Invasive breast carcinoma - IARC

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Clinical features Bartholin gland carcinoma occurs predominantly in women over 50 years of age and presents as an enlargement in the Bartholin gland area that may clinically resemble a Bartholin duct cyst. Tumour spread and staging Approximately 20% of cases are associated with ipsilateral inguinofemoral lymph node metastases at presentation {556,1634,3108}. A Histopathology The tumour is typically solid and deeply infiltrative. A transition from an adjacent Bartholin gland to tumour is of value in identifying its origin. Various types of carcinoma have been described. Adenocarcinoma Adenocarcinoma accounts for approximately 40% of Bartholin gland tumours {556,1634}. Adenocarcinomas may be mucinous, papillary or mucoepidermoid in type. They are usually carcinoembryonic antigen immunoreactive. B Fig. 7.10 Paget disease of the vulva. A Paget disease of cutaneous origin. Clusters of large pale Paget cells with atypical nuclei are present within the epidermis. A mitotic figure is evident. B Paget disease of urothelial origin. Clusters of large pale cells resembling transitional cell carcinoma involve predominantly the parabasal area of the epidermis with sparing of the basal layer. clinically involves the perianal mucosa and skin, as well as the adjacent vulva. Histopathology The Paget cell of cutaneous origin is typically a large, round cell with a large nucleus and prominent nucleolus. The cytoplasm is pale on routine hematoxylin and eosin stain, is often vacuolated and stains with mucicarmine. The cytoplasm contains PAS-positive material that is resistant to diastase. The Paget cells may also express CA125 and Her-2/neu but do not express estrogen receptor {573,3119,3121}. Paget disease that is related to urothelial neoplasia contains cells with the morphological features of high grade urothelial neoplasms {1746,3121}. It may histologically resemble primary cutaneous Paget disease, though it has a different immunohistochemical profile. Somatic genetics Three cytogenetically abnormal clones were detected in Paget disease of the vulva {2897}, a finding consistent with the view that this disease may arise multicentrically from pluripotent stem cells within the epidermis. DNA aneuploidy in Paget disease is associated with an increased risk of recurrence {2553}. Bartholin gland carcinoma Definition Primary carcinoma of diverse cell types located at the site of the Bartholin gland. Squamous cell carcinoma This tumour accounts for approximately 40% of Bartholin gland tumours and is composed of neoplastic squamous cells. Adenoid cystic carcinoma Adenoid cystic carcinoma accounts for approximately 15% of Bartholin gland tumours {556,675}. It is composed typically of rounded islands of uniform malignant epithelial cells with a cribriform pattern. A hyaline stroma may form cylinders separating rows of tumour cells. The intraluminal material is basement membrane-like rather than a secretion, supporting a squamous rather than glandular origin. The cytogenetic analysis of an adenoid cystic carcinoma of Bartholin gland revealed a complex karyotype involving c h romosomes 1, 4, 6, 11, 14 and 22 {1457}. Adenosquamous carcinoma Adenosquamous carcinoma accounts for approximately 5% of Bartholin gland tumours. It is composed of neoplastic mucin-containing glandular and neoplastic squamous cells. Transitional cell carcinoma Transitional cell carcinoma is a rare tumour of Bartholin gland composed of 322 Tumours of the vulva
Table 7.02 Immunohistochemical findings of Paget disease. Type of Paget disease CK-7 CK 20 GCDFP-15 CEA UP-III Primary skin neoplasm + - + + - Related to anorectal carcinoma + + - + - Related to urothelial carcinoma + (+) - - + Fig. 7.11 Paget disease of the vulva. Note the red, eczematous appearance. ______ Abbreviations for antibodies used as follows: CK = cytokeratin; CEA = carcinoembryonic antigen; GCDFP-15 = gross cystic disease fluid protein-15; UP-III = uroplakin III {2088,3121}. neoplastic urothelial-type cells, occasionally with a minor component of glandular or squamous cells. Small cell carcinoma This rare highly malignant neoplasm is composed of small neuroendocrine cells with scant cytoplasm and numero u s mitotic figures {1361}. Benign neoplasms of Bartholin gland Adenoma and adenomyoma B a rtholin gland adenoma is a rare benign tumour of Bartholin gland characterized by small clustered closely packed glands and tubules lined by columnar to cuboidal epithelium with colloid-like secretion arranged in a lobular pattern and contiguous with identifiable B a rtholin gland elements. Bart h o l i n gland adenoma has been reported in association with adenoid cystic carcinoma {1487}. Bartholin gland nodular hyperplasia can be distinguished from adenoma by the preservation of the normal duct-acinar relationships present in hyperplasia. Bartholin gland adenomyoma has a fibromuscular stromal element that is immunoreactive for smooth muscle actin and desmin as well as a lobular glandular architecture with glands lined by columnar mucin-secreting epithelial cells adjacent to tubules {1487}. Tumours arising from specialized anogenital mammary-like glands Definition Malignant and benign tumours, usually of glandular type and resembling neoplasms of the breast, may arise in specialized anogenital mammary - l i k e glands. These glands and the tumours that arise from them are usually identified in or adjacent to the intralabial sulcus. Adenocarcinoma with morphological feat u res of breast carcinoma has been re p o rted as a primary vulvar tumour {687}. Such tumours are curre n t l y thought to arise from the specialized anogenital glands and not from ectopic breast tissue {2991,2992}. The papillary hidradenoma is an example of a benign neoplasm {2991,2992}. Intraductal adenocarcinoma of mammary-type within a hidradenoma has been reported {2212}. Papillary hidradenoma Definition A benign tumour composed of epithelial s e c re t o ry cells and underlying myoepithelial cells lining complex branching papillae with delicate fibrovascular stalks. Epidemiology This tumour is rare in the vulva but is the most common benign glandular neoplasm at this site. Clinical features It usually presents as an asymptomatic mass within or adjacent to the intralabial sulcus and may cause bleeding resembling carcinoma if the gland prolapses and/or ulcerates. Histopathology The tumour is distinctly circumscribed and composed of complex papillae and A B Fig. 7.12 Bartholin gland neoplasms. A Squamous cell carcinoma. Aggregates of neoplastic squamous cells infiltrate Bartholin gland seen on the left. B Adenoid cystic carcinoma. Note the cribriform pattern with the lumens containing basophilic mucin. C Bartholin gland adenoma. A nodule is composed of clustered glands lined by mucinous epithelium. C Epithelial tumours 323
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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
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Secondary tumours of the uterine co
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WHO histological classification of
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Epithelial tumours M. Wells J.M. Ne
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Fig. 5.04 Mechanisms of human papil
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Fig. 5.08 Keratinizing squamous cel
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in their Asian population {2957}. I
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Page 272 and 273: e red by squamous epithelium {380}.
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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
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 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
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Page 350 and 351: Breast tumours Frequency Breast can
Page 352 and 353: Fig. 8.14 Codon distribution of som
Page 354 and 355: Breast tumours Age distribution and
Page 356 and 357: Hereditary non-polyposis colon canc
Page 358 and 359: essary in the evaluation of the pat
Page 360 and 361: Age distribution and penetrance Mos
Page 362 and 363: Contributors Dr Vera M. ABELER** De
Page 364 and 365: Dr Carlo LA VECCHIA Laboratory of E
Page 366 and 367: Dr Manuel TEIXEIRA Department of Ge
Page 368 and 369: 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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Invasive breast carcinoma - IARC

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