Invasive breast carcinoma - IARC

Lymphomas and leukaemias
L.M. Roth
R. Vang
Malignant lymphoma
Definition
A malignant lymphoproliferative neoplasm
that may be primary or secondary.
Epidemiology
Although unusual, ovarian involvement is
more frequent than that of other sites in
the female genital tract {1588}. The peak
incidence of ovarian involvement by lymphoma
is in the fourth and fifth decades,
although it may occur at any age.
Ovarian involvement by lymphoma may
either be primary or secondary; however,
the latter is much more common.
Clinical features
Lymphoma rarely presents clinically as
an ovarian mass, and in most cases it is
only one component of an intra-abdominal
or generalized lymphoma {483}. An
exception is Burkitt lymphoma, which
may account for about one-half of the
cases of malignant ovarian neoplasms in
childhood in endemic areas {2605}. In
such cases involvement of one or both
ovaries is second in frequency only to
jaw involvement.
Macroscopy
Lymphoma is bilateral in approximately
one-half of the cases. The tumours are
large and typically have an intact capsule.
The sectioned surfaces are typically
white, tan or grey-pink and occasionally
contain foci of haemorrhage or necrosis.
Tumour spread and staging
Ovarian involvement by lymphoma is rare
and is associated with simultaneous
involvement of the ipsilateral tube in 25%
of the cases {2119}.
Histopathology
The histological appearance of ovarian
lymphomas is similar to that observed at
other sites; however, the neoplastic cells
tend to proliferate in cords, islands and
trabeculae with occasional follicle-like
spaces or alveoli and often have a sclerotic
stroma {2605}. In some cases ovarian
follicular structures may be spared,
but in others the entire ovarian architecture
is obliterated.
Almost any type of lymphoma may occur
in the ovary; however, the most common
are diffuse large B-cell, Burkitt and follicular
lymphomas {1900,2119}.
Differential diagnosis
Dysgerminoma is the most important and
perhaps the most difficult diff e re n t i a l
diagnosis of ovarian lymphoma, particularly
of the large B-cell type, which it may
mimic both macroscopically and histologically
{2605,3226}. Careful attention to
the appearance of the cell nuclei and
immunohistochemical stains for lymphoid
markers and placental-like alkaline
phosphatase are important in reaching
the correct diagnosis. Other tumours that
may be confused with lymphoma include
granulocytic sarcoma, undiff e re n t i a t e d
c a rcinoma, small carcinoma of the
h y p e rcalcaemic type and metastatic
breast carcinoma {2605,3226}.
Prognosis and predictive factors
Almost one-half (47%) of the patients
with lymphoma who presented with ovarian
involvement were alive at their last follow
up with a median survival of 5 years
{1900}.
Leukaemia
Definition
A malignant haematopoetic neoplasm
that may be primary or secondary.
Epidemiology
Ovarian involvement by leukaemia may
either be primary or secondary; however,
the latter is much more common {428}. A
series of primary granulocytic sarcomas
of the female genital tract including 7
cases of the ovary was reported {2099}.
A
Fig. 2.128 Diffuse large B-cell lymphoma of ovary. A Intermediate-power magnification shows a diffuse growth pattern. Nuclei are medium-sized to large and polymorphic.
B Immunohistochemical stain is positive for CD20.
B
Lymphomas and leukaemias
191