Invasive breast carcinoma - IARC

A
Fig. 2.124 Luteoma of pregnancy. A The tumour is composed of polygonal eosinophilic cells that form follicle-like spaces filled with pale fluid. B The tumour is composed
of large polygonal eosinophilic cells that are mitotically actiive.
B
f i b ro s a rcoma {1517,1867}, leiomyo
m y o s a rcoma {917,1416,1895,1983,
2037}, malignant peripheral nerve sheath
tumour {2797}, lymphangiosarc o m a ,
a n g i o s a rcoma {2021,2064}, rhabd
o m y o s a rcoma {2018}, osteosarc o m a
{1215} and chondro s a rcoma {2851}.
These tumours should be classified
a c c o rding to the WHO Histological
Typing of Soft Tissue Tumours {3086}.
Similarly, tumours may also arise as a
component of a complex ovarian tumour
such as malignant müllerian mixed
t u m o u r, adenosarcoma, immature teratoma
or dermoid cyst or from heterologous
elements in a Sertoli-Leydig cell
tumour. Rare sarcomas of various types
may be associated with surface epithelial
s t romal tumours, particularly sero u s ,
mucinous and clear cell adenocarcinoma.
These tumours must be distinguished
from metastatic sarcoma to the
ovary {3222}.
Benign soft tissue tumours not
specific to the ovary
Of the remaining soft tissue tumours,
leiomyomas and haemangiomas are
most common. Occasional benign neural
tumours, lipomas, lymphangiomas,
c h o n d romas, osteomas and gang
l i o n e u romas have been re p o rt e d .
Their appearance is similar to soft tissue
tumours in other locations. These
tumours should be classified accord i n g
to the World Health Organization
Histological Typing of Soft Tissue
Tumours {3086}.
Tumour-like conditions
Definition
Non-neoplastic conditions that can
mimic an ovarian neoplasm clinically,
macroscopically and/or histologically.
Luteoma of pregnancy
Definition
Single or multiple nodules composed of
lutein cells with abundant eosinophilic
cytoplasm that are detected at the end of
a term pregnancy.
Synonym
Nodular theca-lutein hyperplasia of pregnancy.
Epidemiology
Patients with luteoma of pregnancy are
typically in their third or fourth decade and
m u l t i p a rous, and 80% are Black
{ 2 0 5 6 , 2 3 6 4 , 2 7 8 8 } .
Clinical features
Most patients are asymptomatic, and the
tumour is usually found incidentally at
t e rm during caesarean section or postpartum
tubal ligation {2788}. Exceptionally, a
pelvic mass is palpable or obstructs the
b i rth canal. Approximately 25% of patients
a re hirsute or show signs of virilization.
Elevated levels of plasma testostero n e
and other androgens may be observed.
Macrosocopy
The tumours vary from not being macroscopically
detectable to over 20 cm. In
one series the medium diameter of the
tumour was between 6-7 cm {2056}. The
sectioned surface is circumscribed, solid,
fleshy and red to brown. In appro x i m a t e l y
one-half of cases the lesions are multiple
and at least one-third are bilateral.
Histopathology
There is a diffuse proliferation of polygonal,
eosinophilic cells that contain little or
no lipid {2364}. The nuclei are round and
contain prominent nucleoli. Follicle-like
spaces may be present. Mitotic figures
may be frequent. The tumour cells were
found to be positive for alpha-inhibin,
CD99, cytokeratin and vimentin {2242}.
Differential diagnosis
The diff e rential diagnosis includes lipidpoor
steroid cell tumours, metastatic
melanoma and corpus luteum of pre g n a n-
c y. Steroid cell tumours occurring during
p regnancy may present a difficult diff e re n-
tial diagnosis; however, the typical clinical
setting of luteoma of pregnancy would be
an unusual presentation for a steroid cell
t u m o u r. The presence of follicle-like
spaces or multiple nodules favours the
diagnosis of luteoma of pre g n a n c y. In
contrast to luteoma of pre g n a n c y, stero i d
cell tumours that have a high mitotic rate
a re likely to exhibit significant nuclear
atypia. Metastatic melanoma may be
multinodular and contain follicle-like
spaces; however, the presence of melanin
pigment in some cases and positive
stains for S-100 protein and often HMB-45
and Melan A and negative stains for
alpha-inhibin would confirm the diagno-
188 Tumours of the ovary and peritoneum