The Histology of Borderline Cancer: With Notes on Prognosis PDF
Preview The Histology of Borderline Cancer: With Notes on Prognosis
W. Wallace Park The Histology of Border line Cancer With Notes on Prognosis With the collaboration of J ames W. Corkhill 314 illustrations Springer-Verlag Berlin Heidelberg New York W. Wall ace Park, MD (Edin.), FRCPath. University Department of Pathology Ninewells Hospital Dundee, Scotland United Kingdom J ames W. Corkhill, FIMLT Senior Technician (ret.) Department of Pathology The University Dundee, Scotland United Kingdom ISBN-13: 978-1-4471-1297-6 e-ISBN-13: 978-1-4471-1295-2 DOI: 10.1007/978-1-4471-1295-2 Library of Congress Cataloging in Publication Data Park, W W The histology of borderline cancer, with notes on prognosis. Inc1udes index. 1. Cancer-Diagnosis. 2. Histo!ogy, Patho!ogicaI. I. Corkhill, James W., joint author. 11. Title. RC269.P37 616.9'94'07583 79-26151 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is con cerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. © by Springer-Verlag Berlin . Heidelberg 1980 Softcover reprint of the hardcover 1s t edition 1980 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. This book Is for fellow-pathologists But is dedicated To surgeons, of all sorts, Who withstand, With such patience And friendly forbearance, Our forever peering over their shoulder It is dedicated also to Dorothy, Jill and Daphne Preface Often enough, in diagnosing cancer the last word possibly neoplastic, some not. In essence, the rests with the pathologist and his or her micro book is concerned with interpretation of the scope. Often enough, too, the pathologist is borderline or histologically equivocal case and thought to dispense absolute truth: he does his the clinical implications thereof. It is based on best, but the truth he dispenses is not absolute. so me 390 examples of which most are individu Rather, with a greater or lesser degree of con ally described in brief. No useful purpose is fidence, he is making aprediction or expressing served by giving in detail the clinical and patho a prob ability of a certain kind of biological logical circumstances of every patient with, say, behaviour, and the degree of confidence with a dubious lesion of endometrium or larynx, or which he operates is based on experience. This with a similarly borderline papilloma in bladder experience is, in turn, based on the recollection or rectum, for each of these lesions exemplifies of earlier events, counsel from his mentors, from a familiar and 'standard' problem. Problems of his studies, and from discussions with colleagues. this kind will be examined as such but not the It would be going too far to agree with those details of every patient who posed them. Circum clinicians said to prefer their pathologist, as they stances have been described individually, in most prefer their cheese, slightly mouldy, but there instances simply because each seemed to have is no substitute for lengthy practice, consulta something useful to teach. At the same time, they tion and debate. Every such effort is designed can hardly avoid giving much of the text a the better to define the correlation between strongly parochial, even anecdotal, ring. We offer the pattern of a tissue and its likely future in explanation that very many of the diagnostic behaviour. and prognostic difficulties can or could be For many years, with exactly this object in matched exactly in countless laboratories every mind, it has been the custom within the Univer where: none is peculiar to this area or even to sity Department of Pathology, Dundee, to hold the United Kingdom or Western Europe; their regular slide sessions at which sections of inter relevance is universal. est have been examined by so me six to twelve A further possible shortcoming is that not all pathologists of varied experience. Throughout, the cases individually described are accompanied all sections have been examined initially in the by illustrations as perhaps, in the context of absence of any information, not even the sex or morphology, they should be. Rightly or wrongly, age of the patient or the anatomical site being considerations of space were allowed to prevaiI revealed. This practice, of which more is said in in the belief that the more important cases have Chapter 1, is not one that commends itself im been illustrated and in the hope that, for the mediately to all, but few who have come as rest, the text will suffice. We refer in pI aces to critics have failed to leave as converts, and none lesions or circumstances not represented in the has failed to find it educative and revealing. local series. Their inclusion has been prompted This book is based largely on the experience by a wish to include supplementary information gained from these meetings. Few lesions, even wherever it seemed likely to be useful as a guide tropical lesions, are not represented in the col to prognosis. lection of slides that accrued, some neoplastic or So essential to the quality of prediction, which vB l'iii Preface is the giving of a prognosis, is knowledge of the The explanation may simply be that the necessary later events in the life of alesion and its owner ingredients rarely coincided; a relatively stable that it seems surprising that departments of population, a geographically stable pathologist, histopathology did not long antedate depart and cooperative clinical colleagues. All these ments of radiotherapy in instituting a system of have coincided here and allowed the analysis regular follow-up enquiry for borderline cases. that folIows. Acknowledgements We owe our most appreciative thanks to many gists in the UK know, much of the credit for the for help in compiling this book. First, we warmly technical standards attained and maintained thank all our past and present colleagues and within the Department goes to our former col associates in the Department of Pathology, ini leagues Professor A. C. Lendrum and Mr D. S. tially of the University of St Andrews, then of Fraser, FIMLT. the University of Dundee. Over aperiod of some Our special thanks go to Mr R. S. Fawkes 25 years, all have contributed in some measure who, with the help of Mrs Sheila Gibbs, pre by discussion, debate and friendly collaboration. pared many of the more recent illustrations after We are equally indebted to our c1inical col one of us (JWC) had retired; to Mrs Isla leagues, mostly surgeons of all disciplines, Bloomer who typed most of the script and also whether general, gynaecological, orthopaedic or to Mrs Elizabeth Cargill who started it; and to others, but also on occasion physicians and the various other members of the secretarial staff dermatologists, and indeed virtually all those, who have without exception been ever willing to inc1uding haematologists, microbiologists and help on many occasions. biochemists, who have c1inical responsibilities: We could not have enjoyed greater help and all have given all the cooperation we could have co operation from a publishing firm than we have wished. For help with the tracing of patients we had from Messrs Springer-Verlag. At all times owe much to our Department of Radiotherapy our contacts with Mr Michael J ackson, Medical and the local Cancer Registry, and also to many Editor (UK), and his associate, Mr S. Whitting of our General Practitioner colleagues in and harn Boothe, and with Mr Chester Van Wert, around Dundee. In the early stages of the proj Production Editor (NY), have been of the ect, generous support was given for the same friendliest and carried out on their part (though purpose by the former Board of Management rather less so, we regret, on ours!) with an im for the Dundee General Hospitals. pressive efficiency. The essential prerequisite for an acceptable We finally mention with deep gratitude the photomicrograph is the proper fixation, process understanding, tolerance and help of our families. ing, cutting and staining of the tissue, and this All have been generous in their help, patience has been the responsibility of our many technical and, so much appreciated, keen interest in the associates. Without their skills, the production of production of the 'borderline' book. our volume would have been virtually impossi ble: we pay tribute to this skill, and extend to W. Wall ace Park them our deep appreciation. As fellow-patholo- James W. Corkhill h: Contents 1 A Philosophy of Cancer Diagnosis by Microscopy 1 Series of Cases Analysed 1 Rationale of Histopathological Diagnosis 3 Validity of Histological Criteria of Malignancy 6 Use of CIinical Data 8 The Histopathological Audit 10 2 Lesions of the Breast 13 Local Series 14 Summarised Totals 15 Case Data 15 Commentary on Local Series 27 General Commentary 28 Dysplasia 28 Lobular Carcinoma In Situ 28 Intraduct Carcinoma 30 Paget's Disease of the Nipple 32 Cystosarcoma Phyllodes 33 Prognosis 33 Conc1usions 38 3 Lesions of the Thyroid Gland 41 Local Series 42 Summarised Totals 42 Case Data 42 Commentary on Local Series 57 General Commentary 57 Microfollicular Adenoma 57 Papillary Carcinoma 59 Multifocal Carcinoma 60 Medullary Carcinoma 60 Lymphoreticular Neoplasms 61 Hyperthyroidism 62 Cryptic Carcinoma 62 Conc1usions 63 xi xii Contents 4 Lesions of Lymph Nodes 67 Local Series 71 Case Data I: ? Hodgkin's Disease 73 Cas e Data 11: ? Malignant Lymphoma Other than Hodgkin's Disease 104 Commentary on Local Series 123 General Commentary 124 Hodgkin's Disease 124 Non-Hodgkin's Lymphomas 128 Lesions that may Simulate ML 130 Conclusions 138 5 Lesions of the Soft Tissues 143 Local Series 144 Summarised Totals 144 Case Data 146 Commentary on Local Series 193 General Commentary 194 Pseudo-sarcomatous Lesions 194 Myxoma 195 Mesenchymoma, Benign and Malignant 196 Neoplasms of Fat 198 Fasciitis (Pseudo-sarcomatous, Nodular) 200 Histiocytoma 201 Juvenile Fibromatoses 206 Desmoid Tumour 207 Fibrosarcoma 207 Granulation Tissue Sarcoma: Haematoma-sarcoma 208 Granular Cell Myoblastoma 209 Proliferative Myositis 210 Myositis Ossificans 210 Bony Neoplasms of Soft Tissue 211 Synovial Overgrowths 213 Epithelioid Sarcoma 214 'Staging' of Soft Tissue Sarcomas 214 Conclusions 215 6 Lesions of Bone and Cartilage 221 Local Series 221 Summarised Totals 221 Case Data 222 Commentary on Local Series 240 General Commentary 240 Clinical Evidence vs Histological Evidence 242 Inflammatory Patterns vs Neoplastic Patterns 242 Chondroma vs Chondrosarcoma 245 Callus vs Osteosarcoma vs Chondrosarcoma 247 Predominantly Fibroblastic Lesions Containing Giant Cells 250 Conclusions 255 Contents xiii 7 Lesions of the Skin 259 Part A: Epithelial Lesions Other than Melanocarcinoma 260 Overgrowths of Stratified Squamous Epithelium 260 Local Series 260 General Commentary 261 Basal Cell Carcinoma 265 Extramammary Paget's Disease (EMPD) 266 Conclusions 266 Part B: The Problem 01 Mycosis Fungoides and Comparable Conditions 267 Local Series 267 General Commentary 269 Lymphocytic Infiltrations of the Skin 271 Other Pseudo-malignant Lesions 271 Conclusions 273 Part C: Melanocarcinoma 274 Local Series 275 Summarised Totals 275 Case Data 276 Commentary on Local Series 308 General Commentary 311 Classification 311 Constituent Cells 313 Lentigo Maligna 314 Spitz Naevus 316 Diagnosis by Frozen Section 316 Trauma 317 Lymphadenectomy 317 Pregnancy 319 Influence of Age 320 Delay in Metastasis 320 Conclusions 320 8 Lesions of the Digestive Tract 325 Local Series 325 Summarised Totals 325 Case Data 326 Commentary on Local Series 356 General Commentary 356 Oral Cavity 356 Salivary Tissue 357 Palate 358 Pharynx 358 Oesophagus 359 Stomach 360 Small Intestine 361 Large Intestine 362 Carcinoid Tumour 363 Malignant Lymphoma and Pseudo-lymphoma 365
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