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

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Fig. 4.115 Leiomyosarcoma. Coronal, T2-weighted, MR image shows a large heterogeneous mass filling the left hemiscrotum and extending into the inguinal canal. It is displacing the base of the penis to the right (black arrow). A normal testis is seen within the right hemiscrotum (arrow). Fig. 4.116 Leiomyosarcoma of spermatic cord shows intersecting fascicles composed of atypical smooth muscle cells with blunt ended nuclei. Imaging Liposarcomas generally present as large extratesticular masses, which are often hyperechoic by ultrasound. However, the sonographic appearance of these tumours is variable and nonspecific. CT and MR imaging are much more specific with fat being easily recognized with both modalities {372,801}. By CT, fat will appear very low density similar to subcutaneous fat. On MR imaging the fat in a liposarcoma will follow the signal intensity of surrounding fat on all imaging sequences. Additionally a fat suppressed imaging sequence should be performed for confirmation. Fat will lose signal intensity (i.e. turn dark) on this sequence. Benign lipomas and hernias containing omentum are potential mimics, but lipomas are generally smaller and more homogeneous, and hernias are elongated masses, which can often be traced back to the inguinal canal. With the exception of liposarcoma, none of the other sarcomas can be differentiated from one another radiologically. They all tend to be large, complex, solid masses {372}. Because of their large size, their extent is better demonstrated by CT and MR imaging rather than ultrasound. Histopathology Haemangiomas are classified according to the vessel type. Capillary and cavernous haemangiomas are most common within the scrotum, whereas angiokeratoma is the most common cutaneous vascular lesion {2578}. The latter features a superficial, dilated blood filled spaces initially associated with the epidermis, showing varying degrees of hyperkeratosis. Fibrous hamartoma of infancy is a subcutaneous lesion composed of streaks of fibroblasts, mature fat, and spherical clusters of primitive mesenchymal cells {2096}. Calcifying fibrous (pseudo)tumour is a densely collagenous, paucicellullar fibroblastic tumefaction that typically contains scattered psammomatous calcifications and a patchy lymphoplasmacytic infiltration. Granular cell tumours of the scrotum may be multifocal and are similar to those elsewhere in the skin. Leiomyomas are composed of mature smooth muscle cells. Larger tumours often have hyalinization, myxoid change and calcification. Some of these tumours arise from the tunica dartos {1886,2406}. Focal nuclear atypia may occur, but the presence of prominent atypia should lead to a careful search for mitotic activity or coagulation necrosis which are features of leiomyosarcoma. Leiomyosarcomas are typically composed of spindled cells with often elongated, blunt ended nuclei and variably eosinophilic, sometimes clumpy cytoplasm. Areas with round cell or pleomorphic morphology may Fig. 4.117 Paratesticular rhabdomyosarcoma. occur. The level of mitotic activity varies widely, but is often low. Male angiomyofibroblastoma-like tumour is grossly circumscribed, lobulated soft to rubbery mass. Distinctive at low magnification are prominent, large vessels with perivascular fibrinoid deposition or hyalinization. The tumour cells between the vessels are tapered spindled cells with limited atypia, separated by fine collagen fibers. Focal epithelioid change is present in some cases. Nuclear palisading may occur, and a fatty component may be present; the latter has raised a question whether these tumours are fatty related neoplasms. Mitotic activity is very low. The tumour cells are immunohistochemically variably positive for desmin, muscle actins, CD34 and estrogen and progesterone receptors. This tumour is probably analogous to cellular angiofibroma as reported in females. Although some similarities with angiomyofibroblastoma of female genitalia have also been noted, these two processes are not considered synonymous {1442}. Aggressive angiomyxoma, a tumour that typically occurs in women, has been reported in men {1162,2649}. Our review of potential male cases in the AFIP files did not reveal any diagnostic examples of this entity. It seems likely that many tumours originally reported as male aggressive angiomyxomas, in fact, represent other entities, such as the male angiomyofibroblastoma-like tumour. Great majority of liposarcomas are well differentiated with various combinations of lipoma-like and sclerosing patterns. Presence of significant nuclear atypia in adipocytes is decisive. Multivacuolated lipoblasts may be present, but are not required for diagnosis. Dedifferentiation to spindle cell “fibrosarcoma-like” or pleomorphic “MFH-like” phenotype occurs in a proportion of paratesticular liposarco- Fig. 4.118 Embryonal rhabdomyosarcoma. Typical nuclear positivity for MyoD1. Tumours of paratesticular structures 275
A B Fig. 4.119 Embryonal rhabdomyosarcoma. A Embryonal rhabdomyosarcoma can have a well differentiated pattern with abundant rhabdomyoblasts. B Embryonal rhabdomyosarcoma may be composed of primitive, hyperchromatic oval cells. mas {1076}. The dedifferentiation may occur at the inception or in a recurrent tumour. This component can give rise to metastases. Some liposarcomas of the scrotum can have smooth muscle elements; these have been designated as combined lipoleiomyosarcomas {2539}. Malignant fibrous histiocytoma and fibrosarcoma are diagnoses by exclusion. The former is a pleomorphic fibroblasticmyofibroblastic sarcoma, and the latter has a more uniform spindle cell pattern. The majority of paratesticular rhabdomyosarcomas are of the embryonal type, but a small percentage (10-15%) have been classified as the alveolar type in the largest clinicopathological series {753,1283,1563,2146}. A typical example of embryonal rhabdomyosarcoma contains large number of primitive round to oval cells and smaller numbers of differentiating rhabdomyoblasts with eosinophilic cytoplasm and possible cytoplasmic cross striations. However, the number of differentiating rhabdomyoblasts varies widely. Myxoid matrix is often present. A rare variant of embryonal rhabdomyosarcoma is composed of predominantly spindled cells, with some resemblance to smooth muscle cells. This type has been referred to as spindle cell or leiomyosarcoma-like rhabdomyosarcoma {1483}. Although cytoplasmic cross striations may be noted, especially in the spindle cell rhabdomyosarcoma, they are not required for the diagnosis. Diagnostic confirmation should be obtained by immunohistochemistry. Virtually all RMS are positive for desmin and muscle actins (HHF35), and most have nuclear positivity for myogenic regulatory proteins, MyoD1 and myogenin (the latter demonstrated with Myf4 antibody). Cytoplasmic positivity for MyoD1 occurs in various tumours and has no diagnostic significance. Post chemotherapy specimens can show extensive rhabdomyoblastic differentiation. 276 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
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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
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A B Fig. 3.74 A Inflammation withou
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Squamous neoplasms T.H. Van der Kwa
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Neuroendocrine tumours P.A. di Sant
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Mesenchymal tumours J. Cheville F.
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Fig. 3.89 Sarcoma of the prostate.
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Miscellaneous tumours P.H. Tan L. C
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A Fig. 3.96 A Adenocarcinoma of the
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WHO histological classification of
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Introduction F.K. Mostofi I.A. Sest
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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 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: Fig. 4.111 Angiomyofibroblastoma-li
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
Page 303 and 304: 115. Ariel I, Sughayer M, Fellig Y,
Page 305 and 306: 246. Birt AR, Hogg GR, Dube WJ (197
Page 307 and 308: 374. Cardone G, Malventi M, Roffi M
Page 309 and 310: 502. Corti B, Carella R, Gabusi E,
Page 311 and 312: 633. Donhuijsen K, Schmidt U, Richt
Page 313 and 314: 768. Fischer J, Palmedo G, von Knob
Page 315 and 316: 900. Goedert JJ, Cote TR, Virgo P,
Page 317 and 318: 1028. Hartmann A, Dietmaier W, Hofs
Page 319 and 320: 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
Page 353 and 354:
Promoter methylation, 21 Prostate s
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