CHAPTER X CHAPTER 4 - Cancer et environnement

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A B Fig. 4.119 Embryonal rhabdomyosarcoma. A Embryonal rhabdomyosarcoma can have a well differentiated pattern with abundant rhabdomyoblasts. B Embryonal rhabdomyosarcoma may be composed of primitive, hyperchromatic oval cells. mas {1076}. The dedifferentiation may occur at the inception or in a recurrent tumour. This component can give rise to metastases. Some liposarcomas of the scrotum can have smooth muscle elements; these have been designated as combined lipoleiomyosarcomas {2539}. Malignant fibrous histiocytoma and fibrosarcoma are diagnoses by exclusion. The former is a pleomorphic fibroblasticmyofibroblastic sarcoma, and the latter has a more uniform spindle cell pattern. The majority of paratesticular rhabdomyosarcomas are of the embryonal type, but a small percentage (10-15%) have been classified as the alveolar type in the largest clinicopathological series {753,1283,1563,2146}. A typical example of embryonal rhabdomyosarcoma contains large number of primitive round to oval cells and smaller numbers of differentiating rhabdomyoblasts with eosinophilic cytoplasm and possible cytoplasmic cross striations. However, the number of differentiating rhabdomyoblasts varies widely. Myxoid matrix is often present. A rare variant of embryonal rhabdomyosarcoma is composed of predominantly spindled cells, with some resemblance to smooth muscle cells. This type has been referred to as spindle cell or leiomyosarcoma-like rhabdomyosarcoma {1483}. Although cytoplasmic cross striations may be noted, especially in the spindle cell rhabdomyosarcoma, they are not required for the diagnosis. Diagnostic confirmation should be obtained by immunohistochemistry. Virtually all RMS are positive for desmin and muscle actins (HHF35), and most have nuclear positivity for myogenic regulatory proteins, MyoD1 and myogenin (the latter demonstrated with Myf4 antibody). Cytoplasmic positivity for MyoD1 occurs in various tumours and has no diagnostic significance. Post chemotherapy specimens can show extensive rhabdomyoblastic differentiation. 276 Tumours of the testis and paratesticular tissue
Secondary tumours C.J. Davis Definition Tumours of the testis which do not originate in the testis or result from direct extension of tumours arising in adjacent intrascrotal sites. Incidence This is one of the most uncommon causes of testicular tumour, accounting for 2.4-3.6% {1800,2664}. Clinical features Most patients are over age 50, with a mean of 55-57, but one third have been under age 40 {1042,2663,2664}. It is most often found at autopsy in patients with known disseminated disease or after orchiectomy for prostatic carcinoma {1691}, but in 6-7% of cases it has presented as the initial evidence of disease as a palpable mass {548,1691, 2664}. Bilaterality has occurred in 15- 20% {548, 2664}. Origin of metastasis A multitude of tumour types have metastasized to the testes, including some sarcomas but most studies have found prostate, lung, melanoma, colon and kidney in descending order of frequency, to be the more common ones {548,2664}. The excess of prostate cases is doubtless related to the routine examination of orchiectomy specimens from patients with prostate carcinoma {2663}. Macroscopy The cut surface shows one or more nodules of tumour or a solitary diffuse mass. Histopathology The tumour exhibits an interstitial growth pattern with preservation of tubules and only uncommonly does tumour involve tubular lumina. Vascular invasion is usually a prominent feature. Fig. 4.120 Atrophy and metastatic carcinoma from prostate (bilateral orchiectomy). A Fig. 4.121 Metastatic carcinoma from prostate in epididymis. B Fig. 4.122 Secondary tumours of the testis. A Metastatic lung carcinoma. This example, unlike most metastatic tumours, shows luminal involvement. B Metastatic prostatic carcinoma with PSA reactivity. Secondary tumours 277
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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.
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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 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: Fig. 4.115 Leiomyosarcoma. Coronal,
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CHAPTER X CHAPTER 4 - Cancer et environnement

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