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

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tinguished from Sertoli cell nodules, and Leydig cell tumours, and rete adenomas. Sertoli cell nodules, however, are small, incidentally discovered, non neoplastic lesions composed of aggregates of small tubules lined by immature Sertoli cells and contain prominent basement membrane deposits. The rete adenomas occur within the dilated lumens of the rete testis. Prognosis Most Sertoli cell tumours are benign. Malignant Sertoli cell tumour ICD-O code 8640/3 Epidemiology Malignant Sertoli cell tumour not otherwise specified is rare {1194}. Less than 50 cases have been reported. Age distribution does not differ from that of the benign form, occurring from childhood to old age. Clinical features Some patients present with metastases; most commonly to inguinal, retroperitoneal and/or supraclavicular lymph nodes. Approximately one third has gynecomastia at presentation, but apart from that no specific lesions or syndrome are known to be associated with malignant Sertoli cell tumour. Macroscopy They tend to be larger than the benign counterparts {2894}, usually more than 5 cm but range 2 to 18 cm. The macroscopic appearance may differ from that of the benign tumour by necrosis and haemorrhage. Histopathology Microscopically, the cellular features and Fig. 4.75 Sclerosing type of Sertoli cell tumour. growth patterns are similar to those of the benign counterpart but tend to be more variable within the same tumour and between tumours. The solid, sheet-like growth pattern is often prominent. The nuclei may be pleomorphic with one or more nucleoli, which are usually not very prominent. Mitotic figures may be numerous, and necrosis may occur. A fibrous, hyalinized or myxoid stroma occurs in varying amounts, but is usually sparse. Lymphovascular invasion may be seen. Lymphoplasmacytic infiltration is reported in some cases varying from sparse to pronounced and even with secondary germinal centres. The most important differential diagnoses are classical and spermatocytic seminoma and variants of yolk sac tumour, however granulomatous reactions and intratubular germ cell neoplasia are not present in the surrounding testicular parenchyma. Endometrioid adenocarcinoma and metastases, and among the latter especially adenocarcinomas with pale or clear cytoplasm, as well as melanoma should also be considered. Immunohistochemical staining is helpful in defining the Sertoli cell nature of the tumour but not its malignant potential {1074,1194}. The tumour cells are cytokeratin and vimentin positive and they may also be positive for epithelial membrane antigen. They stain for inhibin A, but usually not very intensely, and they may be S100 positive. They are PLAP and CEA negative. Granulosa cell tumour group Definition Granulosa cell tumours of the testis are morphologically similar to their ovarian counterparts. Two variants are distinguished: adult and juvenile types. Fig. 4.76 Malignant Sertoli cell tumour. A Fig. 4.77 Malignant Sertoli cell tumour. A Solid and tubular components. B Vimentin staining in the tubular component. B Sex cord / gonadal stromal tumours 255
ICD-O codes Granulosa cell tumour 8620/1 Adult type granulosa cell tumour 8620/1 Juvenile type granulosa cell tumour 8622/1 Adult type granulosa cell tumour Incidence and clinical features This tumour is rare {1,477,1443,1705,1 812,2567}, grows slowly and only two dozen cases have been reported {1901}. Some are incidental. About 25% of patients have gynecomastia. The average age at presentation is 44 years (range, 16- 76 years). Patients have elevated serum levels of both inhibin, as occurs in other sex cord-stromal tumours {1781}, and Müllerian-inhibiting hormone, as occurs in similar ovarian tumours {1433}. Macroscopy These tumours are circumscribed, sometimes encapsulated, have a firm consistency and vary from yellow to beige. They vary from microscopic to 13 cm in diameter. The tumour surface may show cysts from 1-3 mm in diameter. Necrosis or haemorrhage are unusual. Histopathology Several patterns occur: macrofollicular, microfollicular, insular, trabecular, gyriform, solid and pseudosarcomatous. The microfollicular pattern is the most frequent. Microfollicles consist of palisading cells, which surround an eosinophilic material (Call-Exner bodies). Tumour cells are round to ovoid with grooved nuclei (coffee-bean nuclei) with one to two large peripheral nucleoli. Cellular pleomorphism and mitotic figures are infrequent, except for those areas showing fusiform cell pattern. The tumour may intermingle with seminiferous tubules and infiltrate the tunica albuginea. Some show focal theca cell differentiation, or have smooth muscle or osteoid {46}. Tumour cells are immunoreactive for vimentin, smooth muscle actin, inhibin, MIC2 (013-Ewing sarcoma marker), and focally cytokeratins. Fig. 4.78 Granulosa cell tumour, adult type. Juvenile type granulosa cell tumour This tumour is multicystic and its structure resembles that of Graafian follicles. Although it is rare, it is the most frequent congenital testicular neoplasm {1022, 2528}, comprising 6.6% of all prepubertal testicular tumours {1275}. Clinical features The tumour presents as a scrotal or abdominal asymptomatic mass, preferentially located in the left testis {1896}. It involves an abdominal testis in about 30% of cases. The contralateral testis is often undescended too. Most of the tumours are observed in the perinatal period, and presentation after the first year of life is exceptional. External genitalia are ambiguous in 20% and the most frequent associated anomaly is mixed gonadal dysgenesis, followed by hypospadias. In all cases with ambiguous genitalia the karyotype is abnormal: 45X / 46XY mosaicism or structural anomalies of Y chromosome. Neither recurrences nor metastases have been observed {400,2092,2136,2576,2895}. Neither gynecomastia nor endocrine disorders appeared associated. Macroscopy These tumours are usually cystic, with solid areas and partially encapsulated. The tumour size varies from 0.8 to 5 cm in size {1453}. Haemorrhage secondary to a torsion or trauma may make diagnosis difficult {407}. Histopathology Cysts are lined by several cell layers, depending on the degree of cystic dilation. The inner cells are similar to granulosa cells, while the outer cells resemble theca cells. Granulosa-like cells are Prognosis The tumour metastasizes in 20% or more of patients, even several years after the presentation {1223,1647}. Fig. 4.79 Juvenile granulosa cell tumour. Note prominent cysts. 256 Tumours of the testis and paratesticular
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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
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A B Fig. 3.63 A Micropapillary high
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A B Fig. 3.68 A Ductal carcinoma in
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Ductal adenocarcinoma X.J. Yang L.
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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 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: A Fig. 4.73 A Sertoli cell tumour.
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
Page 293 and 294: Secondary tumours of the penis C.J.
Page 295 and 296: Dr John N. EBLE* Dept. of Pathology
Page 297 and 298: Dr Ricardo PANIAGUA Department of C
Page 299 and 300: Source of charts and photographs 1.
Page 301 and 302:
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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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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Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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