Invasive breast carcinoma - IARC

Histopathology
This epithelial tumour may show diffuse,
solid tubular, hollow tubular and sievelike
patterns, and combinations of the
various patterns may occur. Cases have
been reported associated with endometrial
hyperplasia {1262,1289}.
Immunoprofile
The neoplasms are positive for CAM5.2,
cytokeratins 7 and 19 and vimentin but
a re negative for cytokeratin 20,
34betaE12, B72.3, carc i n o e m b ry o n i c
antigen, and epithelial membrane antigen
{2321,2878,2926}. The neoplastic cells
often express CD10 {2110} and often are
weakly positive for alpha-inhibin {1499}.
Histogenesis
Cases have been reported arising within
the rete ovarii {662,2878}. An immunohistochemical
study based on a comparison
with mesonephric remnants and
paramesonephric structures supported
but did not prove a mesonephric origin of
these neoplasms {2926}.
Prognosis and predictive factors
These tumours typically are not aggressive;
however, a significant minority of
patients have had an aggressive course
{3212}. The malignant cases sometimes,
but not always, show nuclear atypia and
increased mitotic activity.
Wilms tumour
Definition
A primary ovarian neoplasm that has the
typical features of a Wilms tumour of the
kidney.
Epidemiology
Several cases of pure Wilms tumour of the
o v a ry have been re p o rted {1303,2506}.
Clinical features
The tumour occurs in patients in the re p roductive
age group and beyond and pre s-
ents as a rapidly growing adnexal mass.
Histopathology
They have the typical appearance of a
Wilms tumour including small tubules,
glomeruloid structures and blastema. No
teratomatous elements were identified.
Prognosis and predictive factors
Two of the patients were living and well
10 months and 7 years postoperatively.
Paraganglioma
Definition
A unique neuroendocrine neoplasm,
usually encapsulated and benign, arising
in specialized neural crest cells associated
with autonomic ganglia (paraganglia).
Synonym
Phaeochromocytoma.
Clinical features
A single case of a paraganglioma of the
ovary in a fifteen year old girl with hypertension
has been reported {832}. In addition
two unpublished cases have been
described {2605}.
Histopathology
The tumours consist of polygonal epithelioid
cells arranged in nests separated by
a fibrovascular stroma.
Immunoprofile
The tumour is positive for chromogranin.
In addition, stains for S-100 protein can
identify sustentacular cells {2605}.
Biochemistry
Epinephrine and norepinephrine were
extracted from the tumour {832}.
Myxoma
Definition
A benign mesenchymal tumour composed
of cells with bland nuclear feat
u res producing abundant basophilic
intercellular ground substance.
Clinical features
Patients with ovarian myxomas present in
the reproductive age group typically with
an asymptomatic unilateral adnexal
mass {757}.
Macrosocopy
The tumours are large, averaging 11 cm
in diameter. The sectioned surface is
soft, often with cystic degeneration.
Histopathology
Myxoma is a sharply demarcated tumour
composed of spindle and stellate-shaped
cells within an abundant, well vascularized
myxoid background. Small foci of
non-myxoid fibrous tissue or smooth muscle
may be present. Lipoblasts are not
identified. Mitoses are rare. The interc e l-
lular material stains with alcian blue and
colloidal iron. Staining is prevented by
p re t reatment with hyaluronidase indicating
that the material is hyaluronic acid.
Immunoprofile
Immunohistochemical stains show that
the tumours are positive for vimentin and
smooth muscle actin but negative for
most other common immunohistochemical
markers {567}.
Electron microscopy
Ultrastructural features of thin filaments
condensed into dense bodies also support
the presence of myofibroblasts {567}.
Histogenesis
Based on an immunohistochemical comparison
with myxoid areas of ovarian stromal
tumours, myxomas were considere d
to be a variant of the thecoma-fibro m a
g roup {3254}.
Prognosis and predictive factors
The tumour is practically always benign
although one case diagnosed originally
as myxoma had a late recurrence after
19 years {2901}. In that case the original
tumour showed occasional mitotic figures
(less than 1 per ten high power
fields), slight atypia and occasional vacuolated
cells. The recurrent neoplasm,
but not the original, was aneuploid by
DNA-flow cytometry {2901}.
Malignant soft tissue tumours not
specific to the ovary
Pure soft tissue sarcomas of somatic
type rarely occur as primary tumours of
the ovary. They typically present as a
rapidly enlarging adnexal mass. Their
histological appearance is similar to soft
tissue tumours in other locations. Among
the reported cases of pure sarcomas are
Fig. 2.123 Luteoma of pregnancy. The sectioned
surface shows a nodular brown tumour.
Miscellaneous tumours and tumour-like conditions of the ovary 187