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Dashora A, Wagner T, Berney DM. Testicular Tumors: New Developments in Germ Cell and Sex Cord Stromal Tumors. Surg Pathol Clin 2022; 15:729-743. [PMID: 36344186 DOI: 10.1016/j.path.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This article reviews the recent advances and potential future changes in the classification of testicular germ cell and sex cord stromal tumors, highlighting changes in the classification system and terminology with description on newer entities. A discussion on approaching difficult areas and diagnostic pitfalls is also included along with the utility of ancillary investigations. Areas with limited knowledge are highlighted to providing direction for future studies and a bulleted summary in the form of critical care points is provided.
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Affiliation(s)
- Abhishek Dashora
- Department of Cellular Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Thomas Wagner
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel M Berney
- Department of Cellular Pathology, Barts Health NHS Trust, London, United Kingdom; Department of Molecular Oncology, Barts Health Cancer and Barts Health NHS Trust, London, United Kingdom.
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2
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Fichtner A, Ströbel P, Bremmer F. [New 2022 WHO classification of testicular tumours]. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:416-424. [PMID: 36129529 DOI: 10.1007/s00292-022-01112-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
The 5th edition of the WHO Classification of Tumours: Urinary and Male Genital Tumours includes some important revisions of the testicular tumour classifications, which are summarized in this article. They concern, for example, the definition of tumours of neuroectodermal and neuroendocrine origin. Furthermore, signet-ring stromal tumours and myoid gonadal stromal tumours are listed as separate entities in the section about sex-cord stromal tumours. Moreover, lymphatic neoplasia as well as soft tissue tumours of the urinary and male genital tract are each combined in a common section.
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Affiliation(s)
- Alexander Fichtner
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Philipp Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Felix Bremmer
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Berney DM, Cree I, Rao V, Moch H, Srigley JR, Tsuzuki T, Amin MB, Comperat EM, Hartmann A, Menon S, Netto GJ, Rubin MA, Turajlic S, Raspollini MR, Tickoo SK. An introduction to the WHO 5th edition 2022 classification of testicular tumours. Histopathology 2022; 81:459-466. [PMID: 35502823 PMCID: PMC9544657 DOI: 10.1111/his.14675] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
The 5th edition of the World Health Organisation Blue Book was published recently and includes a comprehensive update on testicular tumours. This builds upon the work of the 4th edition, retaining its structure and main nomenclature, including the use of the term 'germ cell neoplasia in situ' (GCNIS) for the pre-invasive lesion of most germ cell tumours and division from those not derived from GCNIS. While there have been important developments in understanding the molecular underpinnings of testicular cancer, this updated classification paradigm and approach remains rooted in morphology. Nomenclature changes include replacement of the term 'primitive neuroectodermal tumour' by 'embryonic neuroectodermal tumour' based on the non-specificity of the former term and to separate these tumours clearly from Ewing sarcoma. Seminoma is placed in a germinoma family of tumours emphasising relation to those tumours at other sites. Criteria for the diagnosis of 'teratoma with somatic transformation' have been modified to not include variable field size assessments. The word 'carcinoid' has been changed to 'neuroendocrine tumour', with most examples in the testis now classified as 'prepubertal type testicular neuroendocrine tumour'. For sex cord-stromal tumours, the use of mitotic counts per high-power field has been changed to per mm2 for malignancy assessments, and the new entities, 'signet ring stromal tumour' and 'myoid gonadal stromal tumour', are defined. Well-differentiated papillary mesothelial tumour has now been defined as tumour type with a favourable prognosis. Sertoliform cystadenoma has been removed as an entity from testicular adnexal tumours and placed with Sertoli cell tumours.
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Affiliation(s)
- Daniel M Berney
- Department of Molecular OncologyBarts Cancer Institute, Barts and The London School of Medicine and Dentistry, QMUL and Barts Health NHS TrustLondonUK
| | - Ian Cree
- WHO Classification of Tumours GroupInternational Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Vishal Rao
- Basavatarakam Indo American Cancer Hospital and Research InstituteHyderabadIndia
| | - Holger Moch
- Department of Pathology and Molecular PathologyUniversity Hospital Zurich and University ZurichZurichSwitzerland
| | | | - Toyonori Tsuzuki
- Department of Surgical PathologyAichi Medical University, School of MedicineNagakuteJapan
| | - Mahul B Amin
- Department of Pathology and Laboratory MedicineThe University of Tennessee Health Sciences CenterMemphisTNUSA
- Department of UrologyUniversity of Southern California, Keck School of MedicineLos AngelesCAUSA
| | - Eva M Comperat
- Department of PathologyGeneral Hospital, Medical UniversityViennaAustria
- Department of Pathology Tenon HospitalSorbonne UniversityParisFrance
| | - Arndt Hartmann
- Institute of PathologyUniversity Hospital Erlangen, Friedrich‐Alexander UniversityErlangenGermany
| | - Santosh Menon
- Tata Memorial CentreHomi Bhabha National InstituteMumbaiIndia
| | - George J Netto
- University of Alabama at Birmingham, PathologyBirminghamALUSA
| | - Mark A Rubin
- University of Bern, Director of the Department for BioMedical ResearchBernSwitzerland
| | | | - Maria R Raspollini
- Histopathology and Molecular DiagnosticsUniversity Hospital CareggiFlorenceItaly
| | - Satish K Tickoo
- Memorial Sloan‐Kettering Cancer Center, PathologyNew YorkNYUSA
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Mohanty SK, Lobo A, Cheng L. The 2022 revision of World Health Organization classification of tumors of the urinary system and male genital organs: advances and challenges. Hum Pathol 2022; 136:123-143. [PMID: 36084769 DOI: 10.1016/j.humpath.2022.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 01/07/2023]
Abstract
The fifth edition of the World Health Organization (WHO) classification of urinary and male genital organ tumors has been recently published in 2022. The application of molecular profiling has made a substantial impact on classification of urologic tumors. The new WHO classification introduces a group of molecularly well-defined renal tumor subtypes. The significant changes include addition of a category of "other oncocytic tumors" with oncocytoma/chromophobe renal cell carcinoma (chRCC)-like features, elimination of the subcategorization of type1/2 papillary RCC and inclusion of eosinophilic solid and cystic RCC as an independent tumor entity. The WHO/ISUP grading now has been recommended for all RCCs. Major nomenclature changes include replacement of histologic 'variants' by 'subtypes', 'clear cell papillary renal cell carcinoma' to 'clear cell renal cell tumor','TCEB1-mutated RCC' to 'ELOC-mutated RCC', 'hereditary leiomyomatosis and renal cell carcinoma' to 'fumarate hydratase-deficient RCC', 'RCC-Unclassified' to 'RCC-NOS', 'primitive neuroectodermal tumor' to 'embryonic neuroectodermal tumor', 'testicular carcinoid' to 'testicular neuroendocrine tumor', and 'basal cell carcinoma of the prostate' to 'adenoid-cystic (basal-cell) carcinoma of the prostate'. Metastatic, hematolymphoid, mesenchymal, melanocytic, soft tissue and neuroendocrine tumors are collectively discussed in separate chapters. It has been suggested that the morphological classification of urothelial cancer be replaced with a new molecular taxonomic classification system.
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Affiliation(s)
- Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute and CORE Diagnostics, Gurgaon, India (Zipcode:122016)
| | - Anandi Lobo
- Department of Pathology and Laboratory Medicine, Kapoor Center of Urology and Pathology, Raipur, India (Zipcode:490042)
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Lifespan Academic Medical Center, Providence, RI, USA (Zipcode: 02903).
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Antar SA, El-Gammal MA, Hazem RM, Moustafa YM. Etanercept Mitigates Cadmium Chloride-induced Testicular Damage in Rats "An Insight into Autophagy, Apoptosis, Oxidative Stress and Inflammation". ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:28194-28207. [PMID: 34993805 DOI: 10.1007/s11356-021-18401-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
RATIONALE Cadmium (Cd) is an environmental and occupational toxin that represents a serious health hazard to humans and other animals. One of the negative consequences of cadmium exposure is testicular injury. OBJECTIVE This study aimed to investigate the therapeutic effect of etanercept against cadmium chloride-induced testicular damage and the probable underlying mechanisms of its action. METHODS A total of sixty rats were divided into six groups: control, cadmium chloride (CdCl2) (7 mg/ kg i.p.), and CdCl2 treated with etanercept (5,10 and 15 mg/kg s.c.) and etanercept only (15 mg/kg s.c.). CdCl2 was administrated as a single dose, while etanercept was administered every 3 days for 3 weeks. RESULTS CdCl2 reduced serum testosterone, testicular glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD). However, it elevated the levels of malondialdehyde (MDA) and microtubule-associated protein light chain 3B (LC3B) in the testes. Cadmium caused pathogenic alterations as well as increased levels of inflammatory biomarkers such as tumor necrosis factor-alpha (TNF-α) and nuclear factor-kappa B (NF-κB). Besides, the gene expressions of caspase-3 and inducible nitric oxide synthase (i-NOS) and Beclin-1 protein increased with CdCl2 exposure. Interestingly, etanercept relieved the previous toxic effects induced by CdCl2 in a dose-dependent manner as evidenced by inhibition of oxidative stress, inflammatory markers, Beclin-1, LC3B, and caspase-3 accompanied by improvement in histopathological changes. CONCLUSION Etanercept provides a potential therapeutic approach to treat testicular tissue against the damaging effects of Cd by reducing oxidative stress, inflammation, apoptosis, and autophagy.
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Affiliation(s)
- Samar A Antar
- Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Horus University, New Damietta, 34518, Egypt.
| | - Mohamad A El-Gammal
- Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Horus University, New Damietta, 34518, Egypt
| | - Reem M Hazem
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522, Egypt
| | - Yasser M Moustafa
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522, Egypt
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Badr University, Badr University Cairo, 11829, Egypt
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Roth LM, Michal M, Cheng L. Genetic and epigenetic regulation in neoplasms composed of both germ cells and sex cord elements. Pathol Res Pract 2021; 222:153428. [PMID: 33862561 DOI: 10.1016/j.prp.2021.153428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Lawrence M Roth
- Department of Pathology, Indiana University School of Medicine, Van Nuys Medical Science Building 128, 635 Barnhill Drive, Indianapolis, IN, 46202-5120, United States.
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Pilsen, Pilsen, 304 60, Czech Republic.
| | - Liang Cheng
- Department of Pathology and Urology, Indiana University School of Medicine, Van Nuys Medical Science Building 128, 635 Barnhill Drive, Indianapolis, IN, 46202-5120, United States.
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Roth LM. On the existence of testicular mixed germ cell-germ cell sex cord-stromal tumor as a distinct entity. Virchows Arch 2021; 478:811. [PMID: 33512589 DOI: 10.1007/s00428-021-03024-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/01/2021] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Lawrence M Roth
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Roth LM, Cheng L. Mixed germ cell-sex cord stromal tumour of the testis and ovary: comparison and contrast. Pathology 2020; 53:166-169. [PMID: 33358757 DOI: 10.1016/j.pathol.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
Mixed germ cell-sex cord stromal tumours (MGC-SCSTs) of the testis and ovary differ significantly in their histological appearance, clinical behaviour, and molecular genetics. Until recently, the germ cells of testicular MGC-SCST were considered to be invariably histologically bland, whereas those from neoplasms that arise in the ovary have histological features characteristic of premalignancy. However, a recent histological and molecular genetic study demonstrated histological abnormalities and multiple chromosomal losses and gains in a small subset of testicular cases, thus providing the first evidence that testicular MGC-SCSTs can exceptionally show histological and molecular abnormalities. All cases of testicular MGC-SCST reported to date have been clinically benign, whereas ovarian examples are sometimes the precursor of a malignant germ cell neoplasm that can be clinically aggressive. Both genetic and epigenetic influences likely account for dissimilarities in these uncommon gonadal neoplasms.
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Affiliation(s)
- Lawrence M Roth
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Roth LM. Evidence supporting the existence of testicular mixed germ cell-sex cord stromal tumor Pathol Res Pract. Pathol Res Pract 2020; 217:153296. [PMID: 33307342 DOI: 10.1016/j.prp.2020.153296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Lawrence M Roth
- Department of Pathology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202-5120, USA.
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Affiliation(s)
- J Wolter Oosterhuis
- Department of Pathology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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