CHAPTER X CHAPTER 4 - Cancer et environnement

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testicular parenchyma and tumour tends to be blurred where the tumour infiltrates the testicular interstitium. Nodular excrescences may stud the tunics and the spermatic cord. Histopathology The low power image of rete testis adenocarcinoma comprises large cellular tumour nodules with interspersed, smaller cellular clumps. Slit-like ramifications, reminiscent of Kaposi sarcoma, may permeate these cellular aggregates. The solid cellular zones may show sharply defined necrotic foci. Typically, neoplastic protuberances bulge into the residual dilated rete testis, the channels of which appear dilated. Actual and convincing transition from tumour to normal rete epithelium is the strongest evidence for the diagnosis, but may be difficult to demonstrate. Cellular papillary formations may project into open spaces, but frankly cystic lesions that resemble serous tumours analogous to those of the ovary and peritoneum should not be classified as rete testis carcinoma. Of the tumour types in the differential diagnosis, mesothelioma in particular must be carefully excluded {164,2429}. The tumour may extend to the epididymis, spreading to the para-aortic, iliac and other lymph nodes, to various viscera, and to bone. In one analysis, 56% of 22 patients succumbed within the follow-up period. A B C D E Fig. 4.93 Carcinoma of the rete testis. A Tumour nodules between distended spaces of rete testis. B Tumour aggregates elicit desmoplastic response among dilated rete testis spaces. C Tumour cell nodules next to dilated vessels. D Solid tumour area with brisk mitotic activity. E Tumour infiltrates between atrophic, hyalinised seminiferous tubules. F Tumour cells encircling an atrophic seminiferous tubule. F 266 Tumours of the testis and paratesticular tissue
Tumours of paratesticular structures C.J. Davis P.J. Woodward L.P. Dehner M.A. Jones J.R. Srigley I.A. Sesterhenn W.L. Gerald M. Miettinen J.F. Fetsch Adenomatoid tumour Definition A benign tumour of mesothelial cells characterized by numerous gland-like spaces, tubules or cords. Synonym Benign mesothelioma. ICD-O code 9054/0 Incidence Adenomatoid tumours are the most common tumours of the testicular adnexa, representing 32% of all tumours in this location {287,1800} and 60% of all benign neoplasms in this area {2664}. Clinical features Signs and symptoms These begin to appear in the late teens and up to 79 years and most are seen in A the third through the fifth decades (mean age 36 years) {1800}. They present as small, solid intrascrotal tumours, and are usually asymptomatic. They have typically been present for several years without appreciable growth and are uniformly benign {1800,2664}. Imaging Adenomatoid tumours are smooth, round, and well circumscribed masses of variable size generally arising in the epididymis. They are typically described as hyperechoic and homogeneous. This should not, however, be considered characteristic as great variability has been reported {801,1475}. The most important point is to clearly identify the mass as extratesticular and if it can be shown to be arising from the epididymis, adenomatoid tumour is the most likely diagnosis. They may also arise from the spermatic cord and tunica albuginea, Fig. 4.94 Adenomatoid tumour. A Longitudinal ultrasound image shows a well defined, slightly hypoechoic, extratesticular mass in the region of the epididymal tail (cursors). (T - testis). B Coronal, gadolinium enhanced, T1-weighted MR image of scrotum shows an enhancing mass in the left epididymal head (black arrow). The epididymis on the right is normal (white arrow). (T - testes). B where they can grow intratesticularly. The latter presentation is indistinguishable from testicular germ cell neoplasms. Localization Most of these occur in or near the lower pole or upper pole of the epididymis but other sites include the body of the epididymis, the tunica vaginalis, tunica albuginea and rete testis. Rarely the parietal tunica or spermatic cord may be involved {1800}. Macroscopy and histopathology These are usually small tumours, 2.0 cm or less, but they have ranged from 0.4 to 5.0 cm {2051}. They are round or oval and well circumscribed although they can also be flattened and plaque-like. Microscopically these consist of eosinophilic mesothelial cells forming solid cords as well as dilated tubules with flattened lining cells which may initially suggest an endothelial appearance {166}. Vacuolated cytoplasm is a prominent feature of the cells. The stroma is usually fibrous but may consist largely of smooth muscle. Ultrastructural and immunohistochemical features of these tumours support their mesothelial cell origin. There is an absence of epithelial/carcinoma markers MOC-31, Ber-Ep4, CEA, B72.3, LEA 135 and Leu M1 and also factor VIII and CD34. They invariably express cytokeratin AE1/AE3 and EMA {586,589}. Malignant mesothelioma Definition Malignant tumours originating from the tunica vaginalis or tunica albuginea. ICD-O code 9050/3 A Fig. 4.95 Adenomatoid tumour. A Adenomatoid tumour protruding into the testis. B Paratesticular adenomatoid tumour. B Incidence Intrascrotal mesotheliomas are invariably described as rare although they are the most common paratesticular malignancies after the soft tissue sarcomas {287,1239,2051}. As of the year 2002 Tumours of paratesticular structures 267
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 and 46: Miscellaneous tumours of the testis
Page 47 and 48: Lymphoma and plasmacytoma of the te
Page 49: Tumours of collecting ducts and ret
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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