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

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A B C Fig. 4.49 Teratoma. A Teratoma with various types of mature tissue. B Teratoma with various types of immature tissue. C Teratoma with scar formation. D Carcinoid tumour within teratoma. D Fig. 4.50 Teratoma with vascular invasion. occurred in a child. On gross examination a single cyst is usually seen, and it may contain hair and “cheesy”, keratinous material. On microscopic examination a keratin filled cyst is lined by stratified squamous epithelium with associated pilosebaceous units as normally seen in the skin. A surrounding fibrous wall may also contain sweat glands, glands having ciliated or goblet cell containing epithelium, bundles of smooth muscle, bone, cartilage, thyroid, fat, intestinal tissue, gastric epithelium, salivary gland and pancreatic tissue, all having bland cytological features. The seminiferous tubules usually have normal spermatogenesis and always lack intratubular germ cell neoplasia. Many examples also have an associated lipogranulomatous reaction in the parenchyma. Patients are well on follow-up. Monodermal teratomas Definition A tumour that consists of only one of the three germ layers (endo-, ecto- or mesoderm.) Primitive neuroectodermal tumour has been described {38,1903,1909,2904} either in pure form or as a component of a mixed germ cell tumour. The histology is similar to that in other sites. Only PNET occurring in the metastasis is associated with a poor prognosis {1722}. Pure cartilaginous teratoma has been described {2427}. Epidermoid cysts have been considered as a tumour like lesion. However, recently we have encountered an epidermal cyst with diffuse intratubular malignant germ cells indicating that some may be teratomatous. Teratoma with somatic-type malignancies Definition A teratoma containing a malignant component of a type typically encountered in other organs and tissues, e.g. sarcomas and carcinomas. ICD-O code 9084/3 Clinical features Nongerm cell malignant tumours may arise in primary or metastatic germ cell tumours (GCTs) and are most likely derived from teratomas {1720}. They are seen in 3-6% of patients with metastatic GCTs {484}. Germ cell tumours 245
A B Fig. 4.51 A Cut surface of dermoid cyst, spermatic cord on the right. B Dermoid cyst with a stratified squamous epithelial lining and pilosebaceous units and smooth muscle bundles in its wall. C Epidermoid cyst with laminated keratin in the lumen and at the periphery atrophic seminiferus tubule without intratubuler germ cell neoplasia. C Histopathology Nongerm cell malignant tumours are characterized by an invasive or solid (expansile) proliferation of highly atypical somatic cells that overgrow the surrounding GCT. How much expansile growth is required has not been clearly defined, but some authors have suggested that the tumour should fill a 4X field of view {2668}. Care must be taken not to confuse chemotherapy induced atypia with the development of a secondary malignancy. The most common type of somatic type malignancy seen in patients with testicular GCTs is sarcoma {39,40,484,998,1334,1720,1815,2200, 2597,2665,2666}. About half are undifferentiated sarcomas and most of the remainder display striated or smooth muscle differentiation. Any type of sarcoma may occur in germ cell tumours, including chondrosarcoma, osteosarcoma, malignant fibrous histiocytoma and malignant nerve sheath tumours. Primitive neuroectodermal tumours (PNETs) have been increasingly recognized {38,1282,1722,1763,1815,1909, 2363}; they may resemble neuroblastoma, medulloepithelioma, peripheral neuroepithelioma or ependymoblastoma. Most are cytokeratin-positive and stain with synaptophysin and Leu 7. One third is chromogranin-positive. Tumours may also stain with antibodies to S-100 protein, GFAP and HBA.71. Nephroblastoma like teratomas are rare in the testis {881}, but are more common in metastases {1721}. Carcinomas are less often associated with GCTs. Adenocarcinomas, squamous carcinomas and neuroendocrine carcinomas have all been reported {40, 484,1723,1815,2665}. These tumours stain for cytokeratins, EMA and sometimes CEA. Stains for PLAP, AFP and HCG are negative. Somatic genetics In several cases, the nongerm cell tumour has demonstrated the i(12p) chromosomal abnormality associated with GCTs; some have demonstrated chromosomal rearrangements characteristic of the somatic tumour in conventional locations {1815}. Prognosis If the malignant tumour is limited to the testis, the prognosis is not affected {40,1815}. In metastatic sites, the somatic type malignancies have a poor prognosis {1525,1815}. They do not respond to germ cell tumour chemotherapy; surgical resection is the treatment of choice. Therapy designed for the specific type of somatic neoplasm may also be helpful. Tumours of more than one histological type (mixed forms) Definition This category includes germ cell tumours composed of two or more types. ICD-O codes Tumours of more than one histological type (mixed forms) 9085/3 Others Polyembryoma 9072/3 Synonyms Malignant teratoma intermediate includes only teratoma and embryonal carcinoma, combined tumour is synonymous for seminoma and any other cell type and malignant teratoma trophoblastic for choriocarcinoma and non-seminomatous germ cell tumour types. Incidence Excluding seminoma with syncytiotrophoblastic cells and spermatocytic seminoma with sarcoma, the frequency of mixed germ cell tumours has been reported between 32-54% of all germ cell tumours {1195,1807}. Clinical features Signs and symptoms The age range of these tumours depends on whether or not they contain seminoma. With seminoma, the age is intermediate between that of seminoma and pure non-seminoma; without seminoma, the age is the same as pure nonseminoma. Mixed germ cell tumours are rarely seen in prepubertal children. Patients present with painless or painful testicular swelling. Signs of metastatic disease include abdominal mass, gastrointestinal tract disturbances or pulmonary discomfort. Serum elevations of AFP and hCG are common {2265}. Macroscopy The enlarged testis shows a heterogeneous cut surface with solid areas, haemorrhage and necrosis. Cystic spaces indicate teratomatous elements. Tumour spread The tumours follow the usual route through retroperitoneal lymph nodes to visceral organs. Those with foci of choriocarcinoma or numerous syncytiotrophoblastic cells tend to involve liver and/or brain. 246 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
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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 and 238: have cytoplasmic lacunae that conta
Page 239: A Fig. 4.46 Teratoma. A Longitudina
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.
Page 289 and 290: 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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1816. Moudouni SM, En-Nia I, Rioux-
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1945. Ohori M, Wheeler TM, Kattan M
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2070. Phillips G, Kumari-Subaiya S,
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2199. Riou G, Barrois M, Prost S, T
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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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