CHAPTER X CHAPTER 4 - Cancer et environnement

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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
A B Fig. 4.59 Mixed germ cell tumours. A Embryonal carcinoma and yolk sac tumour. B Embryonal carcinoma, yolk sac tumour and syncytiotrophoblasts. A B Fig. 4.60 Mixed germ cell tumour. A Seminoma intimately admixed with teratoma. B Polyembryoma. Germ cell tumours 249
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 and 30: A B C Fig. 4.49 Teratoma. A Teratom
Page 31: A B Fig. 4.52 Teratoma with somatic
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

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