Invasive breast carcinoma - IARC

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A Fig. 7.23 Vulvar peripheral primitive neuroectodermal tumour. A The neoplasm is composed of relatively small, somewhat irregularly shaped cells with minimal cytoplasm. The nuclei are pleomorphic with granular chromatin and occasional small nucleoli. B Intense immunoreactivity for MIC 2 (CD99) is evident. B Immunohistochemical stains for cytokeratin demonstrate a distinctive perinuclear globular cytoplasmic pattern, and markers of neuroendocrine differentiation a re usually positive {1209}. Electro n microscopic examination demonstrates i n t e rmediate filaments in a globular paranuclear arrangement and dense core granules {554,996,1209}. Histogenesis These neoplasms are derived from small, neuroendocrine cells of the lower epidermis. Peripheral primitive neuroectodermal tumour / Ewing tumour Definition An embryonal tumour arising outside of the central nervous system composed of undifferentiated or poorly differentiated neuroepithelial cells. Clinical features This is a rare primary tumour of the vulva that has been in reported in children and adult women of reproductive age {2839, 3002} and presents as a subcutaneous mass. Histopathology It is circumscribed but not encapsulated and composed of relatively small cells with minimal cytoplasm and ill defined cell borders. The nuclei are h y p e rc h romatic with finely granular c h romatin. Small nucleoli are evident. The mitotic count is variable, with an average of 3 per 10 high power fields re p o rted {3002}. The tumour is usually multilobulated but is variable in appearance with solid areas, sinusoidalappearing areas with cystic spaces containing eosinophilic pro t e i n e a c e o u s material and Homer Wright ro s e t t e s { 2 8 3 9 , 3 0 0 2 } . The tumour cells are immunoreactive for CD99 and vimentin and may be re a c t i v e for synaptophysin. Pan-cytokeratin may be focally positive in some cases. Dense core neuro s e c re t o ry granules are not identified by electron micro s c o p y. Somatic genetics A vulvar peripheral primitive neuroectodermal tumour/Ewing tumour has been shown to express the EWS/FLI1 chimeric transcript due to the chro m o s o m e translocation t(11;22)(q24;q12), which is pathognomonic for this tumour type and is present in approximately 90% of tumours of this type {3002}. Malignant lymphoma Definition A malignant lymphoproliferative neoplasm that may be primary or secondary. Clinical features This is a rare neoplasm that presents as a vulvar mass {1279,2266,3002}. Histopathology In the largest series two-thirds of the cases were diffuse large B-cell lymphomas {3002}. Prognosis and predictive factors Malignant lymphoma of the vulva is usually an aggressive disease {3002}. Leukaemia Definition A malignant haematopoetic neoplasm that may be primary or secondary. Clinical features Rarely, granulocytic sarcoma presents as a vulvar mass {1583} Histopathology See chapters on the cervix and vagina. Secondary tumours of the vulva Definition Tumours of the vulva that originate outside the vulva. Incidence and origin The vulva is a rare site of secondary involvement by tumour. Tumours may involve the vulva by lymphatic spread or contiguous growth. The primary site of a secondary tumour of the vulva is most commonly the cervix, followed by the endometrium or ovary. Occasionally, breast carcinoma, renal cell carcinoma, gastric carcinoma, lung carcinoma, and, r a re l y, gestational choriocarc i n o m a , malignant melanoma or neuroblastoma spread to the vulva. Vaginal, urethral, urinary bladder and anorectal carcinomas may extend directly into the vulva {1631, 1802,3121}. 334 Tumours of the vulva
CHAPTER 8 Inherited Tumour Syndromes Inherited cancer susceptibility is now recognized as a significant risk for cancer of the breast and female genitals organs. For many inherited tumour syndromes, the underlying germline mutations have been identified. This allows genetic testing and counseling of at risk family members and to estimate the asso - ciated disease burden. The genetic basis involves mutational inactivation of tumour supressor and DNA repair genes. Such germline mutations follow a mendelian inheritance pattern and usually confer substantial cancer risks, with breast and ovary as most frequent target organs. Additional familial aggregations have been observed but the responsible genes have not yet been identified and may involve multigenic traits.
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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
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e red by squamous epithelium {380}.
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endometrioid adenocarcinoma of the
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metrial epithelium. In some cases t
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with distinct cell borders and a gr
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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 322 and 323: glandular elements surrounded by fi
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 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
Page 376 and 377: 436. Chang J, Sharpe JC, A'Hern RP,
Page 378 and 379: 562. Costa MJ, Ames PF, Walls J, Ro
Page 380 and 381: 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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