Testicular and paratesticular tumors and tumor-like lesions in the first 2 decades

Ulbright, Thomas M.; Young, Robert H.

doi:10.1053/j.semdp.2014.07.003

Cited by 43 publications

(19 citation statements)

References 364 publications

(399 reference statements)

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“…[5][6][7][8][9][10][11][12] We have encountered patterns and cytologic features that have not been described in the literature or only to a minimal degree, which may potentially cause confusion with other neoplasms, most often yolk sac tumor (YST) or, rarely, other sex cord stromal tumors. 13,14 We therefore undertook a comprehensive morphological analysis of testicular JGCT to highlight not only the classic features but also unusual aspects and those useful in differentiating it from other neoplasms.…”

Section: Discussionmentioning

confidence: 99%

Juvenile Granulosa Cell Tumors of the Testis

Kao

Cornejo

Ulbright

et al. 2015

American Journal of Surgical Pathology

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All authors have no conflict of interest to declare. Abstract 2The clinical and pathologic features of 70 juvenile granulosa cell tumors of the testis are presented. The patients were from 30-weeks gestational age to 10 years old; 60 of 67 (90%) whose age is known to us were < 6 months old. Sixty-two underwent gonadectomy, 6 wedge excision, and 2 only biopsy. Twenty-six tumors were left-sided, and 22 right-sided. Six occurred in an undescended testis and 2 in dysgenetic gonads. The most common presentation was a testicular mass (65%) followed by an "enlarging testis" (25%). Six of 14 patients in whom it was measured had "elevated" serum AFP, likely physiologically, and 1 had gynecomastia. The tumors measured 0.5 to 5 cm (mean, 1.7; median, 1.5) and were most commonly wellcircumscribed and typically yellow-tan; approximately 2/3 had a cystic component, while 1/3 were entirely solid. Microscopic examination typically showed a lobular growth, punctuated in 67 cases by variably-sized and shaped follicles containing material that was basophilic (21%), eosinophilic (44%), or of both characters (35%); 3 lacked follicles. In non-follicular areas, the tumor cells typically grew diffusely, but occasionally had a corded arrangement (26%) or reticular appearance (29%). The stroma was either fibrous or fibromyxoid; hemorrhage associated with hemosiderin-laiden macrophages was focally seen in 16%. The tumor cells were mostly small to medium sized with round to oval nuclei containing inconspicuous nucleoli and moderate to abundant, but occasionally scant, pale to lightly eosinophilic, sometimes vacuolated, cytoplasm; nuclear grooves were infrequent (6%). Focal columnar morphology was seen in 27% of the tumors. Mitoses were plentiful in 37% and apoptosis was prominent in 46%. Intratubular tumor was seen in 43% and entrapped seminiferous tubules in 70%. Lymphovascular invasion was present in 2 cases, rete testis involvement in 4, and necrosis in 1. Rare features/patterns included: regressed tumor with hyalinization and prominent blood vessels (13%), papillary (4%), basaloid (1%), spindle cell predominant (1%), microcystic (1%), adult granulosa cell-like (1%) 3 patterns, and hyaline globules (1%). Inhibin (16/18), calretinin (8/9), WT1 (6/7), FOXL2 (12/12), SF-1 (12/12), and SOX9 (6/11) were positive, while SALL4 and glypican-3 were consistently negative in the neoplastic granulosa cells. Only one tumor was focally positive for AFP. Juvenile granulosa cell tumor is a rare neoplasm with a wide morphologic spectrum that also occurs rarely in undescended testes and dysgenetic gonads. The solid and reticular patterns may pose diagnostic challenges but the lobular appearance and follicular differentiation are characteristic. Immunohistochemical stains may aid in its distinction from other tumors of young males, particularly yolk sac tumor, a neoplasm that peaks at a somewhat later age. Twenty-four patients with follow-up, including 4 of 6 patients treated with wedge resection /biopsy, had no evidence of disease (2-348 months; mean, 83...

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Section: Discussionmentioning

confidence: 99%

Juvenile Granulosa Cell Tumors of the Testis

Kao

Cornejo

Ulbright

et al. 2015

American Journal of Surgical Pathology

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“…A major shift in the restructuring of germ cell tumour classification as introduced above is the discrimination of prepubertal‐type from postpubertal‐type germ cell tumours of the testis . Adult testicular teratomas, even when unmixed with other elements, are overwhelmingly considered to be derived from malignant germ cell tumour components, and are thought to occur through a pathway of differentiation of seminoma, or possibly GCNIS, to other tumour types (yolk sac tumour, embryonal carcinoma, and choriocarcinoma) and subsequent differentiation into teratoma .…”

Section: Prepubertal‐type Tumours (Including Dermoid and Epidermoid Cmentioning

confidence: 99%

“…Adult testicular teratomas, even when unmixed with other elements, are overwhelmingly considered to be derived from malignant germ cell tumour components, and are thought to occur through a pathway of differentiation of seminoma, or possibly GCNIS, to other tumour types (yolk sac tumour, embryonal carcinoma, and choriocarcinoma) and subsequent differentiation into teratoma . In contrast, teratomas occurring in prepubertal patients lack association with GCNIS, have a more organoid architecture, lack significant cytological atypia, and largely lack 12p amplification, and have not been reported to metastasize (except in perhaps rare scenarios of carcinoid tumour or other secondary somatic‐type tumours that may arise from teratoma) . Although distinguishing these two groups by the prepubertal or postpubertal status of the patient is helpful, there is increasingly accumulating evidence that prepubertal‐type tumours can nonetheless be found in postpubertal patients, possibly representing a rarer manifestation of the same process in an older age group or late presentation of a tumour that had been present since childhood.…”

Section: Prepubertal‐type Tumours (Including Dermoid and Epidermoid Cmentioning

confidence: 99%

“…A major shift in the restructuring of germ cell tumour classification as introduced above is the discrimination of prepubertal-type from postpubertaltype germ cell tumours of the testis. 11,56 Adult testicular teratomas, even when unmixed with other elements, are overwhelmingly considered to be derived from malignant germ cell tumour components, and are thought to occur through a pathway of differentiation of seminoma, or possibly GCNIS, to other tumour types (yolk sac tumour, embryonal carcinoma, and choriocarcinoma) and subsequent differentiation into teratoma. 41,57 In contrast, teratomas occurring in prepubertal patients lack association with GCNIS, 58 have a more organoid architecture, lack significant cytological atypia, 59 and largely lack 12p amplification, 60,61 and have not been reported to metastasize 62,63 (except in perhaps rare scenarios of carcinoid tumour or other secondary somatic-type tumours that may arise from teratoma).…”

Section: P R E P U B E R T a L -T Y P E T E R A T O M Amentioning

confidence: 99%

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The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel

et al. 2016

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Since the last World Health Organization (WHO) classification scheme for tumours of the urinary tract and male genital organs, there have been a number of advances in the understanding, classification, immunohistochemistry and genetics of testicular germ cell tumours. The updated 2016 draft classification was discussed at an International Society of Urological Pathology Consultation on Testicular and Penile Cancer. This review addresses the main updates to germ cell tumour classification. Major changes include a pathogenetically derived classification using germ cell neoplasia in situ (GCNIS) as a new name for the precursor lesion, and the distinction of prepubertal tumours (non-GCNIS-derived) from postpubertal-type tumours (GCNIS-derived), acknowledging the existence of rare benign prepubertal-type teratomas in the postpubertal testis. Spermatocytic tumour is adopted as a replacement for spermatocytic seminoma, to avoid potential confusion with the unrelated usual seminoma. The spectrum of trophoblastic tumours arising in the setting of testicular germ cell tumour continues to expand, to include epithelioid and placental site trophoblastic tumours analogous to those of the gynaecological tract. Currently, reporting of anaplasia (seminoma or spermatocytic tumour) or immaturity (teratoma) is not required, as these do not have demonstrable prognostic importance. In contrast, overgrowth of a teratomatous component (somatic-type malignancy) and sarcomatous change in spermatocytic tumour indicate more aggressive behaviour, and should be reported.

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“…The pical mitoses, widespread necroses, sarcomatoid features and psammoma bodies [22,23]. A differential dia gnosis in paratesticular mesothelioma comprises carcinomas of the rete testis, papillary cystadenomas or cystadenocarcinomas of epididymis, and metastases from the prostate, lungs, large bowel, stomach and kidneys [24]. The epithelial tumors of the rete testis and epididymis have their typical locality of origin as well as their usual histomorphological and immunohistochemical characteristics.…”

Section: Case Reportmentioning

confidence: 99%