CHAPTER X CHAPTER 4 - Cancer et environnement

More documents

Recommendations

Info

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
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
Page 1 and 2: CHAPTER 4X Tumours of the of the Te
Page 3 and 4: TNM classification of germ cell tum
Page 5 and 6: Germ cell tumours P.J. Woodward A.
Page 7 and 8: senting symptom: back or abdominal
Page 9 and 10: A B Fig. 4.03 Germ cell tumours gen
Page 11 and 12: process at all {1524}. In addition,
Page 13 and 14: A B Fig. 4.12 Comparison of morphol
Page 15 and 16: small tumour insufficient to produc
Page 17 and 18: A B C Fig. 4.22 Seminoma. A Pseudog
Page 19 and 20: A B Fig. 4.27 Spermatocytic seminom
Page 21 and 22: Differential diagnoses Differential
Page 23 and 24: Histologic patterns Microcystic or
Page 25 and 26: A Fig. 4.40 Yolk sac tumour. A Pleo
Page 27 and 28: Teratoma Teratomas are generally we
Page 29: A B C Fig. 4.49 Teratoma. A Teratom
Page 33 and 34: A B Fig. 4.59 Mixed germ cell tumou
Page 35 and 36: A B C Fig. 4.64 Leydig cell tumour.
Page 37 and 38: A Fig. 4.69 Androgen insensitivity
Page 39 and 40: tinguished from Sertoli cell nodule
Page 41 and 42: ound and have spherical, regularly
Page 43 and 44: Tumours containing both germ cell a
Page 45 and 46: Miscellaneous tumours of the testis
Page 47 and 48: Lymphoma and plasmacytoma of the te
Page 49 and 50: Tumours of collecting ducts and ret
Page 51 and 52: Tumours of paratesticular structure
Page 53 and 54: Epidemiology Nodular mesothelial hy
Page 55 and 56: A B Fig. 4.104 Papillary cystadenom
Page 57 and 58: Fig. 4.109 Desmoplastic small round
Page 59 and 60: Fig. 4.115 Leiomyosarcoma. Coronal,
Page 61 and 62: Secondary tumours C.J. Davis Defini

CHAPTER X CHAPTER 4 - Cancer et environnement

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?