Invasive breast carcinoma - IARC

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glandular elements surrounded by fibrous tissue. Relatively uniform columnar epithelial secretory cells with underlying myoepithelial cells cover the glands and papillary stalks. Adenocarcinoma of Skene gland origin An adenocarcinoma of Skene gland with associated metastasis has been re p o rted {2726}. Skene gland is the female homologue of the male prostate, and the tumour expresses prostate antigens by i m m u n o h i s t o c h e m i s t ry {2726}. A carc i- noma of Skene duct origin was associated with systemic coagulopathy { 2 8 9 5 } . Adenocarcinomas of other types These tumours may arise fro m endometriosis or ectopic cloacal tissue {307,3126,3237}. Adenoma of minor vestibular glands Adenoma of minor vestibular glands is a rare benign tumour composed of clusters of small glands lined by mucins e c reting columnar epithelial cells arranged in a lobular pattern without intervening Bartholin duct elements. It is usually an incidental finding measuring 1-2 mm in diameter, although one example was as large as 10 mm. Nodular hyperplasia of the minor vestibular glands may also occur { 1 4 1 , 2 2 9 5 } Mixed tumour of the vulva Definition A benign epithelial tumour composed of epithelial cells arranged in tubules or nests mixed with a fibrous stromal component that may include chondro i d , osseous and myxoid elements. Synonyms Pleomorphic adenoma, chondro i d syringoma. Clinical features Mixed tumour of the vulva usually presents as a subcutaneous nodule involving the labum majus and/or the Bartholin gland area. Histopathology The histological features are similar to those of mixed tumours of salivary glands. The tumour with its stromal-like elements is believed to arise fro m pluripotential myoepithelial cells that are present in Bartholin gland, sweat glands and the specialized anogenital (mammary-like) glands of the vulva {2410}. Prognosis and predictive factors Although these tumours are considered benign, insufficient cases of vulvar mixed tumours have been reported to determine their natural history at this site. The tumour may recur locally. A carcinoma arising in a mixed tumour has been described {2117}. Complete local excision with free margins is the recommended therapy for the primary tumour as well as for local recurrences. Tumours of skin appendage origin Definition Benign or malignant tumours differentiating towards hair follicles or sweat or sebaceous glands. ICD-O codes Malignant sweat gland tumour 8400/3 Sebaceous carcinoma 8410/3 Syringoma 8407/0 Nodular hidradenoma 8402/0 Trichoepithelioma 8100/0 Trichilemmoma 8102/0 Malignant sweat gland tumours Vulvar malignant sweat gland tumours include eccrine adenocarcinoma, porocarcinoma, clear cell hidradenocarcinoma, and apocrine adenocarcinoma, the last of which may be associated with Paget disease {3112}. Sebaceous carcinoma Vulvar sebaceous carcinoma resembles its cutaneous counterpart. It is a malignant tumour composed of cords and nests of basaloid appearing neoplastic glandular elements with cellular features of sebaceous epithelium. The tumour may be associated with neoplastic sebaceous cells present in pagetoid nests within the parabasal component of the overlying epithelium and in larger clusters near the epithelial surface {405,795}. Sebaceous carcinoma of the vulva may be associated with VIN {1318}. A Fig. 7.13 Papillary hidradenoma of the vulva. A Note the circumscribed tumour composed of complex branching papillae. B The epithelial lining is composed of a double layer of cells, an inner layer of secretory cells and an outer layer of myoepithelial cells. B 324 Tumours of the vulva
Syringoma Definition A benign epithelial tumour believed to arise from eccrine ducts that is composed of small and relatively uniform epithelial-lined tubules and cysts within a densely fibrous dermis. Clinical findings It presents as asymptomatic or pruritic papules that are small, clustere d and non-pigmented and involve the deeper skin layers of the labia majora. The nodules are often bilateral { 4 1 5 } . Histopathology Histologically, small epithelial cysts and dilated duct-like spaces lined by two rows of cells, an inner epithelial and an outer myoepithelial, are seen. The ductular structures typically form comma-like shapes. The tumour lacks a clearly defined capsule or margin; the dermis surrounding the neoplastic ducts has a fibrotic appearance. Nodular hidradenoma Definition Nodular hidradenoma is an infrequent benign tumour of sweat gland origin composed of epithelial cells with clear cytoplasm arranged in lobules and nests. Synonym Clear cell hidradenoma. Histopathology It is composed of epithelial cells with clear cytoplasm arranged in lobules and nests {1950}. Prognosis and predictive factors Complete local excision is considered adequate therapy. Tr i c h o e p i t h e l i o m a Definition A benign tumour composed of complex interconnected nests of basaloid cells that form small "horn cysts" (cysts containing keratin). Fig. 7.14 Syringoma of the vulva. The tumour is composed of well differentiated ductal elements of eccrine type consisting of irregular, sometimes comma-shaped, cord-like and tubular structures that infiltrate the dermis. Clinical features On clinical examination single or multiple cutaneous nodules with overlying skin abnormalities are identified. Histopathology Nests of cells form small keratin-containing cysts. The neoplastic epithelial cells are monomorphic without nuclear hyperchromasia or atypia. The tumour has a defined dermal interface and lacks an infiltrative appearance. Rupture of the keratin-containing cysts may result in a granulomatous reaction with fore i g n body giant cells. Hair follicles may be identified in some cases. Histogenesis The tumour is considered to be of follicular origin {478}. Prognosis and predictive factors The treatment is complete local excision. Trichilemmoma Definition A benign epithelial tumour composed of relatively uniform epithelial cells with pale-staining cytoplasm that may have some nuclear pleomorphism. It is thought to arise from the proliferation of outer root sheath epithelial cells of the hair follicle. Synonym Proliferating trichilemmal tumour. Clinical findings C l i n i c a l l y, these tumours have been reported in the dermis of the labium majus, presenting as a slow-gro w i n g solid mass {140}. Histopathology The tumour has a lobulated appearance with a dermal pushing border that may show no connection with the overlying epithelium. The cells show peripheral palisading and increased clear cytoplasm as they stratify toward the centre. Amorphous keratin is present in the lumens, although no granular layer is formed. Calcification may occur. Uncommon vulvar skin appendage tumours P roliferating trichilemmal cysts (pilar tumours) {2329}, trichoblastic fibroma {1003} and apocrine cystadenoma {1021} have been described on the vulva. A local excision is therap e u t i c . Epithelial tumours 325
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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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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
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
Page 318 and 319: type) is a highly diff e rentiated
Page 320 and 321: Clinical features Bartholin gland c
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
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.
Page 370 and 371: 52. Akhtar M, Robinson C, Ashraf Al
Page 372 and 373:
180. Bapat K, Brustein S (1989). Ut
Page 374 and 375:
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
Page 428 and 429:
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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