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

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A B Fig. 4.52 Teratoma with somatic type malignancies. A Adenocarcinoma in patient with testicular GCT. Goblet cells and glands are present in desmoplastic stroma. B Rhabdomyosarcoma in a GCT patient. Cells with abundant eosinophilic cytoplasm are rhabdomyoblasts. A B Fig. 4.53 Teratoma with somatic type malignancies. A Neuroendocrine carcinoma arising in a GCT patient. The tumour displays an organoid pattern with mitoses. B PNET in a GCT patient. The tumour is composed of small round blue cells with rosettes. Histopathology The various types of germ cell tumour can occur in any combination and their appearances are identical to those occurring in pure form. The diagnosis should include all components that are present and the quantity of each should be estimated. While the basic germ cell tumour types are infrequent in pure forms they are very frequent in the mixed forms. Embryonal carcinoma and teratoma are each present in 47% of cases and yolk sac tumours in 41%. The latter is frequently overlooked {2367}. 40% of mixed germ cell tumours contain varying numbers of syncytiotrophoblastic cells {1796}. The most common combination, in one series, was teratoma and embryonal carcinoma {1195} and in another, the combination of embryonal carcinoma, yolk sac tumour, teratoma and syncytiotrophoblastic cells {1796}. Polyembryoma, {730, 1868} a rare germ cell tumour composed predominantly of embryoid bodies, is considered by some as a unique germ cell tumour and is listed under one histologic type {1805}. However, the individual components consisting of embryonal carcinoma, yolk sac tumour, syncytiotrophoblastic cells and teratoma, suggest that these should be regarded as mixed germ cell tumours with a unique growth pattern. The histology of the metastases reflects that of the primary tumour in about 88% of cases. In embryonal carcinoma, teratoma and yolk sac tumour the metastases are identical to the primaries in 95, 90 and 83% of these tumours, respectively {2367}. Treatment effect Radiation and chemotherapy may produce the following histologic changes. 1) Necrosis is often associated with ghostlike necrotic tumour cells surrounded by a xanthogranulomatous response. 2) Fibrosis may show cellular pleomorphism. 3) Residual teratoma is often cystic and may show reactive cellular pleomorphism or frank malignant change with or without selective overgrowth. 4) Viable tumour may show loss of marker production e.g. AFP or hCG {1797,2663}. Burned out germ cell tumour Occasionally, germ cell tumours of the testis, particularly choriocarcinoma {1556,2252} can completely or partially undergo necrosis and regress {20,144, 145,350,556} leaving a homogeneous scar. The scar is frequently associated with haematoxylin staining bodies that contain not only calcium but also DNA {144}. The scar can be associated with intratubular malignant germ cells or residual viable tumour such as teratoma Germ cell tumours 247
Fig. 4.54 Mixed germ cell tumour. Longitudinal ultrasound image of the testis shows a large, heterogeneous mass (arrows) with cystic areas (arrowheads). There is a small amount of normal parenchyma remaining posteriorly (asterisk). {262,556,2664}. The metastases often differ from the residual viable tumour in the testis {167}. Immunoprofile Most tumours show immunoreactivity for AFP in the yolk sac elements, teratomatous glands and hepatoid cells. There is a strong correlation between elevated serum levels of AFP and the presence of YST {1807,1917}. Syncytiotrophoblastic cells either singly or in association with foci of choriocarcinoma are positive for Fig. 4.55 Mixed germ cell tumour. Gross specimen showing a tumour with cystic areas. hCG and other placental glycoproteins (pregnancy specific ß 1 glycoprotein, human placental lactogen and placental alkaline phosphatase). Genetics A vast amount of knowledge has been accumulated concerning the genetic features of mixed germ cell tumours; it is discussed in the genetic overview to germ cell tumours, earlier in this chapter. Prognosis Clinical criteria Mixed germ cell tumours containing large areas of seminoma appear to respond Fig. 4.56 Teratoma and choriocarcinoma (trophoblastic teratoma). better to treatment than those with no or only microscopic foci of seminoma. Morphologic criteria Vascular/lymphatic invasion in the primary tumour is predictive of nodal metastasis and relapse {802,823,1087, 2367}. The presence and percent of embryonal carcinoma in the primary tumour is also predictive of stage II disease {278,802,823,1817,2249}. In contrast, the presence of teratoma and yolk sac tumour is associated with a lower incidence of metastases following orchiectomy in clinical stage I disease {311,802,823,848,1817,2834}. A B A C Fig. 4.57 A Mixed teratoma and embryonal carcinoma. Note seperation of two components: teratoma (left) and embryonal carcinoma (right). B Embryonal carcinoma, yolk sac tumour, syncytiotrophoblasts. C Mixed seminoma and embryonal carcinoma. D Mixed seminoma and embryonal carcinoma. CD30 immunoreactivity on the right. D B Fig. 4.58 A,B Mixed germ cell tumour: teratoma and yolk sac tumour. 248 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
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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 and 240: A Fig. 4.46 Teratoma. A Longitudina
Page 241: A B Fig. 4.51 A Cut surface of derm
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
Page 291 and 292: 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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2070. Phillips G, Kumari-Subaiya S,
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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
Page 353 and 354:
Promoter methylation, 21 Prostate s
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