Invasive breast carcinoma - IARC

A
Fig. 6.12 Adenosis of the vagina. A By colposcopy red granular areas of adenosis are apparent. B Colposcopy after iodine application. The areas of adenosis do not
stain.
B
since most cases of clear cell adenocarcinoma
are first detected around the time
of pubert y.
Localization
Whilst any part of the vagina may be
involved, clear cell adenocarcinoma most
often arises from its upper part. A primary
vaginal clear cell adenocarcinoma may
also involve the cervix. According to FIGO
criteria about two-thirds of clear cell aden
o c a rcinomas after DES exposure are
classified as tumours of the vagina and
o n e - t h i rd of the cervix {1131}. In non-DES
exposed young women and postmenopausal
women this ratio is re v e r s e d.
Clinical features
Vaginal bleeding, discharge and dysp
a reunia are the most common symptoms,
but women may be asymptomatic.
A b n o rmal cytologic findings may lead to
detection, but care must be taken to
sample the vagina as well as the cervix
since cervical smears are re l a t i v e l y
insensitive for the detection of clear cell
a d e n o c a rcinoma {1132}.
Clear cell adenocarcinomas typically
a re polypoid, nodular, or papillary but
may also be flat or ulcerated. Some
clear cell adenocarcinomas are confined
to the superficial stroma and
may remain undetected for a long time
{1131,2386}. Such small tumours may
be invisible on macroscopic or even colposcopic
examination and are only
detected by palpation or when tumour
cells are shed through the mucosa and
detected by exfoliative cytology. Large
tumours may be up to 10 cm in diameter.
Histopathology
Clear cell adenocarcinoma of the vagina
has an appearance similar to those arising
in the cervix, endometrium and ovary.
Clear cell adenocarcinomas may show
several growth patterns; the most common
pattern is tubulocystic, but it also
may be solid or mixed. A papillary growth
pattern is seldom predominant. The main
cell types are clear cells and hobnail
cells. The appearance of the clear cells
is due to the presence of abundant intracytoplasmic
glycogen. Hobnail cells are
characterized by inconspicuous cytoplasm
and a bulbous nucleus that protrudes
into glandular lumens. The tumour
cells may also be flat with bland nuclei
and scant cytoplasm in cystic areas or
have granular eosinophilic cytoplasm
without glycogen. The nuclei vary considerably
in appearance. They may be
significantly enlarged with multiple irregular
nucleoli in clear and hobnail cells, or
they may have fine chromatin and inconspicuous
nucleoli in flat cells. The num-
A
Fig. 6.13 Clear cell adenocarcinoma. A Note the neoplastic tubules lined by hobnail cells on the right and adenosis of the tuboendometrial type on the left. B Cytological
preparation shows hobnail cells with anisonucleosis, unevenly distributed chromatin, nucleoli and vacuolated cytoplasm.
B
298 Tumours of the vagina