Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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Differential diagnoses Differential diagnoses include, among the germ cell tumours, seminoma, solid type of yolk sac tumour, and choriocarcinoma. Among other tumours anaplastic large cell lymphoma, malignant Sertoli cell tumour and metastases are considerations. The age of the patient, microscopic examination of representative sections from the tumour including all growth patterns, and a small panel of immunohistochemical stains yields the correct diagnosis in the majority of the cases. Fig. 4.30 Embryonal carcinoma. Transverse ultrasound image of the testis (cursors) shows an ill defined, irregular, heterogeneous mass (arrows). ing abnormal forms. Syncytiotrophoblastic cells may occur scattered among the tumour cells as single cells or in small cell groups. Cells at the periphery of the solid tumour formations may appear degenerated, smudged or apoptotic resulting in a biphasic pattern that may mimic choriocarcinoma. The stroma that varies from scant within the solid formations, to more abundant at the periphery of the tumour is usual fibrous, more or less cellular and with or without lymphocytic infiltration. Eosinophils are rarely present as is granulomatous reaction. In the adjacent testicular tissue intratubular embryonal carcinoma is often present, and is often more or less necrotic, and sometimes calcified. In the surrounding tissue vascular and lymphatic invasion are also common and should be carefully distinguished from the intratubular occurrence and from artificial implantation of tumour cells into vascular spaces during handling of the specimen. Loose, "floating" tumour cells in vascular spaces, usually associated with surface implants of similar cells should be considered artefactual. Fig. 4.31 Embryonal carcinoma. The tumour is fleshy and has foci of haemorrhage and necrosis. Immunoprofile Embryonal carcinoma contains a number of immunohistochemical markers reflecting embryonic histogenesis but the majority have hitherto not been very useful diagnostically. CD30 can be demonstrated in many cases {2202}. Cytokeratins of various classes are present while epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) and vimentin can usually not be demonstrated {1894}. Placental alkaline phosphatase (PLAP) occurs focally as a membranous and/or cytoplasmic staining {1615}. Many embryonal carcinomas are strongly positive for TP53 in up to 50% of the tumour cells {2667}. AFP may occur in scattered cells {1196,1198}. Human placental lactogen (HPL) is occasionally found focally in the tumour cells {1198,1807}. HCG occurs in the syncytiotrophoblastic cells, which may be present in the tumour, but not in the embryonal carcinoma cells and the same applies to pregnancy specific ß 1 glycoprotein (SP1) {1807}. Ultrastructure Ultrastructural examinations have not proven to be diagnostically useful although it may differentiate embryonal carcinoma from seminoma and glandular like pattern of embryonal carcinoma from somatic type adenocarcinomas. Prognosis The most important prognostic factor is clinical tumour stage. In general, the tumour spread is lymphatic, first to the retroperitoneal lymph nodes and subsequently to the mediastinum. Haematogeneous spread to the lung may also be seen. Patients with pure embryonal carcinoma and with vascular invasion tend to have higher stage disease {1200}. This is emphasized by studies defining high risk patients as those with pure embryonal carcinoma, predominant embryonal carcinoma, embryonal carcinoma unassociated with teratoma, and/or tumours with vascular/lymphatic invasion and advanced local stage {1803,1817}. Yolk sac tumour Definition A tumour characterized by numerous patterns that recapitulate the yolk sac, allantois and extra embryonic mesenchyme. ICD-O code 9071/3 Synonym Endodermal sinus tumour, orchioblastoma. Epidemiology In the testis yolk sac tumour (YST) is seen in two distinct age groups, infants and young children and postpubertal males. In children, it is the most common testicular neoplasm {1274} and occurs in all races. It is less common in Blacks, Native Americans, and in Indians {490, A Fig. 4.32 Embryonal carcinoma. A Positive staining for CD30 in embryonal carcinoma. B Positive staining for AFP in scattered cells of embryonal carcinoma. B Germ cell tumours 237
A B Fig. 4.33 Embryonal carcinoma. A Embryonal carcinoma composed of blastocyst-like vesicles. B Solid type of embryonal carcinoma. A B Fig. 4.34 Embryonal carcinoma. A Papillary type of embryonal carcinoma. B Intratubular embryonal carcinoma. Note the tumour necrosis. 1490} and may be more common in Orientals when compared to Caucasians {1276}. In adults, it usually occurs as a component of a mixed germ cell tumour and is seen in approximately 40% of NSGCTs. In adults, it is much more common in Caucasians than in other races. The age incidence corresponds to the age incidence of testicular malignant mixed germ cell tumours {2564}. Fig. 4.35 Embryonal carcinoma. Vascular invasion of embryonal carcinoma. Clinical features Signs and symptoms In children, the median age at the presentation is 16-17 months but may extend to 11 years {1274,2244}. There is a right sided preponderance {1274}. Almost ninety percent of cases present with an otherwise asymptomatic scrotal mass {1274}. Seven percent of cases present with a history of trauma or acute onset pain and 1 percent present with a hydrocele {1274}. Alpha fetoprotein levels are elevated in 90 percent of cases {1274, 2595}. Ultrasound examination reveals a solid intratesticular lesion with a different echo texture from that of the testis. Tumour spread Ten to twenty percent of children have metastases at presentation {1274,2078}. The nodal spread is to the retroperitoneum {1274,2244}. In children there appears to be a predilection for haematogenous spread, 40% presenting with haematogenous spread alone {326}. In 20-26 percent of cases the first site of clinical involvement is the lungs {326, 1274}. Although it is not clear if retroperitoneal nodes are also involved in those cases, in adults, the pattern of spread is similar to that seen in other NSGCTs. Macroscopy Macroscopically pure yolk sac tumours are solid, soft, and the cut surface is typically pale grey or grey-white and somewhat gelatinous or mucoid {1021,1274}. Large tumours show haemorrhage and necrosis {2564}. Histopathology The histopathological appearance is the same, regardless of patient age {1021, 1274,2564}. Several different patterns are usually admixed, and may be present in equal amounts, although not infrequently one pattern may predominate {1201}. Tumours composed entirely of a single histologic pattern are rare {2564}. 238 Tumours of the testis and paratesticular tissue
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World Health Organization Classific
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This volume was produced in collabo
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Contents 1 Tumours of the kidney 9
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CHAPTER 1 Tumours of the Kidney Can
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TNM classification of renal cell ca
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one quarter of kidney cancers in bo
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Familial renal cell carcinoma M.J.
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Table 1.02 Genotype - phenotype cor
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A B Fig. 1.11 A Multiple cutaneous
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A B Fig. 1.14 Birt-Hogg-Dubé syndr
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Clear cell renal cell carcinoma D.J
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Fig. 1.20 Clear cell renal cell car
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Papillary renal cell carcinoma B. D
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A B Fig. 1.29 Papillary renal cell
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Fig. 1.33 Chromophobe RCC with sarc
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Carcinoma of the collecting ducts o
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Renal medullary carcinoma C.J. Davi
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Renal carcinomas associated with Xp
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Renal cell carcinoma associated wit
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Papillary adenoma of the kidney J.N
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of this tumour. Microscopic extensi
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A B Fig. 1.59 Metanephric adenoma.
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esults in intratumoral aneurysms. O
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peritumoural fibrous pseudocapsule.
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increases in prevalence to approxim
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Nephrogenic rests and nephroblastom
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Cystic partially differentiated nep
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A B Fig. 1.80 Clear cell sarcoma of
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A B Fig. 1.85 Rhabdoid tumour of th
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transcription factor is fused to th
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Leiomyosarcoma S.M. Bonsib Definiti
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Angiomyolipoma G. Martignoni M.B. A
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melanocytic and smooth muscle marke
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Multinucleated and enlarged ganglio
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Haemangioma P. Tamboli Definition H
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Fig. 1.107 Juxtaglomerular cell tum
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Intrarenal schwannoma I. Alvarado-C
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Mixed epithelial and stromal tumour
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Synovial sarcoma of the kidney J.Y.
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Renal carcinoid tumour L.R. Bégin
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Primitive neuroectodermal tumour (E
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Paraganglioma / Phaeochromocytoma P
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Leukaemia A. Orazi Interstitial inf
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WHO histological classification of
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TNM classification of carcinomas of
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The risk of bladder cancer goes dow
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Tumour spread and staging Urinary b
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feature in such patients undergoing
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A Fig. 2.12 Infiltrative urothelial
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A Fig. 2.15 A Infiltrating urotheli
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A B Fig. 2.19 A Infiltrative urothe
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Fig. 2.23 Infiltrative urothelial c
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ing systems have been proposed on t
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Non-invasive urothelial tumours G.
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chronically inflamed urothelium and
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Inverted papilloma G. Sauter Defini
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muscle invasive disease, but there
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Fig. 2.42 Non-invasive urothelial n
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A Fig. 2.45 Non-invasive urothelial
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for DBCCR1 silencing {984,2476}. Th
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Squamous cell carcinoma D.J. Grigno
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Fig. 2.51 Squamous cell carcinoma.
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Adenocarcinoma A.G. Ayala P. Tambol
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A B Fig. 2.61 A Adenocarcinoma in s
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A B Fig. 2.65 Intramural urachal ca
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Müllerian origin is postulated for
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A Fig. 2.69 Small cell carcinoma. A
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Carcinoid L. Cheng Definition Carci
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Leiomyosarcoma J. Cheville Definiti
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Osteosarcoma L. Guillou Definition
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Leiomyoma J. Cheville Definition A
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Haemangioma L. Cheng Definition Hae
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Metastatic tumours and secondary ex
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Tumours of the renal pelvis and ure
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nodular, ulcerative or infiltrative
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Tumours of the urethra F. Hofstädt
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usually show enteric, colloid or si
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CHAPTER 3X Tumours of of the the Pr
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TNM classification of carcinomas of
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contrast, mortality among migrants
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Fig. 3.06 Transrectal ultrasound of
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PSA-related diagnostic strategies.
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A B C Fig. 3.10 A,B Section of pros
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pale-clear, similar to benign gland
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A B Fig. 3.20 A, B Adenocarcinoma w
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prostate adenocarcinomas exhibit AR
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A Fig. 3.27 A, B Foamy gland adenoc
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A B Fig. 3.32 A Sarcomatoid carcino
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A B Fig. 3.37 A Gleason score 1+1=2
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A B Fig. 3.43 A Prostate cancer Gle
Page 181 and 182: Fig. 3.48 Heat map-nature. From S.M
Page 183 and 184: Fig. 3.51 Prostate cancer. Major su
Page 185 and 186: many stage T1b cancers. Stage T2 Mo
Page 187 and 188: Fig. 3.58 Patterns of seminal vesic
Page 189 and 190: Prostatic intraepithelial neoplasia
Page 191 and 192: A B Fig. 3.63 A Micropapillary high
Page 193 and 194: A B Fig. 3.68 A Ductal carcinoma in
Page 195 and 196: Ductal adenocarcinoma X.J. Yang L.
Page 197 and 198: Papillary pattern can be seen in bo
Page 199 and 200: A B Fig. 3.74 A Inflammation withou
Page 201 and 202: Squamous neoplasms T.H. Van der Kwa
Page 203 and 204: Neuroendocrine tumours P.A. di Sant
Page 205 and 206: Mesenchymal tumours J. Cheville F.
Page 207 and 208: Fig. 3.89 Sarcoma of the prostate.
Page 209 and 210: Miscellaneous tumours P.H. Tan L. C
Page 211 and 212: A Fig. 3.96 A Adenocarcinoma of the
Page 213 and 214: WHO histological classification of
Page 215 and 216: Introduction F.K. Mostofi I.A. Sest
Page 217 and 218: wartime birth cohorts illustrate th
Page 219 and 220: Similar tumours as those of group 1
Page 221 and 222: crucial for the development of this
Page 223 and 224: A B Fig. 4.09 Spermatocytic seminom
Page 225 and 226: A B Fig. 4.14 Intratubular germ cel
Page 227 and 228: A B Fig. 4.19 Seminoma. A Typical s
Page 229 and 230: Fig. 4.24 Seminoma. Vascular invasi
Page 231: Fig. 4.28 Spermatocytic seminoma wi
Page 235 and 236: A B Fig. 4.38 Yolk sac tumour. A En
Page 237 and 238: have cytoplasmic lacunae that conta
Page 239 and 240: A Fig. 4.46 Teratoma. A Longitudina
Page 241 and 242: A B Fig. 4.51 A Cut surface of derm
Page 243 and 244: Fig. 4.54 Mixed germ cell tumour. L
Page 245 and 246: Sex cord / gonadal stromal tumours
Page 247 and 248: A B C Fig. 4.67 Malignant Leydig ce
Page 249 and 250: A Fig. 4.73 A Sertoli cell tumour.
Page 251 and 252: ICD-O codes Granulosa cell tumour 8
Page 253 and 254: ICD-O code 8592/1 Clinical features
Page 255 and 256: A B Fig. 4.83 Germ cell-sex cord/go
Page 257 and 258: A Fig. 4.85 A, B Brenner tumour of
Page 259 and 260: typical grade III follicular morpho
Page 261 and 262: testicular parenchyma and tumour te
Page 263 and 264: A B the surgical scar and adjacent
Page 265 and 266: Immunoprofile Ordóñez and associa
Page 267 and 268: often have a grey-white cut surface
Page 269 and 270: Fig. 4.111 Angiomyofibroblastoma-li
Page 271 and 272: A B Fig. 4.119 Embryonal rhabdomyos
Page 273 and 274: Table 4.05 Secondary tumours of the
Page 275 and 276: WHO histological classification of
Page 277 and 278: A Fig. 5.04 A, B Squamous cell carc
Page 279 and 280: deformed by an exophytic mass. In s
Page 281 and 282: A B C Fig. 5.12 A Warty (condylomat
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A Fig. 5.20 Bowenoid papulosis. A,
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three had been circumcized by 9 yea
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Mesenchymal tumours J.F. Fetsch M.
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Fig. 5.31 Neurofibroma of the penis
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oectodermal tumour/Ewing sarcoma [p
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Secondary tumours of the penis C.J.
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Dr John N. EBLE* Dept. of Pathology
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Dr Ricardo PANIAGUA Department of C
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Source of charts and photographs 1.
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References 1. Anon. (1955). Case re
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115. Ariel I, Sughayer M, Fellig Y,
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246. Birt AR, Hogg GR, Dube WJ (197
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374. Cardone G, Malventi M, Roffi M
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502. Corti B, Carella R, Gabusi E,
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633. Donhuijsen K, Schmidt U, Richt
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768. Fischer J, Palmedo G, von Knob
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900. Goedert JJ, Cote TR, Virgo P,
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1028. Hartmann A, Dietmaier W, Hofs
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1162. Iezzoni JC, Fechner RE, Wong
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1293. Keetch DW, Catalona WJ (1995)
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1424. Ladanyi M, Lui MY, Antonescu
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1548. Lopez-Beltran A, Croghan GA,
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2693. van Echten J, Timmer A, van d
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2816. Wick MR, Berg LC, Hertz MI (1
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2937. Zhuang Z, Park WS, Pack S, Sc
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CCNB, 226 CCND1, 105, 108 CCND2, 22
Page 351 and 352:
J Juvenile type granulosa cell tumo
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Promoter methylation, 21 Prostate s
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Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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