CHAPTER X CHAPTER 4 - Cancer et environnement

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A B Fig. 4.83 Germ cell-sex cord/gonadal stromal tumour, unclassified. A Loose clusters of germ cells occur in a tumour consisting of small nests and cords of sex cord cells and spindled stromal cells. B The germ cells have round nuclei with fine chromatin and inconspicuous nucleoli. gonads are most often diploid unlike those from non dysgenetic testis {351,1004,2198}. Germ cell-sex cord/gonadal stromal tumour, unclassified Germ cell-sex cord/gonadal stromal tumour, unclassified type is defined as a neoplasm having a combination of neoplastic germ cells and neoplastic sex cord-stromal elements arranged in a diffuse pattern, as opposed to the nested pattern of gonadoblastoma {266,1648, 2142,2563}. Recent evidence {2671}, however, casts doubt on the neoplastic nature of the germ cells, thereby providing support that most, and perhaps all, of the purported examples represent sex cord-stromal tumours with entrapped, non neoplastic germ cells. This viewpoint, however, is controversial. These tumours have occurred mostly in young men who presented with masses, although an occasional case has been in a child. The tumours are usually white, grey or tan circumscribed masses. On microscopic examination, the predominant element is the sex cord-stromal component, which is often arranged in tubules or cords with transition to spindled stromal cells. The germ cells are most common at the periphery but may be more diffuse or central. They are commonly loosely clustered with clear cytoplasm and round, uniform nuclei having fine chromatin. Immunostains for placental alkaline phosphatase and c-kit have been negative {2671}, while the sexcord-stromal elements have often been positive for alpha subunit of inhibin. Malignant behaviour has not been reported, but the sex cord-stromal component should be analysed for features that are associated with metastases in sex cordstromal tumours. 260 Tumours of the testis and paratesticular tissue
Miscellaneous tumours of the testis F.K. Mostofi I.A. Sesterhenn J.R. Srigley H.S. Levin Carcinoid tumour Definition An epithelial tumour of usually monomorphous endocrine cells showing mild or no atypia and growing in the form of solid nests, trabeculae, or pseudoglandulae. ICD-O code 8240/3 Epidemiology The incidence is less than 1% of testicular neoplasms. In the series by Berdjis & Mostofi it accounts for 0.23% {214}. Clinical features The ages range from 10-83 years, with a mean age of 46. Primary carcinoid of the testis usually presents as a mass, and only rarely with carcinoid syndrome {1045}. Symptoms of testicular swelling range from a few months to 20 years {214,766,1938,2569,2923}. Macroscopy The tumours measure between 1.0 cm to 9.5 cm with a mean of 4.6 cm. They are solid, and yellow to dark tan. Calcifications may be present. Histopathology The microscopic appearance is identical to that described in other sites but the trabecular and insular pattern predominate. The larger tumours may show necrosis. Neuroendocrine granules can be identified by electron microscopy {2569,2923}. The cells are positive for endocrine markers (e.g. chromogranin) {1970,2923,2932}. Rarely, primary carcinoids of the testis are malignant metastasizing to lymph nodes, liver, skin and skeletal system {1127,1285,2393,2533}. Carcinoids in teratomas have been included in the category of teratoma with somatic type malignancy {1805}. Carcinoids from other sites (e.g. ileum) can metastasize to the testis {1823}. Tumours of ovarian epithelial types Definition Tumours of testis and adjacent tissues that resemble surface epithelial tumours of the ovary. Incidence These are very rare tumours. Clinical features The patients ages range from 14-68 years. The patients present with scrotal enlargement {2664}. Macroscopy The macroscopic appearance varies with the tumour type. Cystic lesions are usually serous tumours of borderline malignancy or, if mucin is present, mucinous cystadenoma. The more solid tend to be carcinomas {2664,2902}. They may be located in the tunica and paratesticular tissue as well as the testis. Histopathology The histologic appearance is identical to their ovarian counterparts. The reader is referred to the volume dealing with ovarian tumours. Most of the lesions reported in the literature are serous tumours of borderline malignancy {570,2166,2767, 2902}. They also include serous carcinomas {1242}, well differentiated endometrioid adenocarcinoma with squamous differentiation {2902}, mucinous cystadenoma {1295}, and mucinous borderline tumours and cystadenocarcinoma {685,1906}. Differential diagnosis The differential diagnosis includes carcinoma of the rete and mesothelioma. The rete carcinoma should be centered around or in the rete. Immunohistochemistry will be helpful to distinguish mesothelioma from papillary serous tumours. The differential diagnosis of mucinous carcinoma and endometrioid carcinoma should include metastatic adenocarcinoma. A B Fig. 4.84 A Mucinous borderline tumour of the paratesticular tissue. B Endometrioid carcinoma. Miscellaneous tumours of the testis 261
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 and 32: A B Fig. 4.52 Teratoma with somatic
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: Tumours containing both germ cell a
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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