Carcinoma in situ in testicular biopsies

Carcinoma in situ of the testis is an abnormality of the seminiferous epithelium characterized by aneuploid cells with clear cytoplasm located along the tubular basement membrane or in the lumina of tubules. Morphological, cytogenetic, and histochemical features of this anomaly are presented. An adequate fixation of testicular tissue samples is necessary for correct diagnosis. The fact that approximately 50% of carcinoma in situ may develop into malignant germ cell tumours of the testis in 5 years and the investigations of the testicular tissue adjacent to these tumours support the malignant nature and invasive potential of testicular carcinoma in situ. The incidence of carcinoma in situ in persons at risk is reviewed.

Isochromosome 12p in mediastinal germ cell tumor

The occurrence of an i(12p) in an extragonadal mediastinal germ cell tumor indicates that this chromosome change, which is characteristic for testicular germ cell tumors, can also occur in germ cell tumors present elsewhere in the body. In addition, the karyotype in this patient was near-diploid, in contrast with testicular germ cell tumors, which as a rule are near-triploid or near-tetraploid.

Are germ cell tumors part of the Li-Fraumeni cancer family syndrome?

The occurrence of six cases of germ cell tumors, five testicular and one ovarian, in relatives of children with bone or soft tissue sarcomas is described. It is proposed that germ cell tumors may be an uncommon manifestation of the genetic predisposition to cancer that exists in the Li-Fraumeni cancer family syndrome.

[Expression of myc family oncogenes in primary human testicular cancer]

In order to understand the role of myc family genes (c-myc, N-myc and L-myc) in the development and progression of human testicular cancer, we have analyzed the expression of myc family genes in three different types of primary human testicular cancer (seminoma, embryonal carcinoma and teratocarcinoma) and normal testis using Northern blot analysis. Expression of N-myc gene, which is usually limited in the neoplasms derived from neuroectoderm, was detected in seven out of ten cases of seminomas and two out of two cases of embryonal carcinomas. Gene amplification was not observed in these cases. Expression of N-myc gene was not detected in teratocarcinomas and normal testes. Expression of c-myc gene was observed in seminomas, embryonal carcinomas, teratocarcinomas and normal testes, but specific expression of c-myc gene was not seen in these cancers and normal testes. Expression of L-myc gene was not detected in all cases examined in our studies. Since N-myc gene expression was observed only in undifferentiated testicular neoplasm, such as seminoma and embryonal carcinoma, its expression may be positively related to the development and progression of special types of human testicular cancer.

[Establishment and characterization of ovarian pure dysgerminoma cell line secreting human chorionic gonadotropin]

A cell line, designated KURATOU, was established from a human chorionic gonadotropin (hCG)-secreting pure dysgerminoma of the ovary. The cell line comprised small cells resembling original tumor cells and large ones possessing one or a few nuclei. Population doubling time was calculated to be about 10 days. An enzyme immunoassay study of hCG in media showed that the cells produced 7-9 x 10(-6) IU/cell of hCG. Immunocytochemical studies revealed hCG in almost all of the cultured cells. The chromosomal number was distributed in triploid and the modal chromosomal number was 69. Some cells contained HLA-ABC antigens, but none contained HLA-DR antigens. The cell line was transplanted into a nude mouse and produced a tumor resembling the original tumor but with no other tumor elements.

Ovarian gonadoblastoma with dysgerminoma in a woman with two normal children

An unusually rare case of unilateral gonadoblastoma with dysgerminoma occurring in the ovary of a 28-year-old woman with two normal children is reported.

Testicular tumors occurring in non-twin brothers: a case report

The present report describes two cases of seminoma that occurred simultaneously in non-twin brothers. These siblings were typed for HLA-A, -B, -C and -DR specificities, and manifested identical haplotypes. Sixty-four sets of affected siblings have been reported prior to the present cases. We examined HLA-DR antigen in brothers with testicular tumors and hereditary roles in the etiology are discussed.

Familial 46,XY pure gonadal dysgenesis and gonadoblastoma/dysgerminoma: case report

The case reports of two sisters admitted for evaluation of primary amenorrhea are presented. Gynecological and endocrinological investigations and chromosomal analysis led to the diagnosis of familial 46,XY gonadal dysgenesis. Both sisters underwent bilateral salpingo-oophorectomy and hysterectomy. Histological examination revealed dysgenetic gonads with gonadoblastoma and dysgerminoma. Five years after treatment by surgery and irradiation the patients are well and free of recurrence. These cases again confirm the risk of malignancy and the necessity of prophylactic gonadectomy in all patients with gonadal dysgenesis and Y chromosomal material.

Cytogenetic analysis of ten human seminomas

A cytogenetic analysis of ten seminomas has been carried out after direct harvesting of the tumor cells. Modal chromosome numbers ranged from 63 to 112. These numbers were in agreement with flow cytometric determination of the DNA content of the tumors. Eight tumors had at least one copy of an i(12p) among other chromosomal abnormalities. Two seminomas lacked the i(12p).

Ploidy of primary germ cell tumors of the testis. Pathogenetic and clinical relevance

The ploidy of testicular germ cell tumors (GCT), a heterogeneous group of neoplasms, was studied by DNA flow cytometry. The DNA index for infantile yolk sac tumor (N = 10), seminomas (N = 20), and nonseminomas (N = 36), was: 1.91, 1.66, and 1.43, respectively. These values differed significantly one from another (p less than 0.01). The seminoma and nonseminoma components of combined tumors (N = 16) had a significantly different median DNA index of 1.61 and 1.40, respectively. Three of the 10 infantile yolk sac tumors, but only one of the 72 testicular GCT of adults were diploid. The consistent aneuploidy of testicular GCTs of adults might be helpful in the differential diagnosis of primary nongerm cell tumors of the testis, and in differentiating between metastases of testicular GCTs and primary extragonadal malignant GCTs. These data fit into a model of pathogenesis of testicular GCTs of adults in which all tumors, with the possible exception of spermatocytic seminoma, pass through a seminoma stage. Tumor evolution seems to result from net loss of chromosomes from a (near)tetraploid carcinoma in situ cell. The pathogenesis of infantile yolk sac tumor might be different from that of testicular GCTs of adults.

Loss of heterozygosity in human germinal tumors

The frequency of losses of heterozygosity has been investigated in 14 germinal tumors of the testis. Nonrandom deletion of whole or part of chromosome 11 was observed in four cases. In addition, loss of heterozygosity of all the informative loci analyzed was detected in one ovarian teratoma, indicating its post-meiotic origin. These results suggest that different genetic mechanisms (chromosomal deletions or meiotic segregation) that unmask putative recessive mutations are involved in the onset of germinal tumors.

45,X streak gonad syndrome associated with bilateral 'burnt out' gonadoblastoma

A 28-year-old woman with well-developed female secondary sexual characteristics, secondary amenorrhea, short stature and a few somatic anomalies of streak gonad syndrome who had bilateral 'burnt out' gonadoblastoma associated with 45,X karyotype is reported. Although the exact source of steroid production in the present case could not be defined, it seems probable that the tumor once secreted steroid hormones which were responsible for the development of the female secondary sexual characteristics. At the time of diagnosis there was no evidence of hormonal activity of the tumor. Cases of gonadoblastoma without Y chromosome are reviewed. The diagnostic difficulties encountered in patients with gonadoblastoma not associated with Y chromosome are discussed.

Unilateral microscopic gonadoblastoma in a prepubertal Turner mosaic with Y chromosome material identified by restriction fragment analysis

A high incidence of gonadal tumors has been demonstrated in patients with gonadal dysgenesis in the presence of Y chromosome material. A unilateral, microscopic gonadoblastoma was found in the dysgenetic gonad of a ten-year-old, phenotypic female, with Turner stigmata and chromosome mosaicisms of three cell populations 45,X/46,X,+mar,/47,X,+mar,+mar. It is often impossible to determine by cytogenetic analysis if the marker chromosome has derived from the X or Y chromosome. The origin of these marker chromosomes was elucidated by the use of DNA probe (pDP34) for male-specific sequences of the Y chromosome. The presence of Y-specific fragments in the patient's DNA led to surgical exploration and the detection of a gonadoblastoma.

Cytogenetic study of a combined germ cell tumor of the testis

The cytogenetic findings in both components of a combined germ cell tumor of the testis are described. The only structural chromosomal abnormality in common was an i(12p).

Expression of the HST1 oncogene in human germ cell tumors

HST1 (or HSTF1 in human gene nomenclature) is a transforming gene isolated from several cancerous and noncancerous cells. The HST1 protein is a heparin-binding growth factor with significant homology with human fibroblast growth factors and the mouse Int-2 protein. Here, we report the identification of expression of HST1 in a human teratoma cell line and in 5 out of 9 surgically resected human testicular germ cell tumors including seminomas and embryonal carcinomas. Mouse HST1 homologue was expressed in a certain stage of mouse embryo but not in postnatal mice.

Testicular tumors in non-twin brothers from a consanguineous marriage

Malignant testicular tumors occurring in non-twin brothers are reported. Both of the brothers suffered from amentia and epilepsy and were the product of a consanguineous marriage. One brother presented with teratocarcinoma and the other seminoma. With a review of the literature, genetic roles in the etiology of testicular neoplasia are discussed.

Fragile X syndrome and neoplasia

Among 100 males with fragile X [fra(X)] or Martin-Bell syndrome, two have developed malignancies. The first case, a 57-year-old man with fra(X) expression in 12% of peripheral blood lymphocytes, developed a seminoma of the left testis at age 45 years and in the right testis at age 50 years. The second case, a 16-year-old white boy with fra(X) expression in 23% of lymphocytes, developed a mucin-producing adenocarcinoma of the colon at age 14 years. Because of the unusual nature of the tumors observed in these patients and in 2 other patients from the literature, we suggest that individuals with the fra(X) syndrome may be at increased risk of cancer.

HLA association of testicular seminoma

Clinical and epidemiological studies suggest that genetic factors may be involved in the etiology and pathogenesis of testicular germ-cell tumors (GCTs). Previous HLA studies have tried to support the concept of genetic anticipation of GCTs, however, the results obtained have been inconsistent. The reasons for the divergent results are mainly statistical problems, i.e., small patient populations, high numbers of antigens tested, and inhomogeneous study populations. In the present retrospective study, 52 patients with histologically pure seminoma were typed for their HLA-A, B, C, and DR antigens. Only BW41 proved to be significantly increased in frequency after correction for the number of antigens tested (chi Q = 12.73; P = 0.0005). HLA-DR1 was shown to be decreased, however, the difference was not significant. Regarding metastatic seminoma alone, there was a trend towards an increase of A29, BW41, and DR7. Our study gives only weak evidence for the participation of genetic factors in the pathogenesis of seminoma. The statistical trend of HLA association observed in metastatic seminoma deserves further concern as does the question of whether MHC class II antigens are also involved in the pathogenesis of testicular seminoma.

Familial double testicular tumors: identical chromosome changes in seminoma and embryonal carcinoma of the same testis

An identical abnormal chromosome, i(12p), and a marker chromosome of unknown origin were seen in 2 tumors of different histology (seminoma and embryonal carcinoma) in the same testis. A younger brother of the patient also had undergone orchiectomy for 2 seminomas in the left testis 2 years previously. These findings are discussed in relation to the possible cellular background of testicular tumors and their genetic parameters.

[Case report on testicular tumors in non-twin siblings]

A case report of testicular tumors in non-twin siblings is presented. A 42-year-old male was admitted to Kansai Electric Power Hospital with the complaint of swelling of the left scrotal contents. Left radical orchiectomy was performed with the diagnosis of a left testicular tumor. Histological examination revealed a seminoma of the left testis. Fifteen years later, his 43-year-old younger brother was admitted to Osaka University Hospital with the complaint of painless swelling of the left scrotal contents. Left radical orchiectomy was carried out with the diagnosis of a left testicular tumor. Histological examination showed a seminoma of the left testis. The former patient had a history of a scrotal trauma, but there was no history of orchitis or cryptorchism in these two siblings. To our knowledge, there have been reported 44 sets of testicular tumors in siblings. Eleven of these sets appeared in twins, while the other 33 sets were described in non-twin siblings. We discussed the 45 cases including our case of testicular tumors in siblings.

Abnormal chromosomes including small metacentrics in 14 ovarian cancers

In direct preparations of 14 ovarian cancers including 11 primary tumors, chromosomes #1 (12 tumors), #3 (12 tumors, including 3q- chromosomes in five), #6 [eight tumors, including six with a 6q- and two with an i(6p)], #11 (11p + in seven tumors), and #14 (14q+ in at least seven tumors) were most frequently involved in structural aberrations. Also, abnormal small metacentrics were seen in 11 tumors. In ten of these the chromosome appeared to be an i(4p) or i(5p) and in one of these, a mixed Müllerian tumor, there was also an i(12p); the latter anomaly was also present (in duplicate) in a dysgerminoma.

A chromosome study of three ovarian tumors

The cytogenetic results of three different types of malignant ovarian tumors are reported. Their chromosomes were studied indirectly by using either peritoneal washings or ascitic fluids. Detected in the peritoneal washings from a treated case of serous cystadenocarcinoma with papillary involvement, stage III, was a clone of pseudodiploid cells. They were found after 12 months of chemotherapy. No supporting evidence of malignancy was found cytologically. Relatively simple karyotypes were obtained from metaphases found in the ascitic fluid of a patient surgically treated for an immature teratoma, stage II, grade 3. Consistent abnormalities found were trisomy 2, del(3)(p14), and der(5)t(5;8)(q33;q11). Of prime interest in a case of dysgerminoma, stage IV, was the finding of the isochromosome i(12p), a recognized nonrandom abnormality of malignant testicular tumors [1-5].

Prenatal and familial associations of testicular cancer

In a case-control study of testis cancer 259 cases with testicular cancer, 238 controls treated at radiotherapy centres and 251 non-radiotherapy hospital in-patient controls were interviewed about some possible prenatal and familial risk factors for the tumour. For firstborn men, the risk of testis cancer increased significantly according to maternal age at the subject's birth, and this effect was most marked for seminoma. The association with maternal age was not apparent for cases other than firstborn. The risk of testis cancer was also significantly raised for men from small sibships and of early birth order. These results accord with the theory that raised maternal levels of available oestrogen during the early part of pregnancy are aetiological for testicular cancer in the son, although other explanations are possible; there is evidence that seminoma risk may particularly be affected.

Structure and expression of mos sequences in spontaneous and Moloney murine sarcoma virus-induced yolk sac carcinomas in rats

Facilitation of yolk-sac carcinoma (YSCa) development in fetectomized rats by the Moloney murine sarcoma virus/murine leukemia virus (Mo-MSV/MLV) complex was found to be closely associated with the presence of Mo-MSV sequences in the genomes of the YSCa cells. The virus-induced YSCas consisted of cells of mono- or oligoclonal origin which always contained in their genomes at least I randomly integrated Mo-MSV provirus. In YSCas which developed in the absence of virus, no rearrangement or amplification of c-mos could be detected. In addition, blot hybridization analysis of cellular RNA failed to detect mos-related RNA in cell lines derived from Mo-MSV-induced as well as from non-virally induced YSCas. The methylation level of c-mos DNA was low in all YSCa cell lines. In contrast, v-mos DNA in cell lines derived from Mo-MSV-induced YSCas was heavily methylated.

Expression of growth regulatory genes in primary human testicular neoplasms

Seven testicular tumours of different histological type--two seminomas, two teratomas/teratocarcinomas/embryonal carcinomas, one mixed seminoma/teratoma, one Leydig cell tumour and one testicular lymphoma--were examined for the expression of four potentially growth regulatory genes by Northern blotting. Seven out of seven testicular tumours contained transcripts that hybridized with a human insulin cDNA-probe whereas only four out of seven tumours contained IGF II transcripts. One tumour contained high levels of LDL-receptor transcript whereas all seven tumours contained significant quantities of HMG-CoA-reductase mRNA.

Oncogenes and germ cell tumours

The central problem in cancer therapy is the poor selectivity of current systemic agents against the common solid tumours. The demonstration that unique segments of DNA, constant in location and conserved in evolution are involved in growth control opens new avenues for basic and clinical research. The function of the products of these genes needs to be elucidated. Examples of growth control functions include homology to growth factors, surface receptors, protein kinases and cell cycle control proteins. From DNA sequence data peptides predicted to be exposed within intact molecules can be constructed and used to produce monoclonal antibodies to oncogene products. Such antibodies have now been successfully used to demonstrate the intracellular localization of gene products as well as the cell cycle regulatory role of the c-myc protein. By having a battery of antibodies against the different gene products their direct clinical application for diagnosis and prognosis has become a reality. Immunohistology and flow cytometry permit the geographical and quantitative analysis of function in normal and neoplastic tissues. Furthermore, by purification and biochemical analysis the molecular basis for their action can be elucidated. It is likely that by the end of the decade new drugs that inhibit oncoprotein function will be available for clinical trial.

Cytogenetic studies of human testicular germ cell tumours

In a search for consistent cytogenetic alterations in testicular germ cell cancers we have thus far studied some twenty surgical specimens of seminomas and nonseminomatous tumours. From the literature and our results it is now clear that such testicular tumours generally have a hyperdiploid to hypotriploid chromosomal content, and frequently possess a possibly site-specific chromosomal marker, an isochromosome 12p. A significant correlation between the presence of the i(12p) and advanced clinical stages has been revealed in our study. Several other chromosomal regions are consistently involved in cytogenetic changes: 1p and 1q, 6q, 7p, 9q, 12p, 17q, and 22q. Although there is little doubt that characteristic chromosomal lesions exist in testicular germ cell tumours, the impact which specific lesions may have on tumour progression is still unclear.

Incidence of developmental handicaps among the offspring of men treated for testicular seminoma

Although the issue of fertility in patients successfully treated for testicular seminoma seems to be resolved, it remains to be determined whether these patients can father normal, healthy children. At NYU Medical Center we have surveyed the patients treated between 1969 and 1984 who were treated with radiotherapy for testicular seminomas. The survey requested information regarding the qualitative development in offspring produced before and after radiation treatments. In the 33 patients responding we were unable to find any detrimental effect, either emotionally, physically, or developmentally in offspring sired by fathers following radiation therapy for testicular seminoma.

Dysgerminoma, gonadoblastoma, and testicular germ cell neoplasia in phenotypically female and male siblings with 46 XY genotype

46 XY gonadal dysgenesis is a syndrome characterized by a female phenotype with streak gonads and complicated by the frequent occurrence of germ cell tumors. The syndrome and the risk of malignant disease occur in female siblings sharing the XY genotype, and screening of female siblings and prophylactic gonadectomy in those affected is generally recommended. A family of four siblings is described in which two phenotypically female XY children and one male each have developed germ cell tumors, demonstrating that brothers of affected sisters may also be at risk.

Familial occurrence of testicular cancer

A case of testicular cancer in 2 brothers is reported and a review of the literature about testicular malignancies and etiologic factors in closely related family members is given. The familial incidence of testicular tumor is found to be 3% in twins and 0.6-2.1% in less closely related men. Tumors were of the same histology in 70-77% of the twins, whereas in brothers and in other degrees of relationship tumors of different histology mostly occur. Following the diagnosis of the tumor in the first man, the average interval to presentation of the tumor in the relative was 3.7 years in twins, 7.7 years in nontwin brothers and 13.5 years for less closely related men. The need for a thorough checkup of other family members is advised.

Inheritance and testicular cancer. Arguments based on a report of 3 cases and a review of the literature

Cryptorchidism and antecedent contralateral testicular tumor formation are risk factors for the formation of testicular germ cell neoplasms. The question arises if familial occurrence of testicular cancer constitutes another risk factor. In a series of 184 patients, treated for testicular tumors, three pairs of non-twin brothers were recorded. The analysis of 82 cases reported in the literature to date as well as the clinical features of early age of onset, high incidence of bilateral testicular tumors in familial cases, ethnic differences in occurrence of testicular cancer, HLA studies and the detection of oncogenes give relevance to the concept of the participation of genetic factors in the etiology of testicular germ cell cancer.

Complete and incomplete Drash syndrome: a clinicopathologic study of five cases of a dysontogenetic-neoplastic complex

Drash syndrome is a complex disorder characterized by abnormal renal function, abnormal sexual differentiation with predisposition to developing gonadal neoplasms, and nephroblastoma. The authors report five cases with various manifestations of this syndrome. Dysgenetic gonads and abnormal sexual differentiation were present in all patients; two had unilateral and two bilateral gonadoblastomas; in addition, one of the latter had a juvenile granulosa cell tumor. Renal failure was present in all patients. One patient had bilateral Wilms' tumor, and one patient had a metanephric hamartoma. Each element of the triad in this syndrome is analyzed with regard to possible pathogenetic mechanisms and current models of carcinogenesis. Cases with complete forms of the syndrome reported in the literature are reviewed. Patients with incomplete forms of the syndrome must be followed carefully because other elements of this complex may become manifest.

Autoimmune phenomena and cytogenetic findings in a patient with carcinoma (seminoma) in situ

Routine examination of a testis biopsy from a patient with oligospermia and a large varicocele in his left testicle and who was childless for over 2 years showed carcinoma in situ (CIS) with atypic spermatogonia in his right testicle. Immunohistochemical investigations of this tissue revealed large intracellular deposits of immunoglobulin G (IgG) restricted to the atypical cells. By blot-immunobinding test of the patient's serum, circulating antibodies against a molecule with an approximate molecular weight of 60 kD were found. Such antibodies were not found in a total of over 500 infertile patients and fertile controls examined. This molecule was extracted from pooled normal human sperms by trypsin digestion and eluted out of a sodium dodecyl-sulphate polyacrylamide gel (SDS-PAGE). This elute is currently used for raising monoclonal antibodies. An analysis of the direct chromosome preparations from the testis biopsy showed both numerical and structural chromosomal aberrations. This might indicate that the atypical cells have already been transformed and hence could be considered as malignant.

Imbalance of sex chromosomes, with gain of early-replicating X, in human solid tumors

An imbalance of sex chromosomes was observed in several cases of solid tumors: colorectal, anal canal and breast carcinomas. Replication studies, using BUdR incorporation, show that in males there is a tendency towards a gain of early-replicating X and a deficiency of Y chromosomes. In females, there is a tendency towards a gain of early-replicating X and a loss of late-replicating X chromosomes. Although almost no replication studies have been published in the literature, making it impossible to distinguish between late- and early-replicating Xs, it is likely that a similar situation exists for several solid tumors other than those we have studied. A possible consequence of this imbalance is briefly discussed.

Gonadoblastoma presenting as isosexual precocious puberty in a genetic female

A 6 1/2-year-old female with pseudoprecocious puberty was found to have a gonadoblastoma. Her karyotype was 46, XX; serum estradiol level was markedly elevated; and androgens were within the range of normal. The importance of the Y chromosome and dysgenetic gonad in the predisposition to development of a gonadoblastoma is reviewed. A further categorization of gonadoblastomas based on the presence or absence of the Y chromosome is suggested.

Malignant testicular germ cell tumors in a father and two sons. Case report and literature review

The authors report the 17th case of primary malignant testicular tumors in father-son pairs, the 61st case occurring in male first-degree relatives, and the first case identified in a father and two sons. The father had bilateral seminomas at ages 31 and 44 years. His oldest son developed left testicular teratoma with elements of seminoma and embryonal carcinoma at age 29 years. The second son developed pure seminoma of the right testicle at age 26 years. The father had mumps orchitis at age 17 years. None of the three had a history of cryptorchism, trauma, or hernia. Literature reports of familial testicular neoplasia are becoming more frequent, and evidence is presented that family history may represent a risk factor independent of cryptorchism for the development of testicular cancer. Aggressive follow-up of closely-related male relatives is advocated.

A case of simultaneous bilateral germ cell tumors arising from cryptorchid testes

We report a rare case of simultaneous bilateral testicular germ cell tumors arising from uncorrected cryptorchid testes. Each side had a different histological type, which consisted of pure high grade seminoma on the left side, and teratocarcinoma with choriocarcinoma and yolk sac tumor elements in addition to seminoma on the right side. Patients with cryptorchidism are known to have a higher risk of germ cell tumors. Genetic factors also may have a role in the oncogenesis in our patient, since his older brother had had a seminoma in the left cryptorchid testis previously. Both patients had the HLA-Aw24 antigen. The characteristics of familial testicular tumors are discussed.

Management of phenotypic female patients with an XY karyotype

Nine phenotypic female patients with XY karyotype were evaluated through a clinical, cytogenetic, hormonal, endoscopic and histologic diagnostic protocol. Seven patients complained of primary amenorrhea and two patients of abnormal puberal development. The final diagnosis was XY gonadal dysgenesis (n = 5) and testicular feminization syndrome (n = 4). Two patients were less than 155 cm tall, and the remainder were over 155. Minor somatic anomalies were found in two patients with XY gonadal dysgenesis. Patient with testicular feminization syndrome had FSH and LH within the normal range, and patients with XY gonadal dysgenesis had elevated FSH and LH levels. Gonadoblastomas were found in two patients with XY gonadal dysgenesis (one patient with XO/XX/XY mosaicism). Laparoscopy and gonadal biopsy might be useful in some patients to avoid confusion between XY gonadal dysgenesis and testicular feminization syndrome. Early diagnosis of XY gonadal dysgenesis is always desirable, and bilateral gonadectomy is indicated as soon as the diagnosis is made in patients with a Y chromosome and elevated FSH levels. Surgical removal of the gonads from patients with testicular feminization should be delayed until the completion of puberty because of the low risk of malignancy.

A human testicular germ cell tumor with borderline histology between seminoma and embryonal carcinoma secreted beta-human chorionic gonadotropin and alpha-fetoprotein only as a xenograft

Two macroscopically distinguishable components (designated soft and firm) of a human testicular germ cell tumor with borderline histology between seminoma, embryonal carcinoma and yolk sac tumor, were maintained as xenografts in nude mice for over 20 passages. Levels of beta-human chorionic gonadotropin (beta-HCG) and of alpha-fetoprotein (AFP) were normal in the patient's serum and were undetectable by immunohistochemical studies of the surgical specimen. The xenografted soft part, however, with morphologic characteristics of an embryonal carcinoma, secreted beta-HCG and AFP during early passages. The firm variant, histologically resembling a seminoma, did not produce these markers. Chromosomal and flow cytophotometric analyses showed genetic differences between the clonally stable variants. A common origin, however, is indicated by two similar marker chromosomes present in both variants.

Gonadoblastoma and Y-chromosome fluorescence

In this report we summarize our experience in 4 patients with 45,X/46,XY, one patient with 45,X/47,XYY mosaicism, and one patient with 46,XY karyotype and ambiguous external genitalia. In the 3 patients with a fluorescent Y-chromosome, the development of one or two gonadoblastomas was found, independent of the age of the patients at the time of examination. In the 3 patients with 45,X/46,XYnf mosaicism no gonadoblastoma was detected. This finding prompted us to review the data on patients reported with 45,X/46,XYnf mosaicism. Up to now, no patient with well documented 45,X/46,XYnf mosaicism and convincing evidence of development of gonadoblastoma has been reported. These data seem to confirm that alterations of the characteristic distal fluorescence of Yq may protect the dysgenetic gonad against tumoral degeneration in patients with 45,X/46,XY mosaicism. Possible mechanisms responsible for these changes in the oncogenic potential of Yq in relation with the Y chromosome fluorescence are discussed.

Chromosome analysis of three seminomas

Each of three seminomas revealed chromosome #1 and #12 structural changes in direct preparations and short-term cultures. The #1 changes involved duplication of 1q and loss of 1p; in two, the breakpoint was in the heterochromatic region. The anomaly in #12 was a short arm isochromosome, usually present in duplicate. In one tumor, these were the only structural changes; in the other two, there was also involvement of #7, with extra copies of 7p. In one of these two tumors, a heterochromatic minute was identified after C-banding, and in the other, aside from two different markers containing part of #7, there was a dicentric derived from two chromosomes #15; this tumor proved to be prognostically unfavorable. Three normal chromosomes #1 and XXY sex chromosomes were present in each tumor. Chromosomes #11 and #13 were generally underrepresented, and #12 and #19-22 were over-represented.

Testicular neoplasms occurring in four brothers. A search for a genetic predisposition

Four brothers who developed testicular neoplasms, one bilaterally, are described. Histologic examination showed four of the tumors to be seminomas and one to be a mixed germ cell tumor. Three of the brothers are alive. Apart from a late-onset bladder carcinoma in their father and a pulmonary cancer in a maternal uncle, cancers were not recorded in the extended kindred. One patient, a sister, and the parents had normal frequency of sister chromatid exchange (SCE) and chromosome aberrations, whereas the two patients sampled after radiation showed increase in one or both. The father was found heterozygous in 12 and the mother in 8 genetic marker systems among 25 tested. For the blood group gene loci JK and MNSs, and the erythrocyte enzyme locus GPT the father had given the same allele to all three affected sons examined. The mother had given different alleles to the sons in all of her informative markers. On the model of a recessively acting susceptibility gene, only JK and GPT remained consistent with linkage without recombination. These investigations did not add support to a genetic etiology for the unusual family occurrence of testicular cancer. An apparent birth-order effect on time at onset/diagnosis in this and published families suggests time-limited environmental factors. Nevertheless, JK, MNSs, and GPT should be included in future testis cancer families to test the model of a "dominant" genetic predisposition.