Invasive breast carcinoma - IARC

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A Fig. 4.46 A Gestational choriocarcinoma. Note the plexiform pattern with triphasic differentiation into cytotrophoblast, syncytiotrophoblast and intermediate trophoblast and marked cytological atypia. B Intraplacental choriocarcinoma. There is a distinct interface between malignant biphasic trophoblast in the maternal intervillous space seen on the lower right and mature chorionic villi on the left. B Trophoblastic tumours Definition Neoplasms derived from trophoblast. ICD-O codes Choriocarcinoma 9100/3 Placental site trophoblastic tumour 9104/1 Epithelioid trophoblastic tumour 9105/3 Gestational choriocarcinoma Definition A malignant neoplasm composed of large sheets of biphasic, markedly atypical trophoblast without chorionic villi. Clinical features Gestational choriocarcinoma may occur subsequent to a molar pregnancy (50% of instances), an abortion (25%), a normal gestation (22.5%) or an ectopic pregnancy (2.5%) {1203}. In rare cases an intraplacental choriocarcinoma is diagnosed immediately following pregnancy from placental pathological examination {343,722,907,1923}. Histopathology Choriocarcinoma consists of an admixt u re of syncytiotrophoblast, cytotrophoblast and intermediate trophoblast as single cells and clusters of cells with prominent haemorrhage, necrosis and vascular invasion {775a,1593,1801a, 1802a,2011,2024a,2077a}. Choriocarc i - noma does not possess tumour stroma or vessels; correspondingly, the diagnostic viable tumour is located at the periphery of haemorrhagic foci. E x t r a o rd i n a r i l y, choriocarcinomas have developed and been diagnosed as intraplacental tumours {112,343,722,907, 1562,1923,2103}. Immunoprofile All trophoblastic cell types are strongly immunoreactive for cytokeratins {640}. In addition, the syncytiotrophoblast is strongly immunoreactive for β-hCG and weakly immunoreactive for human placental lactogen (hPL); intermediate trophoblast shows the opposite immunoprofile {935}. Differential diagnosis The differential diagnosis of choriocarcinoma in endometrial curettings includes previllous trophoblast from an early gestation, persistent molar tissue following h y d a t i d i f o rm mole, placental site trophoblastic tumour, epithelioid tro- A Fig. 4.47 A Placental site trophoblastic tumour. Coronal section shows the neoplasm diffusely infiltrating the uterine wall. B Tumour cells show marked cytological atypia and numerous mitotic figures. B Gestational trophoblastic disease 251
A Fig. 4.48 Epithelioid trophoblastic tumour. A Neoplastic aggregates are better defined than in placental site trophoblastic tumour and may resemble carcinoma. B Groups of tumour cells, occasionally with clear cytoplasm, are separated by a hyaline stroma. B phoblastic tumour and undifferentiated carcinoma. Somatic genetics Recent studies using cDNA microarray analysis have demonstrated decreased expression of heat shock protein-27 in choriocarcinoma, a finding which has been associated with chemotherapy responsiveness in other cancers {3014}. Placental site trophoblastic tumour Definition A monophasic neoplasm composed of i n t e rmediate trophoblast and cytotrophoblast without a significant component of syncytiotrophoblast. Histopathology The tumour cells are medium to large sized and mononuclear or multinucleated with mild to marked nuclear atypia, prominent nucleoli, eosinophilic to clear cytoplasm, scattered mitoses and occasional intranuclear inclusions {746,747, 8 4 2 , 8 6 1 , 9 3 3 , 1 0 1 8 , 1 0 1 9 , 1 1 7 7 , 1 2 3 7 , 1 5 1 1 , 1 5 4 0 , 1 5 4 3 , 1 5 8 9 , 2 9 6 7 , 3 2 0 2 , 3 2 2 7 } . They permeate the myometrium and vessels in a manner reminiscent of the implantation site trophoblast. Differential diagnosis The differential diagnosis of placental site trophoblastic tumour includes placental site nodule, exaggerated implantation site, epithelioid leiomyosarcoma, epithelioid trophoblastic tumour and poorly diff e rentiated carc i n o m a . Extensive sampling and immunohistochemistry for keratin, β-hCG and hPL are helpful in distinguishing among the above lesions {2658,2659}. Somatic genetics A Y- c h romosomal locus and/or new (paternal) alleles not present in adjacent normal uterine tissue was demonstrated in all cases of placental site trophoblastic tumour studied confirming the placental origin of these neoplasms {2747}. Prognosis and predictive factors Placental site trophoblastic tumours are rare, and their biological behaviour is variable. The major prognostic variable is a long interval from the last known antecedent pregnancy. All patient deaths from placental site trophoblastic tumour in the Charing Cross series occurred when the interval from the last known pregnancy was greater than 4 years. An elevated mitotic index predicts a poor outcome {842}. Epithelioid trophoblastic tumour Definition A tumour composed of a monomorphic population of intermediate trophoblastic cells closely resembling those of the chorion laeve (membranous chorion). Histopathology The epithelioid trophoblastic tumour is a relatively uncommon, recently described neoplasm that differs from the placental site trophoblastic tumour in that the tumour cells of the epithelioid trophoblastic tumour are smaller and less pleomorphic and grow in a nodular as opposed to a diffusely infiltrative pattern. Because they are frequently found in the cervix, they may be confused with hyalinizing squamous cell carc i n o m a s . Epithelioid trophoblastic tumours are focally immunoreactive for placental-like alkaline phosphatase (PLAP) and hPL but strongly and diffusely immunoreactive for E-cadherin and epidermal growth factor receptor {2658}. Somatic genetics A Y- c h romosomal locus and/or new ( p a t e rnal) alleles not present in adjacent n o rmal uterine tissue was demonstrated in all cases of epithelioid tro p h o b l a s t i c tumour studied confirming the placental origin of this neoplasm {2747}. Prognosis and predictive factors Based on available data, the behaviour of epithelioid trophoblastic tumour re s e m b l e s that of placental site trophoblastic tumour. Hydatidiform mole Definition An abnormal placenta with villous hydrops and variable degrees of trophoblastic proliferation. ICD-O codes Hydatidiform mole, NOS 9100/0 Complete 9100/0 Partial 9103/0 Invasive 9100/1 Complete hydatidiform mole Definition A hydatidiform mole involving most of the 252 Tumours of the uterine corpus
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Previous volumes in this series Kle
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World Health Organization Classific
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Published by IARC Press, Internatio
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CHAPTER 1 Tumours of the Breast Can
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TNM classification of carcinomas of
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Invasive breast carcinoma I.O. Elli
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Rapid growth and greater adult heig
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tives, administrative and clerical
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Grade 1 - well differentiated: 3-5
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ent and this is occasionally extens
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Most melanotic tumours of the breas
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A Fig. 1.22 A Classic invasive lobu
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yet others at 90% {97,2147}. For pr
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Fig. 1.27 Medullary carcinoma. The
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myoepithelial cells in fibro a d e
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A Fig. 1.33 Neuroendocrine carcinom
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Macroscopy Fisher et al. reported t
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Fig. 1.39 Apocrine carcinoma. Note
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cells contain intracytoplasmic lume
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A Fig. 1.50 Carcinosarcoma. A Two a
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A B C Fig. 1.75 Lobular neoplasia.
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Intraductal proliferative lesions F
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A B absence of either microcalcific
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Fig. 1.83 Atypical ductal hyperplas
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A B Fig. 1.88 Large excision biopsy
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unusual variants as well. Using thi
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esemble those identified in invasiv
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A B Fig. 1.97 Microinvasive carcino
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A Papilloma may be subject to morph
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A B C Fig. 1.103 Papillary intraduc
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colour measuring from 0.5 to 12 cm.
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Immunoprofile The cases studied by
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Glycogen-rich, clear cell carcinoma
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Differential diagnosis There may be
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quality metaphase spreads from an i
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Fig. 1.67 Lobular carcinoma of brea
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detectable distant metastasis displ
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detected at a late stage as small t
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Extent of ductal carcinoma in situ
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Benign epithelial proliferations G.
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Fig. 1.112 Microglandular adenosis.
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A Apocrine adenoma ICD-O code 8401/
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A B Fig. 1.128 Adenomyoepithelioma,
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Mesenchymal tumours M. Drijkoningen
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1113,1275}. There is a complex patt
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A B Fig. 1.137 A Lipoma. Intraparen
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Fig. 1.141 Angiosarcoma after breas
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A Fig. 1.144 Mammary osteosarcoma.
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Fibroepithelial tumours J.P. Belloc
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aged women (average age of presenta
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lished data suggests a 21% rate of
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A Fig. 1.157 Syringomatous adenoma
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Malignant lymphoma and metastatic t
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used. Inflammatory conditions in th
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male population both in the USA and
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CHAPTER 2 Tumours of the Ovary and
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Polyembryoma 9072/3 Non-gestational
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Surface epithelial-stromal tumours
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A Fig. 2.04 A Serous borderline tum
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A Fig. 2.06 Serous borderline tumou
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A Fig. 2.10 Invasive peritoneal imp
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Fig. 2.15 Mucinous carcinoma with i
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Fig. 2.20 Mucinous endocervical-lik
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A Fig. 2.28 Mucinous cystic tumour
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early secretory endometrium {2605}.
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IV, 6% {2233}. Patients with grade
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A Fig. 2.37 A This polypoid intracy
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Fig. 2.40 Endometrioid cyst with at
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1 tumours are extremely rare. Almos
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Fig. 2.50 Borderline Brenner tumour
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express thrombomodulin and have bee
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serous and transitional cell carcin
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is yellow to tan with a variable ad
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Genetic susceptibility JGCTs may pr
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Clinical features F i b romas may b
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distinguishes this tumour from the
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A Fig. 2.77 A Retiform Sertoli-Leyd
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Mean ages of 21 and 38 years and me
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Tumours unassociated with PJS form
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mal origin without crystals of Rein
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Germ cell tumours F. Nogales A. Tal
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cases, anisokaryosis has no prognos
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ation may coexist in the same neopl
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Table 2.06 Grading of ovarian immat
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A B Fig. 2.102 A Mature cystic tera
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Diagnostic procedures Elevated urin
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associated with mature teratomas sh
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atives intimately admixed. The germ
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Fig. 2.113 Mixed germ cell-sex cord
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A Fig. 2.116 A Adenomatous hyperpla
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Fig. 2.117 Small cell carcinoma, hy
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Clinical features Adenoid cystic-li
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Histopathology This epithelial tumo
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sis. Corpus luteum of pregnancy has
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Lymphomas and leukaemias L.M. Roth
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Secondary tumours of the ovary J. P
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Occasionally, the colonic adenocarc
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Peritoneal tumours S.C. Mok J.O. Sc
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A B Fig. 2.140 Cystic adenomatoid m
Page 202 and 203: whelmingly poor {1038,1547,2310}. H
Page 204 and 205: CHAPTER 3 Tumours of the Fallopian
Page 206 and 207: TNM and FIGO classification of carc
Page 208 and 209: Endometrioid adenocarcinoma Endomet
Page 210 and 211: Two examples of adenofibroma of bor
Page 212 and 213: A Fig. 3.11 Adenomatoid tumour. A T
Page 214 and 215: Clinical features Patients range in
Page 216 and 217: Fig. 3.16 Uterus-like mass. The cys
Page 218 and 219: CHAPTER 4 Tumours of the Uterine Co
Page 220 and 221: TNM and FIGO classification of non-
Page 222 and 223: Epithelial tumours and related lesi
Page 224 and 225: endometrioid adenocarcinoma fro m a
Page 226 and 227: fers from the prototypical type I e
Page 228 and 229: the ovary and bladder. Unlike prima
Page 230 and 231: schema {1535,2602}. Although this c
Page 232 and 233: Table 4.03 Altered gene function in
Page 234 and 235: Mesenchymal tumours and related les
Page 236 and 237: areas are limited to less than 30%
Page 238 and 239: A B C Fig. 4.30 Leiomyosarcoma. A T
Page 240 and 241: e used sparingly and is reserved fo
Page 242 and 243: A B Fig. 4.38 Leiomyoma with perino
Page 244 and 245: cytological atypia, tumour cell nec
Page 246 and 247: Mixed epithelial and mesenchymal tu
Page 248 and 249: Prognosis and predictive factors Th
Page 250 and 251: tumours may superficially invade th
Page 254 and 255: A Fig. 4.49 A Classic complete hyda
Page 256 and 257: Sex cord-like, neuroectodermal and
Page 258 and 259: Secondary tumours of the uterine co
Page 260 and 261: WHO histological classification of
Page 262 and 263: Epithelial tumours M. Wells J.M. Ne
Page 264 and 265: Fig. 5.04 Mechanisms of human papil
Page 266 and 267: Fig. 5.08 Keratinizing squamous cel
Page 268 and 269: in their Asian population {2957}. I
Page 270 and 271: have a strong association with high
Page 272 and 273: e red by squamous epithelium {380}.
Page 274 and 275: endometrioid adenocarcinoma of the
Page 276 and 277: metrial epithelium. In some cases t
Page 278 and 279: with distinct cell borders and a gr
Page 280 and 281: Mesenchymal tumours M.L. Carcangiu
Page 282 and 283: {781}, liposarcoma {2840,3016}, ost
Page 284 and 285: Mixed epithelial and mesenchymal tu
Page 286 and 287: Fig. 5.44 Wilms tumour. The tumour
Page 288 and 289: A Fig. 5.47 Implant of endometrial
Page 290 and 291: CHAPTER 6 Tumours of the Vagina Alt
Page 292 and 293: Epithelial tumours E.S. Andersen A.
Page 294 and 295: Aetiology The fact that both VAIN a
Page 296 and 297: Fig. 6.10 Fibroepithelial polyp.A m
Page 298 and 299: er of mitoses varies but is usually
Page 300 and 301: ICD-O codes Adenosquamous carcinoma
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A C Fig. 6.17 Sarcoma botryoides. A
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1-11 cm. They may arise anywhere in
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elsewhere in the female genital tra
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A Fig. 6.24 Yolk sac tumour. A The
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g rowing in sheets. Some may have s
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WHO histological classification of
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Epithelial tumours E.J. Wilkinson M
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even with additional sectioning, it
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type) is a highly diff e rentiated
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Clinical features Bartholin gland c
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glandular elements surrounded by fi
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Mesenchymal tumours R.L. Kempson M.
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Table 7.03 Differential diagnosis o
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Prognosis and predictive factors A
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Table 7.04 Clark levels of cutaneou
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A Fig. 7.23 Vulvar peripheral primi
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Familial aggregation of cancers of
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BRCA1 syndrome Definition Inherited
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dispose individuals to the developm
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Fig. 8.05 To assess whether wild-ty
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Fig. 8.07 Factors that modify risk
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BRCA2 syndrome R. Eeles S. Piver S.
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tubal or ovarian carcinomas. Howeve
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in typical nuclear foci that may re
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Breast tumours Frequency Breast can
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Fig. 8.14 Codon distribution of som
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Breast tumours Age distribution and
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Hereditary non-polyposis colon canc
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essary in the evaluation of the pat
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Age distribution and penetrance Mos
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Contributors Dr Vera M. ABELER** De
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Dr Carlo LA VECCHIA Laboratory of E
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Dr Manuel TEIXEIRA Department of Ge
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02.100 Dr. A. Ostor 02.101 Dr. F.A.
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52. Akhtar M, Robinson C, Ashraf Al
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180. Bapat K, Brustein S (1989). Ut
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307. Bolis GB, Maccio T (2000). Cle
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436. Chang J, Sharpe JC, A'Hern RP,
Page 378 and 379:
562. Costa MJ, Ames PF, Walls J, Ro
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689. Di Domenico A, Stangl F, Benni
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820. Falck J, Petrini JH, Williams
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943. Gad A, Azzopardi JG (1975). Lo
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1067. Grimes MM (1992). Cystosarcom
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1197. Herod JJ, Shafi MI, Rollason
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1323. Jacques SM, Qureshi F, Ramire
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1449. Khalifa MA, Mannel RS, Harawa
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1564. Lagios MD (1977). Multicentri
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1687. Loman N, Johannsson O, Kristo
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1807. McCluggage G, McBride H, Maxw
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1937. Mukai M, Torikata C, Iri H (1
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2056. Norris HJ, Taylor HB (1967).
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2180. Park JS, Jones RW, McLean MR,
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2304. Puls LE, Hamous J, Morrow MS,
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2 4 3 4 . Rosen PP, Groshen S, Saig
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2559. Schlesinger C, Silverberg SG
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2686. Silverberg SG (1999). Protoco
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2806. Stutz JA, Evans AJ, Pinder S,
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2942. Tornos C, Silva EG, Ordonez N
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3061. Wargotz ES, Norris HJ (1990).
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3189. Yoshioka T, Tanaka T (2000).
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References 425
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Biphasic teratomas, 168 BLM, 341, 3
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G GADD45, 343, 353 GCDFP-15, 25, 33
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MPNST, see Malignant peripheral ner
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Small cell / oat cell carcinoma, 32
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