Invasive breast carcinoma - IARC

Diagnostic procedures
Elevated urine 5-hydro x y i n d o l e a c e t i c
acid (5-HIAA) and serum serotonin levels
are found in patients with carcinoid syndrome
{631,2388}.
Macroscopy
Primary ovarian carcinoids are unilateral
and present as a firm tan nodule (less
than 5 cm) protruding into a typical dermoid
cyst (32-60% of tumours) or are
predominantly solid with small cysts. The
sectioned surface is firm, homogeneous
and tan to yellow.
Histopathology
Insular carcinoid accounts for 26-53% of
cases {631,2743}) and resembles midgut
derivative carcinoids. It is composed of
nests of round cells with uniform nuclei
and abundant eosinophilic cytoplasm
enclosing small red argentaffin granules
at the periphery of the nests. Acinus formation
and a cribriform pattern with luminal
eosinophilic secretion are present
{2388}.
Trabecular carcinoid accounts for 23-
29% of cases {631,2743} and resembles
hindgut or foregut derivative carcinoids.
It exhibits wavy and anastomosing ribbons
composed of columnar cells with
the long axes of the cells parallel to one
another and oblong nuclei with prominent
nucleoli. The abundant cytoplasm is
finely granular with red-orange argyrophilic
granules at both poles of the
nucleus {2392}.
Mucinous carcinoid accounts for only
1.5% of cases {2743} and resembles
goblet cell carcinoids arising in the
appendix. The well differentiated mucinous
carcinoid is composed of numerous
small glands lined by columnar or
cuboidal cells, some of which contain
intracytoplasmic mucin or have a goblet
cell appearance, whilst others disclose
Fig. 2.107 Carcinoid arising in a teratoma. Nests and cords of carcinoid cells proliferate next to a chrondroid
nodule.
o r a n g e - red neuroendocrine granules.
Individual tumour cells may contain both
mucin and neuroendocrine granules.
Glands may be floating within pools of
mucin that also dissect the surrounding
fibrous stroma with isolated signet-ring
cells infiltrating the stroma. Atypical
mucinous carcinoid demonstrates
crowded glands or a cribriform pattern.
Carcinoma arising in mucinous carcinoid
exhibits large islands of tumour cells or
closely packed glands with high grade
nuclei, numerous mitoses and necrosis
{166}.
Strumal carcinoid accounts for 26-44%
of cases {631,2743} and is composed of
a variable proportion of thyroid tissue
and carcinoid, the latter mostly having a
trabecular arc h i t e c t u re. The neuro e n-
docrine cells invade progressively the
strumal component, replacing the follicular
lining cells. Glands or cysts lined by
columnar epithelium with goblet cells
may be found {2390}.
Carcinoids with mixed patterns (essentially
insular and trabecular), are classified
according to the pattern that predominates
{2388}.
Immunoprofile
C a rcinoids are immunoreactive to at least
one of the neuroendocrine markers (chromogranin,
synaptophysin, Leu-7) and
various peptide hormones such as panc
reatic polypeptide, gastrin, vasoactive
intestinal peptides and glucagon {166}.
Differential diagnosis
Metastatic gastrointestinal carcinoid to
the ovary should be ruled out specifically
when extraovarian disease is detected.
Bilateral and multinodular ovarian
involvement, the absence of other teratomatous
components and the persistence
of the carcinoid syndrome after
oophorectomy favour the diagnosis of
metastasis {166,2391}.
Prognosis and predictive features
Almost all primary trabecular and strumal
carcinoids occur in women with stage I
disease and have an excellent outcome.
The overall survival of patients with insular
carcinoid is 95% at 5 years and 88%
at 10 years {2388}.
P r i m a ry ovarian mucinous carcinoid, like
those in the appendix, has a more agg
ressive behaviour with extraovarian
s p read and lymph node metastases. The
p resence of frank carcinoma within the
tumour is an important prognostic factor
{166}.
Fig. 2.106 Struma ovarii. The struma resembles a thyroid
microfollicular adenoma with dystrophic nuclei.
Neuroectodermal tumours
Definition
Tumours composed almost exclusively of
neuroectodermal tissue, closely resem-
Germ cell tumours 173