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

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Teratoma Teratomas are generally well circumscribed complex masses. Cartilage, calcification, fibrosis, and scar formation result in echogenic foci, which result in variable degrees of shadowing. Cyst formation is commonly seen in teratomas and the demonstration of a predominately cystic mass suggests that it is either a teratoma or a mixed germ cell tumour with a large component of teratoma within it. Fig. 4.45 Cystic trophoblastic tumour. The cyst is lined by relatively inactive appearing mononucleated trophoblastic cells. mononucleated trophoblastic cells with abundant eosinophilic cytoplasm. The nuclei often have smudged chromatin; mitotic figures are infrequent. Focal reactivity for hCG is found {427}. Teratomas Definition A tumour composed of several types of tissue representing different germinal layers (endoderm, mesoderm and ectoderm). They may be composed exclusively of well differentiated, mature tissues or have immature, fetal-like tissues. It has been recommended to consider these morphologies as a single entity based on genetics. Teratomas in children and the dermoid cyst are benign. Tumours consisting of ectoderm, mesoderm, or endoderm only are classified as monodermal teratomas e.g. struma testis. A single type of differentiated tissue associated with seminoma, embryonal carcinoma, yolk sac tumour or choriocarcinoma is classified as teratomatous component. Teratoma may contain syncytiotrophoblastic giant cells. ICD-O codes Teratoma 9080/3 Dermoid cyst 9084/0 Monodermal teratoma Teratoma with somatic type malignancies 9084/3 Synonyms Mature teratoma, immature teratoma, teratoma differentiated (mature), teratoma differentiated (immature). Epidemiology Teratoma occurs in two age groups. In adults, the frequency of pure teratoma ranges from 2.7-7% {804,1807} and 47- 50% in mixed TGCTs {172,2753}. In children, the incidence is between 24-36% {326,2366}. A number of congenital abnormalities, predominantly of the GU tract have been observed {883,2664}. In the prepubertal testis, the presence of IGCNU is not proven, because the markers used are not specific at this period of life for IGCNU {1617,2264,2482}. Clinical features Signs and symptoms In children, 65% of teratomas occur in the 1st and 2nd year of life with a mean age of 20 months. In postpubertal patients, most are seen in young adults. Symptoms consist of swelling or are due to metastases. Occasionally, serum levels of AFP and hCG may be elevated in adult patients {1211}. Most patients present with a mass that is usually firm, irregular or nodular, nontender and does not transilluminate. Approximately 2-3% of prepubertal testis tumours may be associated with or misdiagnosed as a hydrocele, particularly if the tumour contains a cystic component. Since neither of these tumours is hormonally active, precocious puberty is not seen. Serum alpha-fetoprotein (AFP) levels are helpful in the differentiation of teratomas from yolk sac tumours {924,2264}. Imaging Epidermoid cyst The distinctive laminated morphology is reflected in ultrasound images. They are sharply marginated, round to slightly oval masses. The capsule of the lesion is well defined and is sometimes calcified. The mass may be hypoechoic but the laminations often give rise to an “onion-skin” or “target” appearance {813,2377}. Teratomas and other malignant tumours may have a similar appearance and great care should be taken in evaluating the mass for any irregular borders, which would suggest a malignant lesion {671,813}. Macroscopy The tumours are nodular and firm. The cut surfaces are heterogeneous with solid and cystic areas corresponding to the tissue types present histologically. Cartilage, bone and pigmented areas may be recognizable. Tumour spread Metastatic spread from teratomas in prepubertal children is not reported {326, 330,2805}. Conversely, similar tumours found after puberty are known to metastasize. Histopathology The well differentiated, mature tissue types consist of keratinizing and nonkeratinizing squamous epithelium, neural and glandular tissues. Organoid structures are not uncommon, particularly in children such as skin, respiratory, gastrointestinal and genitourinary tract. Thyroid tissue has rarely been observed {2792}. Of the mesodermal components, muscular tissue is the most common {548}. Virtually any other tissue type can be seen. Fetal type tissue may also consist of ectodermal, endodermal and/or mesenchymal tissues. They can have an organoid arrangement resembling primitive renal or pulmonary tissues. It can be difficult to differentiate fetal-type tissues from teratoma with somatic type malig- Germ cell tumours 243
A Fig. 4.46 Teratoma. A Longitudinal ultrasound image of the left testis (cursors) shows the normal parenchyma being replaced by complex, multiseptated, cystic mass. B Gross specimen confirms the cystic nature of the mass. A Fig. 4.47 Epidermoid cyst. A Transverse ultrasound image through the lower pole of the testis shows a well marginated, hypoechoic, oval mass (arrow). Multiple concentric rings are visualized giving an "onion-skin" appearance. B Epidermoid cyst within the stroma of the testis. Note the laminated structure. nancies. Some have classified foci indistinguishable from primitive neuroectodermal tumours as malignant irrespective of size {1797} whereas others recognize a nodule equal to or greater than a (4x objective) microscopic field as PNET {1722}. Monodermal teratomas have been described as struma testis {2427}, pure cartilagenous teratoma {2427}, and possibly epidermal (epidermoid) cyst. Teratoma can show invasion of paratesticular tissue and intra and extratesticular vascular invasion. B B Immunoprofile The differentiated elements express the immunophenotype expected for that specific cell type. Alpha-fetoprotein production occurs in about 19-36% of teratomas in intestinal and hepatoid areas {1196,1198,1807}. Other markers include alpha-1 antitrypsin, CEA and ferritin {1198}. hCG can be seen in syncytiotrophoblastic cells. PLAP is also demonstrable in glandular structures {346,1615, 1807,2658}. Genetics Teratomas of the infantile testis are diploid {1350,2413}. Karyotyping, as well as CGH, even after microdissection of the tumour cells, has failed to demonstrate chromosomal changes in these tumours [{1792,2054} for review]. It remains to be shown whether the recently identified constitutional translocation between chromosome 12 and 15 as found in a family with a predisposition to sacral teratoma at young age {2724} is involved in the genesis of this type of tumour. In contrast to the diploidy of teratomas of neonates and infants, teratoma is hypotriploid in adult patients {1763,1963,2209}. In fact, teratomas as part of TGCTs have similar genetic changes compared to other components. In addition, the fully differentiated tumour cells found in residual teratomas as a remainder after chemotherapy of a non-seminoma of adults, are hypotriploid {1542}. Prognosis The behaviour of teratoma in the two different age groups is strikingly different. In the prepubertal testis, teratoma is benign {2264}. In the postpubertal testis, despite appearance, teratoma shows metastases in 22-37% of cases. Teratoma shows mostly synchronous metastases; in 13% of cases, it is metachronous {1806}. If it is associated with a scar (burned out component), the metastatic frequency is 66%. In a series from Indiana, 37% of 41 adult patients with pure teratoma showed synchronous metastases {1471}. Teratoma may metastasize as such {793,1204,1966, 2128,2509}, or in some instances precursor cells may invade vascular spaces and differentiate at the metastatic site {1800}. The cellular composition of metastases may differ from that of the respective primary tumour {548}. Dermoid cyst Definition A mature teratoma with a predominance of one or more cysts lined by keratinizing squamous epithelium with skin appendages, with or without small areas of other teratomatous elements. Epidermoid cysts lack skin appendages. ICD-O code 9084/0 A Fig. 4.48 A Teratoma. B Teratoma. Carcinoid tumour within the testis. B Testicular dermoid cyst is a specialized, benign form of cystic teratoma that is analogous to the common ovarian tumour {2670}. It is rare, with less than 20 cases reported {126,324,349,629,976, 1392,1609,2670}. Most have been in young men who presented with testicular masses, but an occasional example has 244 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
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Fig. 3.48 Heat map-nature. From S.M
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Fig. 3.51 Prostate cancer. Major su
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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 and 232: Fig. 4.28 Spermatocytic seminoma wi
Page 233 and 234: A B Fig. 4.33 Embryonal carcinoma.
Page 235 and 236: A B Fig. 4.38 Yolk sac tumour. A En
Page 237: have cytoplasmic lacunae that conta
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
Page 283 and 284: A Fig. 5.20 Bowenoid papulosis. A,
Page 285 and 286: three had been circumcized by 9 yea
Page 287 and 288: 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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1681. McLaughlin JK, Silverman DT,
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2070. Phillips G, Kumari-Subaiya S,
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2327. Schmidt L, Junker K, Weirich
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2450. Smith G, Elton RA, Beynon LL,
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2572. Tamboli P, Mohsin SK, Hailema
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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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