Tumors of specialized gonadal stroma in human male patients.Androblastoma, sertoli cell tumor, granulosa-theca cell tumor of the testis, and gonadal stromal tumor

Malignant Sertoli cell tumour of the testis. An immunohistochemical study and a review of the literature

The fifteenth case of malignant Sertoli cell tumour is reported and the literature is reviewed. The reported case was unilateral with lung metastases. Immunohistochemical examination showed positive staining reaction within the tumour cells for vimentin and cytokeratin, while AFP, HCG, PLAP, EMA and CEA were not found, which is in accordance with the staining pattern found in normal Sertoli cells.

Malignant mixed germ-cell-sex cord-stromal tumors of the ovary associated with isosexual precocious puberty

Two cases of hormonally active, metastasizing malignant mixed germ cell-sex cord-stromal tumors are described in otherwise normal prepubertal girls. Isosexual precocity was noted 5 months and 1 month before surgery. One child died 1 year after presentation, and the other was alive, with no apparent tumor, 1 year after diagnosis. These two cases represent the first recorded instance of a unique tumor in which metastases of several cell types were encountered.

Newborn granulosa cell tumor of the testis

We describe a male newborn who presented with a nodular mass in the right testicle. The alpha-fetoprotein level was greater than 450 ng. per ml. Scrotal ultrasound showed a multicystic "swiss-cheese"-appearing mass replacing most of the testicle, which suggested a teratoma. An operation was postponed until the physiological jaundice subsided. At orchiectomy a juvenile granulosa cell tumor of the testis was removed.

Malignant gonadal stromal tumor of the testis arising with a malignant teratoma

We report a case of a rare malignant gonadal stromal tumor arising with a malignant teratoma of the testis. The malignant gonadal stromal element of the tumor or the nongerminal cell component was resistant to chemotherapy and ultimately metastasized to the lymph nodes, lung, bones and liver. Nongerminal cell tumors arising with germinal cell neoplasms may become more common because the chemosensitive germ cell tumor may be destroyed and the chemoresistant nongerminal tumor remains. The nongerminal cell tumor is the most important prognostic factor and also dictates possible later changes in therapy.

Chylous ascites following retroperitoneal lymphadenectomy for granulosa cell tumor of the testis

We report on an infant with chylous ascites following retroperitoneal lymphadenectomy for granulosa cell tumor of the testis. Granulosa cell tumor of the testis is an extremely rare lesion, with only 8 cases reported previously, including 1 in an infant. Chylous ascites is a rare problem in children and it has been reported in only 92 cases. The options for management of this difficult problem are discussed.

Testicular tumors in infants and children

Primary malignant tumors of the testis are uncommon in infants and children. Tumors of germ cell origin are identified most frequently. The clinical presentation is usually due to the presence of an enlarging scrotal mass. Determinations of the serum alpha fetoprotein (AFP) and beta subunit of human chorionic gonadotropin (beta-hCG) levels are helpful for diagnosis and management. All suspected testicular tumors should be surgically evaluated through a high inguinal incision. Postoperative chemotherapy is recommended for some patients with yolk sac tumor and all patients with embryonal rhabdomyosarcoma. Prolonged relapse-free survival is possible for most infants and children with malignant testicular tumors.

Neonatal gonadal stromal tumor of the testis: limitations of tumor markers

We report case 10 of a gonadal stromal tumor of the testis in a neonate. This tumor may occur in the testis or ovary, and is defined as a tumor of any of the specialized supporting structures of the male or female gonad. All neonatal tumors reported to date have been benign. The serum alpha-fetoprotein level, although elevated for adults, was within the normal range for an infant.

Malignant Sertoli cell tumor of testicle

The eleventh case of malignant Sertoli cell tumor of the testicle is described. The tumor displayed malignant character with local invasion into the epididymis. Retroperitoneal lymph node dissection revealed a malignant deposit around the left renal artery.

Juvenile granulosa cell tumor of the infant testis: case report with ultrastructural observations

This report describes the light-microscopic and ultrastructural features of a juvenile granulosa cell tumor of infant testis. Microscopic examination revealed a macrofollicular patterns simulating the preovulatory Graafian follicle and the juvenile granulosa cell tumor of the ovary. Ultrastructure confirmed three cell types: granulosa, theca interna, and externa, with occasional luteinized cells lacking crystalloids of Reinke. Charcot-Bottcher crystalloids were not detected, though rare cells contained a complex arrangement of filaments. An ultrastructural comparison was carried out with infant testes (2 cases), preovulatory Graafian follicle (1 case), juvenile granulosa cell tumor of ovary, adult granulosa cell tumor of ovary, and adult Sertoli cell tumor of testis and ovary. Ultrastructural similarities were noted between the present case and primitive Sertoli cells, preovulatory granulosa cells, and juvenile granulosa cell tumor of ovary. This may reflect the common histogenesis of Sertoli/granulosa cells from the common specialized gonadal stroma.

Benign and malignant epithelial tumors of the rete testis in mice

Two papillary cystadenomas and one papillary cystadenocarcinoma in the rete testis were found in two of 500 very old male JCL:ICR mice; the hosts had no other tumors. One mouse had bilateral cystic tumors. A 5 x 3 x 3 mm papillary cystadenoma was observed in the rete of the right testis. A 7 x 3 x 3 mm tumor with a mixed pattern of papillary cystadenocarcinoma and papillotubular adenocarcinoma was found in the rete of the left testis; the latter extended from the mediastinum to the ductuli efferents and the caput epididymis. The other mouse had a 9 x 5 x 5 mm papillary cystadenoma of borderline malignancy in the rete of the right testis. The mice had no clinical signs.

Malignant sex cord-stromal tumor of testis

We report a case of sex cord-stromal tumor in the testis, which metastasized to the retroperitoneal space, resulting in death 13 months after orchiectomy. The primary lesion consisted of granulosa cells, theca cells, Sertoli cells and undifferentiated gonadal stroma. Biopsy of the retroperitoneal metastasis showed predominance of the Sertoli cell component.

Juvenile granulosa cell (sex cord-stromal) tumor of fetal testis

A case is reported of a juvenile variant of the rare, testicular granulosa cell (sex cord-stromal) tumor in a fetus. The variant has been reported in the ovary but not in the testis. Sex cord-stromal tumors in general have not been reported in fetal testes.

Sertoli cell testicular tumors

The testicular Sertoli cell tumor is generally considered a benign tumor that can be treated by orchiectomy and close follow-up. It accounts for less than 1.5 per cent of testis tumors and may be malignant in 10 per cent of cases. Approximately 30 per cent have endocrine activity. We present 5 additional cases to the 75 previously reported in the world literature.

Malignant gonadal stromal tumor: case report and review of the literature

Of the 80 cases of gonadal stromal tumor reported in the literature 10 were malignant. We herein report another malignant case. The role of chemotherapy and radiation therapy in malignant gonadal stromal tumor has not been defined. While the only sue evidence of malignancy is metastatic disease we recommend that if macroscopic and microscopic examination of the primary tumor suggests malignancy a retroperitoneal node dissection should be performed.

Peutz-Jeghers syndrome with feminizing sertoli cell tumor

A case involving a 6-year-old boy with Peutz-Jeghers syndrome and an unilateral feminizing Sertoli cell tumor is described. Endocrinologic studies revealed consistently high plasma and urine levels of estrogens and normal levels of testosterone and dihydrotestosterone. The increased levels of estrogens did not show changes that could be correlated with exogenous gonadotropin administration, thus indicating an autonomous nature. The histopathologic studies of nontumorous testicular tissue revealed changes in the seminiferous tubules which suggested that estrogens, directly or indirectly, may have had both stimulating and atrophying effects. It is concluded that gonadal tumors are in additional manifestation of the Peutz-Jeghers syndrome gene in both male and female patients.

Extratesticular gonadal stomal tumor in the pelvis. A case report with immunoperoxidase findings

A 40-year-old man with two normally descended testicles and no signs of hormonal anomalies developed a fist-sized extraperitoneal tumor to the left of the urinary bladder. Histologic diagnosis was that of a probably malignant gonadal stromal tumor because of considerable mitotic activity and widespread vascular invasion. Retroperitoneal lymphadenectomy showed no metastatic disease, and the patient is well two years after surgery. By use of an immunoperoxidase method we could demonstrate estradiol and testosterone in the tumor cells. The findings in this case are unique in regard to the extratesticular location of the tumor and support the current view that gonadal stromal tumors arise from a primitive cell with a multidirectional potential for differentiation.

Sertoli cell tumor (gonadal stromal tumor) in an infant

An 8-mo-old boy had an orchiectomy for a Sertoli cell tumor. Malignancy was suspected histologically. He underwent a retroperitoneal lymphadenectomy and no nodes contained metastases. The histologic criteria for malignancy in Sertoli cell tumors are controversial. Individual case reports of patients with these tumors are encouraged to help establish their natural history and optimum management.

Gonadal stromal tumor in black male

A twenty-five-year-old black male presented with a right testicular mass which had progressively increased in size over three years. He was in good health and noted no other general abnormalities. Taking all malignant precautions, excisional biopsy of the lesion revealed gonadal stromal tumor by frozen section. The testis was left in situ, and the patient has continued to remain asymptomatic.

Sex cord-stromal (gonadal stromal) tumors of the testis: a report of 5 cases

Sex cord-stromal (gonadal stromal) tumors of the testis account for less than 4 per cent of the testicular tumors. The Leydig cell tumor in a child may produce isosexual virilization (case 3). In the adult it may have no endocrine manifestation (case 1) or gynecomastia and decrease in libidio may result from production of estrogens (case 2). Sertoli cell tumors (case 4) and granulosa cell tumors (case5) are rare.

Sertoli cell tumors of ovary: light microscopic and ultrastructural study with histogenetic considerations

Two cases of pure Sertoli cell tumors of the ovary are presented. The tumors were grey to brown and generally solid, but with several cystic areas. They showed a highly differentiated, but variable, histologic patterns with solid cords of neoplastic cells, as well as tubular formations. Ultrastructurally, the basal part of the cells rested on a nonfibrillary basement membrane layer while the free border showed occasional cilia. Laterally, the cells showed tight junctions and desmosomes. Abundant rough endoplasmic reticulum and some cystically dilated smooth endoplasmic reticulum were evident. The theories regarding the histogenesis are discussed. Enough similarities, both by light and by electron microscopy, are presented between these tumors and the Sertoli cell to justify classifying these ovarian tumors as Sertoli cell in type. The development of cilia is considered to be a manifestation of focal metaplasia of the neoplastic Sertoli cell.

Bilateral Sertoli cell tumor of testes with feminizing and masculinizing activity occurring in a child

A case of an unusual, histologically atypical, bilateral Sertoli cell tumor of testis, in association with masculinization and feminization effects, that occurring in a 5-year-old boy, is presented. Although Sertoli cell tumors are not infrequent, this case is morphologically and endocrinologically unique.

Feminizing interstitial cell tumor of the testis: personal observations and a review of the literature

A 28-year-old man with evidence of feminization was demonstrated after 4 years of investigation to have a estrogen-secreting interstitial cell tumor. Such feminizing neoplasms are uncommon, only 37 having been described. They are usually benign and are characterized by gynecomastia, a testicular mass and, with lesser frequency, by decreased libido and potency and poor semen quality. The urinary excretion and plasma levels of estrogen are increased and, by selective testicular catheterization, the site of increased estrogen production can be localized. Secondary histologic changes occur in the nontumorous portions of the testis as well as in the contralateral testis; they are most marked in the area immediately adjacent to the tumor. Postoperatively, the gynecomastia regresses, the excessive levels of estrogen return to normal, libido improves, and the sperm count increases to normal.

Topographical Study on Sex Chromatin in Breast Cancer

Report of a topographical study on 12 cases of breast cancer designed to establish whether all the areas of a given tumor had the same sex chromatin, this being essential for the determination of tumoral sex to be a valid therapeutic guide. The results show that, although there may be variations in the number of nuclei with sex chromatin, the variations are not so great as to alter the tumoral sex in a given tumor. The determination of tumoral sex on a single tumor fragment is therefore valid.