Tavassoli FA, Devilee P: Pathology and Genetics: Tumours of the Breast and Female Genital Organs. WHO Classification of Tumours series - volume IV. Lyon, France: IARC Press

Abstract

As with all members of the WHO Classification of Tumours series, this book is well presented and represents exceedingly good value for money. In general the quality of production is good, with the photography of high to very high quality with good illustrations and colour balance. Plentiful micro and macroscopic pictures are presented, the latter being particularly helpful in the sections dealing with gynaecological lesions. Unfortunately, in some cases the illustrations are poor, for example fig 1.105c is out of focus or too small, fig 184, which is stated to show ADH, is of too low power to serve any useful purpose.The text offers a well-organised and comprehensive review of breast and gynaecological tumours. In particular, this volume deserves a lot of praise for its synthesis of taxonomy with molecular pathology and probably gives to date the best ready reckoner for molecular and cytogenetic alterations in breast and gynaecological cancer within a pathology textbook. This synthesis could have been taken further, for example in the breast section no reference to the work relating HER2 amplification with epidermotropism and Paget's disease is given [1,2]. Some of the gynaecological text also deserves particular praise; the section on inherited tumour syndromes gives a masterly overview of a complicated subject.Like all such books there was clear evidence that this text had been written by a committee and in several places the opportunity for reaching a consensus view on some important issues was lost. Most notably, with regards to microinvasion, many different definitions were given, and one would have thought that the WHO were just the body that would provide some unification with regards to this sort of contentious area. On the other hand I am glad to see that a cautious approach to the premature concept of lobular intraepithelial neoplasia (LIN) and ductal intralobular neoplasia (DIN) was adopted. The concept is, in theory, attractive but until the various and probably multiple lines of breast cancer evolution are more clearly identified, this concept must remain in cold storage.In other areas apparent consensus in the book is not matched by reality; the section on mucinous cystic lesions associated with pseudomyxoma peritonei rather oversimplifies what remains a still contentious area of pathology.The pattern of referencing in the text was to a certain extent patchy and didn't include some of the original descriptions of many lesions, for example the co-incidence of mammary hamartoma and pseudoangiomatous stromal hyperplasia [3]. These oversights no doubt relate to the idiosyncratic knowledge of the literature, which many specialist histopathologists have. Occasionally the selectivity is misleading; in the section on lobular carcinoma it is stated that loss of E-cadherin occurs and that this loss is associated with poor prognosis. The implication given was that this related to lobular carcinoma but the references related to breast cancers in general. Even that view has been challenged, because loss of E-ca...

Giant left breast hamartoma in a 45-year-old woman

“…Additionally, this report is notable as hamartomas are uncommon and giant types are rare, only representing about 0.7% of benign breast tumours in women 1. It is thought that this figure is low due to underdiagnosis and under-reporting.…”

“…Giant breast hamartomas are rare and usually occur in perimenopausal women during the fourth or fifth decades of life 1. However, they can occur at any age with a case reported by Venkatesh and Harish in a 14-year-old girl 2.…”

“…WHO defines breast hamartomas as ‘a well demarcated, generally encapsulated mass, composed of all components of breast tissue’ 1. Giant breast hamartomas can vary considerably in their composition.…”

Management of primary neuroendocrine tumour of the breast

“…Diagnosis of primary NET of the breast requires exclusion of NET at non-mammary sites and the presence of histological evidence of intraductal or in situ component [3]. It is a rare entity with a reported incidence of < 1% in postmenopausal females (97%) in the 6th-7th decade of life [1,4,5]. However, Bogina et al have reported neuroendocrine differentiation in 10.4% of breast carcinoma patients in a retrospective analysis of 1232 patients of breast cancer when immunohistochemistry staining was performed with synaptophysin and chromogranin A [6].…”

“…Primary neuroendocrine tumour (NET) of the breast is a rare entity and constitutes less than 1% of all breast cancers [1]. The World Health Organization (WHO) defined mammary neuroendocrine carcinoma (NEC) as a separate entity in 2003 and revised the term NEC in 2012 to carcinoma with neuroendocrine differentiation [2].…”