Invasive breast carcinoma - IARC

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A Fig. 6.24 Yolk sac tumour. A The tumour has a labryinthine pattern with occasional Schiller-Duvall bodies. B Papillary cores and labryinthine structures are lined by primitive cuboidal cells with cytoplasmic vacuolization and rare hyaline globules. B variants have a biphasic composition with areas similar to common blue naevus admixed with round nodules. The cells are arranged in nests and short fascicles with a whorled pattern and are plump and spindle-shaped with oval bland nuclei and pale cytoplasm. Differential diagnosis The common variant should not pose a diagnostic problem. The cellular variant may cause confusion with melanoma and smooth muscle tumours. Nuclear atypia and numerous mitotic figures would favour melanoma. Well defined interlacing fascicles, large thick-walled blood vessels, immunohistochemical positivity for muscle markers and negativity for S-100 protein should assist in making the diagnosis of a smooth muscle tumour. Melanocytic naevus Definition Melanocytic nevi are defined as proliferation of nests of naevus cells. Clinical features Melanocytic nevi of the vagina are thought to be similar to their counterparts in the skin {1539}. Yolk sac tumour Definition A primitive malignant germ cell tumour characterized by a variety of distinctive histological patterns, some of which recapitulate phases in the development of the normal yolk sac. ICD-O code 9071/3 Synonym Endodermal sinus tumour. Clinical features Patients are usually under 3 years of age. Vaginal bleeding and discharge are the most common symptoms. Serum levels of alpha-fetoprotein may be elevated. A polypoid friable mass is seen on clinical examination with a mean size of 3 cm. Histopathology Vaginal cases resemble their ovarian counterparts. Differential diagnosis Although sarcoma botryoides may be simulated clinically, the histological features resolve any confusion. Clear cell and endometrioid carcinomas may create difficulty in histological separation. Prognosis and predictive factors Combined surgery and chemotherapy may provide a favourable outcome. A disease-free survival of up to 23 years is possible {557}. Peripheral primitive neuroectodermal tumour / Ewing tumour Definition Tumours of uncertain lineage within the small round blue cell family of tumours. ICD-O code Peripheral primitive neuroectodermal tumour / 9364/3 Ewing tumour 9260/3 Clinical features Peripheral primitive neuro e c t o d e rm a l tumour/Ewing tumour (PNET/ET) is rare within the vagina {3002}. A reported case occurred in a 35-year-old woman who presented with a vaginal mass. Histopathology Histological features are similar to PNET/ET in non-vaginal sites. Typically, PNET/ET grows as a diffuse sheet of uniform small cells with scant pale cytoplasm and an intermediate to high nuclear to cytoplasmic ratio. The nuclei are round with evenly dispersed chromatin. Mitotic figures may be numerous, and rosettes may be seen. Immunoprofile Expression of CD99 would be expected in almost all cases. Differential diagnosis PNET/ET should not be mistaken for rhabdomyosarcoma, non-Hodgkin lymphoma (NHL), melanoma, small cell carcinoma or endometrial stromal sarcoma because of differences in prognosis and treatment. A broad immunohistochemical panel and, if need be, molecular studies, performed on paraffin-embedded tissue should assist in making the correct diagnosis. Molecular genetics Identification of the EWS/FLI1 fusion transcript derived from the t(11;22)(q24;q12) c h romosomal translocation by the Melanotic, neuroectodermal, lymphoid and secondary tumours 309
Fig. 6.25 Peripheral primitive neuroectodermal tumour. Note the sheets of small to medium sized cells with round, pale nuclei, minimal cytoplasm and high nuclear to cytoplasmic ratios. reverse transcriptase-polymerase chain reaction and Southern blot hybridization would confirm the diagnosis. Prognosis and predictive factors The experience with PNET/ET of the vagina is limited, but patients with localized tumours in soft tissue sites can potentially be cured with a combination of surgery, chemotherapy and radiation therapy. Dermoid cyst Definition A cystic tumour composed of more than one germ cell layer in which all elements are mature. ICD-O code Dermoid cyst 9084/0 Mature cystic teratoma 9080/0 Synonym Mature cystic teratoma. Macroscopy and histopathology These resemble the same tumour in the ovary. Adenomatoid tumour ICD-O code 9054/0 A single case occurring in a 47-year-old woman has been reported {1697}. Lymphoid and haematopoetic tumours Definition Tumours of the lymphoid and haematopoetic systems as well as secondary tumours of the vagina. Lymphoma Definition Tumours with lymphoid diff e re n t i a t i o n arising as either primary (localized) or secondary (disseminated) disease. Clinical features Lymphomas of the vagina are predominantly of the non-Hodgkin’s type {3001}. Patients with primary NHL have a mean age of 42 years, usually present with vaginal bleeding and have a mass on clinical examination. Patients with secondary NHL have a mean age of 65 years, present with vaginal bleeding and usually have a history of NHL. Histopathology Almost all NHLs primary in the vagina a re diffuse large B-cell lymphomas Table 6.03 Immunohistochemical and cytogenetic profile of various small cell tumours of the vagina.* Immunohistochemical Peripheral primitive Rhabdomyosarcoma B-cell Melanoma Small cell Endometrial or molecular markers neuroectodermal non-Hodgkin carcinoma stromal tumour/Ewing tumour lymphoma sarcoma Cytokeratin +/- +/- - - + +/- Muscle specific actin/ desmin - + - - - +/- Chromogranin/ synaptophysin +/- - - - +/- - S-100 protein +/- - - + - - HMB-45 - - - + - - Leukocyte common antigen/ CD20 - - + - - - CD10 - - +/- - - + CD99 + +/- +/- - - - t(11;22) + - - - - - t(2;13)/ t(1;13) - +/- - - - - Monoclonal immunoglobulin heavy chain gene - - +/- - - - rearrangement Key: +/-, variable rate of positivity; *, Not all markers have been thoroughly tested for each tumour, but expected results are listed. 310 Tumours of the vagina
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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
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Table 4.03 Altered gene function in
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Mesenchymal tumours and related les
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areas are limited to less than 30%
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A B C Fig. 4.30 Leiomyosarcoma. A T
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e used sparingly and is reserved fo
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A B Fig. 4.38 Leiomyoma with perino
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cytological atypia, tumour cell nec
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Mixed epithelial and mesenchymal tu
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Prognosis and predictive factors Th
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tumours may superficially invade th
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A Fig. 4.46 A Gestational choriocar
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A Fig. 4.49 A Classic complete hyda
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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}.
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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
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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
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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
Page 318 and 319: type) is a highly diff e rentiated
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
Page 332 and 333: A Fig. 7.23 Vulvar peripheral primi
Page 334 and 335: Familial aggregation of cancers of
Page 336 and 337: BRCA1 syndrome Definition Inherited
Page 338 and 339: dispose individuals to the developm
Page 340 and 341: Fig. 8.05 To assess whether wild-ty
Page 342 and 343: Fig. 8.07 Factors that modify risk
Page 344 and 345: BRCA2 syndrome R. Eeles S. Piver S.
Page 346 and 347: tubal or ovarian carcinomas. Howeve
Page 348 and 349: in typical nuclear foci that may re
Page 350 and 351: Breast tumours Frequency Breast can
Page 352 and 353: Fig. 8.14 Codon distribution of som
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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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