Invasive breast carcinoma - IARC

Differential diagnosis
Stromal hyperplasia is distinguished from
stromal hyperthecosis by the absence of
luteinized stromal cells. It is distinguished
from low grade endometrial stromal
sarcoma by the presence of spindle
shaped rather than round or oval stromal
cells and the absence of mitotic figures
or spiral arterioles.
Fibromatosis
Definition
Fibromatosis is a tumour-like enlargement
of one or both ovaries due to a nonneoplastic
proliferation of collagen-producing
ovarian stroma.
Clinical features
The patients range from 13-39 years with
an average of 25. The typical presentation
is menstrual irregularities, amenorrhea
or, rarely, virilization {3214}.
Macroscopy
The ovaries range from 8-14 cm and
have smooth or lobulated external surfaces.
The sectioned surface is typically
firm and grey or white, and small cysts
may be apparent. About 80% of cases
are bilateral.
Histopathology
There is a proliferation of spindle-shaped
fibroblasts with a variable but usually
large amount of collagen. Foci of
luteinized stromal cells as well as oedema
may be present. Ovarian architecture
is maintained, and the fibrous proliferation
surrounds follicle derivatives. Nests
of sex cord type cells are present in
some cases {384}. Most cases show diffuse
involvement of the ovaries, but
occasional cases are localized.
Differential diagnosis
The lesion is distinguished from fibro m a
in that the latter is usually unilateral and
does not incorporate follicular derivatives.
However, it differs from ovarian
oedema in that oedema in the latter is
massive and fibrous proliferation is not
observed. It differs from stromal hyperplasia
in that the latter does not produce
abundant collagen and is usually
unilateral. The sex cord type nests may
s u p e rficially resemble a Bre n n e r
t u m o u r, but the latter shows transitional
cell features and replaces the ovarian
a rc h i t e c t u re .
Prognosis and predictive factors
The lesion does not spread beyond the
o v a r i e s .
Massive ovarian oedema
Definition
Formation of a tumour-like enlargement
of one or both ovaries by oedema fluid.
Epidemiology
The age range is 6-33 with an average of
21 years {3214}.
Clinical features
Most patients present with abdominal
pain, which may be acute, and a pelvic
mass. {3214}. Others may present with
abnormal uterine bleeding, hirsutism or
virilization. Elevated levels of plasma
testosterone and other androgens may
be observed. At laparotomy ovarian
enlargement, which is usually unilateral,
is encountered, and torsion is observed
in approximately one-half of the patients.
Macrosocopy
The external surface is usually white and
opaque. The ovaries range from 5-35 cm
in size with an average diameter of 11
cm {3214}. The sectioned surface typically
exudes watery fluid.
Histopathology
On histological examination oedematous,
hypocellular ovarian stroma is present,
and the ovarian architecture is preserved.
The outer cortex is thickened
and fibrotic. Clusters of luteinized stromal
cells are present in the oedematous stroma
in a minority of cases, especially
those that have endocrine symptoms.
Differential diagnosis
The differential diagnosis includes an
oedematous fibroma and Krukenberg
Fig. 2.127 Massive ovarian oedema. A portion of the
ovarian cortex remains around an oedematous ovary.
Fig. 2.126 Massive ovarian oedema. The sectioned
surface of the ovary was moist and exuded watery
f l u i d .
tumour. The diffuse nature of the process
and the preservation of ovarian architecture
are unlike an oedematous fibroma,
which is likely to be a circumscribed
mass. The distinction from Krukenberg
tumour is based on the absence of
signet-ring cells and the typically unilateral
mass, whereas Krukenberg tumours
are bilateral in the vast majority of cases.
It is important for the pathologist to recognize
this lesion at the time of intraoperative
consultation so that fertility may be
maintained in these young patients.
Histogenesis
In many cases the oedema is due to partial
torsion of the ovary insufficient to
cause necrosis {1390,2463}.
Prognosis and predictive factors
The lesion is usually treated by oophore c-
t o m y, and the postoperative course in
u n e v e n t f u l .
Other tumour-like conditions
A wide variety of other conditions can, on
occasion, mimic an ovarian neoplasm.
Those not associated with pregnancy
include follicle cyst, corpus luteum cyst,
ovarian remnant syndrome, polycystic
ovarian disease, hilus cell hyperplasia,
simple cyst, idiopathic calcification,
uterus-like adnexal mass {48}, spenicgonadal
fusion, endometriosis and a
variety of infections.
190 Tumours of the ovary and peritoneum