CHAPTER X CHAPTER 4 - Cancer et environnement

More documents

Recommendations

Info

A Fig. 4.85 A, B Brenner tumour of the testis. B Brenner tumour ICD-O code 9000/0 Tumours histologically identical to Brenner tumour of ovary may be encountered in the testis and paratesticular region {312} The age range is 37-70 (mean 57.7) years. Macroscopically, the solid and cystic masses vary from less than1 to 5 cm in diameter. The histology is similar to that of ovarian Brenner tumour with cysts lined by bland transitional Fig. 4.86 Brenner tumour of the testis. epithelium, solid nests of transitional type epithelium and a cellular spindle cell stroma. One mixed Brenner and adenomatoid tumour has been reported {1911}. Most examples of Brenner tumour are benign, although one malignant example showing local invasion, lymphatic space involvement and metastatic deposits in para-aortic lymph nodes has been described {357}. Nephroblastoma ICD-O code 8960/3 Nephroblastoma of testicular adnexa is identical to renal nephroblastoma and is a triphasic tumour comprised of metanephric blastema, epithelial structures consisting of tubular and/or glomerular structures, and mesenchymal structures. Nephroblastomas may occur as a paratesticular tumour {1976} or as a metastasis from a renal nephroblastoma {2303}. Inguinal and scrotal nephroblastomas have occurred in males 3.5 years of age and younger {116}. Paratesticular tumours have been associated with heterotopic renal anlage and one paratesticular nephroblastoma metastasized to the lung {1976}. Primary nephroblastoma has been staged and treated according to NWTS protocol. Paraganglioma ICD-O code 8680/1 In the spermatic cord, these are rare. Five cases have been reported in the literature {605,698,729,2452} and 2 unreported cases are in the Genitourinary Tumour Registry of the Armed Forces Institute of Pathology. They vary in size from 1.5 to 10 cm and are functionally inactive. Histologically, they are indistinguishable from those in other sites. 262 Tumours of the testis and paratesticular tissue
Lymphoma and plasmacytoma of the testis and paratesticular tissues A. Marx P.J. Woodward Definition Primary lymphomas or plasmacytomas of testes or paratesticular tissues arise in the testicles, epididymis or spermatic cord and are neither associated with lymphoma elsewhere nor leukemia. Involvement of these anatomic structures by systemic lymphomas/leukemias or plasma cell myeloma defines secondary testicular or paratesticular lymphomas or plasma cell neoplasias. Incidence and clinical features Testicular lymphoma (TL) and plasmacytoma The majority of primary lymphomas of the male genital tract arise in the testes {756, 1429,2944,2945}. Testicular lymphomas (TL) constitute 2% of all testicular neoplasms, 2% of all high grade lymphomas and 5% of all extranodal lymphomas in men. Primary (stage IE) TL constitute 40- 60% of all TL {1429,2944,2945}. Most patients with TL are 60-80 years of age (19-91), and in this age group TL is the single most frequent testicular tumour {2001,2938,2945}. Only single cases of primary plasmacytoma of the testis, all in older men, have been reported {1166,1968,2541}. One case was associated with HIV infection {2138}. In children primary testicular lymphomas are rare and typically occur prior to puberty (3–10 years of age) {767,1761, 1999,2076}. Secondary involvement of A the testis occurs in about 5% of childhood systemic lymphomas {547,1296}. Paratesticular lymphoma and plasmacytoma The majority of paratesticular lymphomas is seen in connection with TL, and 25- 60% of TL show extension to paratesticular sites {509,756,767,1670,2944}. Secondary involvement of paratesticular structures in the absence of testicular lymphoma is exceedingly rare {1073}. Primary paratesticular lymphomas {1073, 1288,1670,2718} and plasmacytomas {758} are rare as well. Primary paratesticular lymphoma appears to peak in a young (20–30 years of age) {1073} and an older (34–73 years of age) {1073, 2718} age group with a favourable clinical course only in the former {1073}. Clinical features and macroscopy Primary lymphoma and plasmacytoma of testis and paratesticular tissues typically present with unilateral enlargement of the scrotum or swelling in the inguinal region. “B-symptoms” are rare in primary lesions. Bilateral simultaneous involvement of the testis is typical for lymphoblastic lymphoma, but rare in other entities {756}. Bilateral paratesticular lymphoma is rare as well {1670}. By contrast, involvement of the contralateral testis during lymphoma recurrence is common (10-40%) {1429,2944,2945}. Fig. 4.87 Lymphoma. A Coronal T2-weighted MRI shows these lesions as hypointense masses (arrows) within the normal higher signal parenchyma. B Lymphoma involving the spermatic cord. Axial CT image through the level of the spermatic cord shows diffuse enlargement on the right side by a soft tissue mass (large arrow). The left spermatic cord is normal (small arrow). B Macroscopically, the cut surface usually reveals poorly demarcated tan, grey and necrotic or haemorrhagic single or multiple nodules or diffuse enlargement of testis or paratesticular tissues {767,1073, 1296,2076,2718}. Imaging Testicular lymphoma The sonographic appearance of testicular lymphoma is variable and often indistinguishable from that of germ cell tumours. They are generally discrete hypoechoic lesions, which may completely infiltrate the testis {913,1657}. In contrast to most germ cell tumours, lymphoma is often bilateral and multifocal. It may also involve the extratesticular tissues. Paratesticular lymphoma Paratesticular lymphoma may appear radiologically as multiple nodules or as diffuse infiltration of the epididymis or spermatic cord {2070}. Sonographically lymphomatous masses will generally be hypoechoic. The testes are usually also involved. When multiple masses are identified involving both the testicular and extratesticular tissues lymphoma is the first consideration. Although less common, metastases can give a similar appearance. Histopathology Testicular lymphoma (TL) and plasmacytoma In adult testis, primary diffuse large B- cell lymphoma (DLCL) is the single most frequent lymphoma (70-80%) {1429, 2944,2945}. DLCL cells infiltrate around seminiferous tubules, cause arrest of spermatogenesis, interstitial fibrosis, tubular hyalinization and loss of tubules {756,2825}. Primary MALT lymphomas {1174}, follicular lymphomas {756}, T-cell lymphomas {1131,2825}, and CD56+, EBV-associated T/NK-cell lymphomas of nasal type {402} are exceptional. Primary testicular plasmacytoma is less frequent than DLCL {98,643,756,1486, 2497}. It forms nodules composed of Lymphoma and plasmacytoma of the testis and paratesticular tissues 263
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 and 44: Tumours containing both germ cell a
Page 45: Miscellaneous tumours of the testis
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?