cystic teratoma. Adult-type tissues such as intestine tend to have an organoid arrangement with two layers of smooth muscle beneath glandular mucosa. B Note the pigmented retinal epithelium and associated mature glial tissue. Fig. 2.103 Mature teratoma. Note the cerebellar structures adjacent to adipose and fibrous connective tissue. (4) Haemolytic anaemia has been reported in rare cases {1020}. Macroscopy Dermoid cyst is an ovoid, occasionally bilateral (8-15% of cases), cystic mass of 0.5-40 cm (average 15 cm) with a smooth external surface and is filled with sebaceous material and hair. A nodule composed of fat tissue with teeth or bone protrudes into the cyst and is termed a Rokitansky protuberance. Mature solid teratoma is a large, solid mass with multiple cysts of varying size, a soft, cerebroid appearance and small foci of haemorrhage. Histopathology M a t u re teratomas are composed of adult-type tissue derived from two or three embryonic layers. Benign tumours such as struma ovarii, carcinoid, cortic o t roph cell adenoma, pro l a c t i n o m a , naevus and glomus tumour may arise within a typical dermoid cyst {143, 1389,2162,2682}. Histogenesis The presence of Barr bodies (nuclear sex chromatin) and a 46 XX karyotype is consistent with origin through parthenogenetic development. Selective tissue microdissection and genetic analysis of mature ovarian teratomas demonstrated a genotypic difference between homozygous teratomatous tissues and heterozygous host tissue in support of their origin f rom a post-meiotic germ cell {1667, 3032}. Lymphoid aggregates associated with squamous or glandular epithelium within teratomas are heterozygous and derived from host tissue, whereas well differentiated thymic tissue is homozygous, suggesting capability for lymphoid differentiation {3032}. Although multiple teratomas in the same ovary originate independently from different progenitor germ cells, they may appear histologically similar indicating the role of possible local and environmental factors in phenotypic differentiation of ovarian germ cell tumours {683}. Prognosis and predictive factors Dermoid cysts with histological foci (up to 21 mm 2 ) of immature neuroepithelial tissue have an excellent pro g n o s i s {3174}. Recurrence in the form of a dermoïd cyst (3% of cases) or immature teratoma (2-2.6% of cases) in the residual ipsilateral ovary is most frequent when the initial cysts are bilateral or multiple and have ruptured {104,3174}. Monodermal teratomas and somatic-type tumours associated with dermoid cysts Definition Teratomas composed exclusively or predominantly of a single type of tissue derived from one embryonic layer (ectod e rm or endoderm) and adult-type tumours derived from a dermoid cyst. ICD-O codes Struma ovarii 9090/0 Carcinoid 8240/3 Mucinous carcinoid 8243/3 Strumal carcinoid 9091/1 Ependymoma 9391/3 Primitive neuro e c t o d e rmal tumour 9473/3 Glioblastoma multiforme 9440/3 Teratoma with malignant transformation 9084/3 Malignant melanoma 8720/3 Melanocytic naevus 8720/0 Sebaceous adenoma 8410/0 Sebaceous carcinoma 8410/3 Retinal anlage tumour 9363/0 Struma ovarii Definition A mature teratoma composed either exclusively or predominantly of thyroid tissue. Struma ovarii may harbour changes histologically identical to thyroid adenoma, carcinoma (malignant struma ovarii) or both. Those admixed with a carcinoid (strumal carcinoid) are classified separately. Epidemiology Struma ovarii, the most common type of m o n o d e rmal teratoma, accounts for 2.7% of all ovarian teratomas {3146} with Germ cell tumours 171
c a rcinomas are difficult to diagnose since struma ovarii generally lacks a capsule and has irregular margins. The thyroid tissue of struma may be uniformly malignant in some cases, undoubtedly arising in such cases from histological foci of normal-appearing thyroid tissue, which are not extensive enough in itself to qualify for the diagnosis of struma ovarii. Fig. 2.104 Genetic analysis of various histological components selectively microdissected from a mature ovarian teratoma using microsatellite markers INT-2 (11q13) and D95303 (99). Teratomatous components are homozygous showing one allelic band, whereas lymphocytes associated with squamous and respiratory epithelium are heterozygous with both allelic bands, similar to host tissue (normal ovarian stroma). malignant struma ovarii re p re s e n t i n g 0.01% of all ovarian tumours and 5-10% of all struma ovarii. Most patients are in their fifth decade {3146}. Clinical features Signs and symptoms Patients present with a palpable abdominal mass or unusual symptoms including Meigs syndrome {983}, cervical thyroid hypertrophy and thyrotoxicosis (5% of cases) with high pelvic iodine uptake {2697}. An elevated serum level of thyroglobulin occurs in malignant struma ovarii {2412}. Macroscopy The tumour is unilateral and varies from 0.5-10 cm in diameter. It has a brown solid and gelatinous sectioned surface and sometimes appears as a nodule within a dermoid cyst. Entirely cystic strumas containing green gelatinous material also occur {2831}. Histopathology Struma ovarii is composed of normal or hyperplastic thyroid-type tissue with patterns seen in thyroid adenoma such as microfollicular, macrofollicular, trabecular and solid. Oxyphil or clear cells may be found {2832}. Cystic struma is composed of thin fibrous septa lined by flat, cuboidal cells with sparse typical thyroid follicles in the cyst wall {2831}. Immunoreactivity for thyroglobulin may be helpful in problematic cases such as cystic struma, oxyphilic or clear cell variants and a trabecular architecture that might be indistinguishable from Sertoli- Leydig cell tumours. Criteria used for malignant changes within struma ovarii are the same as those used for a diagnosis of malignancy in the thyroid gland {677,2387}. Papillary carcinomas (85% of cases) display the characteristic ground glass nuclei. However, follicular Fig. 2.105 Meiotic division. Primordial germ cells are heterozygous with all informative microsatellite markers. After the first meiotic division and crossing over between homologous chromatids, a homozygous genotype is demonstrated with microsatellite marker “a” while a heterozygous genotype is seen with microsatellite marker ”b”. Prognosis and predictive factors Tumours with the morphology of papillary or follicular thyroid cancer and extraovarian spread at presentation are probably the only lesions that deserve a designation of malignant struma, whilst the so-called "benign strumatosis", peritoneal implants composed of benign thyroid-type tissue, does not alter the prognosis. Factors increasing the likelihood of recurrences include the size, the presence of ascites or adhesions and solid a rc h i t e c t u re, whereas the mitotic rate and vascular invasion (identified in 15% of malignant strumas) are not prognostically helpful features {2387}. Carcinoids Definition These tumours contain extensive components of well diff e rentiated neuro e n- docrine cells and most subtypes resemble carcinoids of the gastro i n t e s t i n a l tract. They may occur in pure form or within a dermoid cyst, a mucinous cystic tumour or a Brenner tumour. It should be distinguished from isolated neuro e n- docrine cells found within some mucinous and Sertoli-Leydig cell tumours. Epidemiology Ovarian carcinoids account for 0.5-1.7% of all carcinoids {2743}, and the age range is 14-79 years (mean 53) {166, 2388,2390,2392}. Clinical features Signs and symptoms Carcinoid syndrome is a clinical sign of insular carcinoids in 30% of patients and is rare in trabecular (13%) and strumal (3.2%) carcinoids {631,2743}. Peptide YY production by the tumour cells causes severe constipation and pain with defecation in 25% of trabecular carcinoids {2656}. Strumal carcinoids may cause symptoms of functioning thyroid tissue in 8% of cases {2390}. 172 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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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 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 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
Page 220 and 221: 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,
Page 378 and 379:
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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