Invasive breast carcinoma - IARC

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{781}, liposarcoma {2840,3016}, osteosarcoma {289,588} and malignant fibrous histiocytoma {308}. Benign mesenchymal tumours and tumour-like lesions A Fig. 5.38 Malignant peripheral nerve sheath tumour (MPNST). A Atypical tumour cells are adjacent to an endocervical gland in a MPNST presenting as an endocervical polyp. B Tumour cells are positive for S-100 protein. Macroscopy These appear macroscopically as a polyp or an intramural nodule measuring less than 5 cm and have a friable or solid consistency. Histopathology They are histologically similar to their counterparts in other sites. Most of the tumours exhibit an alveolar architecture, where nests of tumour cells with central loss of cellular cohesion are supported by thin-walled, sinusoidal vascular spaces. A solid pattern of growth may also be present. The tumour cells have an abundant eosino-philic cytoplasm, large nuclei, prominent nucleoli and contain PAS-positive, diastase-resistant, rodshaped crystals {1056}. A predominantly clear cytoplasm may characterize some neoplasms, and some cells may exhibit p rominent nuclear atypia. Electro n microscopy shows characteristic intracytoplasmic crystals, electro n - d e n s e secretory granules, numerous mitochondria, prominent endoplasmic reticulum, glycogen and a well developed Golgi apparatus {1937}. Prognosis and predictive factors Alveolar soft part sarcomas of the female genital tract, including those primary in the uterine cervix, appear to have a better prognosis than their counterpart in other sites {2017}. B i m m u n o reactive for CD31, CD34, and factor VIII-related antigen {2551}. Malignant peripheral nerve sheath tumour Definition A malignant tumour showing nerve sheath differentiation. Histopathology Cervical malignant peripheral nerve sheath tumour (MPNST) is similar to MPNST arising in other sites including the o c c u r rence of less common variants such as epithelioid and melanocytic types {2721}. The tumour is composed of fascicles of atypical spindle cells invading the cervical stroma and surrounding endocervical glands with a pattern reminiscent of a d e n o s a rcoma. Myxoid paucicellular a reas are characteristically interm i x e d with others with a dense cellularity {1375}. Mitoses are common. The tumour cells a re positive for S-100 protein and vimentin and negative for HMB-45, smooth muscle actin, desmin and myogenin {1424}. Other malignant tumours Other malignant mesenchymal tumours include alveolar rhabdomyosarc o m a Definition Benign mesenchymal tumours and tumourlike lesions that arise in the uterine cervix. ICD-O codes Leiomyoma 8890/0 Genital rhabdomyoma 8905/0 Leiomyoma Definition A benign tumour composed of smooth muscle cells. Epidemiology Leiomyoma is the most common benign mesenchymal tumour of the cervix. It has been estimated that less than 2% of all uteri contain cervical leiomyomas, and that about 8% of uterine leiomyomas are primary in the cervix {2020,2925}. Histopathology Cervical leiomyoma is histologically identical to those that occur in the uterine corpus. Genital rhabdomyoma Definition A rare benign tumour of the lower female genital tract composed of mature striated muscle cells separated by vary i n g amounts of fibrous stroma. Clinical features Cervical rhabdomyoma presenting as a polypoid lesion has been rarely re p o rted {690}. Angiosarcoma Definition A malignant tumour the cells of which variably recapitulate the morphologic features of endothelium. The macroscopic appearance of angiosarcoma is similar to that in other sites form i n g a haemorrhagic, partially cystic or necro t i c mass {2551}, and the neoplastic cells are A Fig. 5.39 Cervical leiomyoma. A Note the endocervical glandular mucosa overlying a leiomyoma. B The tumour is composed of interlacing fascicles of uniform spindle-shaped cells. B 282 Tumours of the uterine cervix
Fig. 5.40 Venous haemangioma. Vascular channels of variable size occupy the cervical stroma. Note a portion of the ectocervical squamous epithelium in the right upper corner of the field. Fig. 5.41 Postoperative spindle cell nodule. The lesion is composed of spindle-shaped mesenchymal and inflammatory cells.. Histopathology The tumour is composed of rhabdomyoblasts with small, uniform nuclei dispersed in a myxoid and oedematous stroma. The typical cambium layer of sarcoma botryoides is absent {690}. Postoperative spindle cell nodule Definition A localized, non-neoplastic re a c t i v e lesion composed of closely packed proliferating spindle cells and capillaries simulating a leiomyosarcoma occurring at the site of a recent excision. Clinical features The lesion develops at the site of a recent operation several weeks to several months postoperatively {1420,2020}. Histopathology The lesion is composed of closely packed, mitotically active, spindle-shaped mesenchymal cells and capillaries often with an accompaniment of inflammatory cells, and may infiltrate the underlying tissue. Differential diagnosis Postoperative spindle cell sarcoma may closely resemble a leiomyosarcoma or other malignant spindle cell tumours, but the history of a recent operation at the same site facilitates its diagnosis. Other benign tumours R a re examples of cervical lipoma {334,1910}, haemangioma {47,629}, glomus tumour {64}, localized neurofibromatosis {381,986}, schwannoma {1093}, pigmented melanocytic schwannoma {2900}, granular cell tumour {553,952, 1101}, ganglioneuroma {858} and paraganglioma {3229} have been reported. Mesenchymal tumours 283
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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
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whelmingly poor {1038,1547,2310}. H
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CHAPTER 3 Tumours of the Fallopian
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TNM and FIGO classification of carc
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Endometrioid adenocarcinoma Endomet
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Two examples of adenofibroma of bor
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A Fig. 3.11 Adenomatoid tumour. A T
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Clinical features Patients range in
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Fig. 3.16 Uterus-like mass. The cys
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CHAPTER 4 Tumours of the Uterine Co
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TNM and FIGO classification of non-
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Epithelial tumours and related lesi
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endometrioid adenocarcinoma fro m a
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fers from the prototypical type I e
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the ovary and bladder. Unlike prima
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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
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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 252 and 253: A Fig. 4.46 A Gestational choriocar
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 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
Page 302 and 303: A C Fig. 6.17 Sarcoma botryoides. A
Page 304 and 305: 1-11 cm. They may arise anywhere in
Page 306 and 307: elsewhere in the female genital tra
Page 308 and 309: A Fig. 6.24 Yolk sac tumour. A The
Page 310 and 311: g rowing in sheets. Some may have s
Page 312 and 313: WHO histological classification of
Page 314 and 315: Epithelial tumours E.J. Wilkinson M
Page 316 and 317: even with additional sectioning, it
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Page 320 and 321: Clinical features Bartholin gland c
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Page 324 and 325: Mesenchymal tumours R.L. Kempson M.
Page 326 and 327: Table 7.03 Differential diagnosis o
Page 328 and 329: Prognosis and predictive factors A
Page 330 and 331: 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,
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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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