Prognosis, malignancy, and curability of the germ-cell tumor occurring in dysgenetic gonads

Clinical pathologic correlation: primary amenorrhoea and bilateral adnexal tumors

A case of bilateral gonadoblastoma in 46,XY gonadal dysgenesis is presented and discussed by both clinician and pathologist, in this traditional clinico-pathologic conference. The discussion includes the differential diagnoses of primary amenorrhoea.

Turner syndrome resulting from partial deletion of Y chromosome short arm: localization of male determinants

Chromosome studies performed because of the possibility of Turner syndrome in an infant girl with pedal edema and mild neck webbing revealed an XY karyotype. Subsequent exploratory laparotomy showed dysplastic ovaries with nests of germ cells with the morphologic features of gonadoblastoma. Repeat chromosome studies from peripheral blood using high-resolution techniques, and also from skin and ovarian fibroblasts, showed an XY karyotype but with a partial deletion of the Y short arm, which was not detected with standard techniques. These findings indicate that testis determining factors are located in this deleted region of the Y chromosome but that other gene(s) remain that induce gonadoblastoma.

Invasive dysgerminoma in a girl with 45,X/46,X; mar mosaicism

We report a 16-year-old girl with features of Turner's syndrome from whom an invasive dysgerminoma was removed. Cytotoxic drugs were given for the next 12 months. Mosaicism of two karyotypes (45,X/46,X; mar) was found in various tissues. The literature is reviewed with special regard to cytogenetic findings and prognosis of malignant growth and differentiation of dysgenetic gonads.

Microscopic gonadoblastoma in dysgenetic gonad of an infant: an ultrastructural study

A microscopic gonadoblastoma found in the dysgenetic gonad of a six-month-old phenotypic female with a 46,XY genotype was studied with the electron microscope and compared with the cells from the testicular portion of the contralateral gonad. The germ cells within the tumor resembled the testicular germ cells and were not different from previously described germ cells in other gonadoblastomas of postpubertal patients. The sex cord cells of the present tumor were inactive and immature, but differed from the Sertoli cells of the patient's testis. The presence of hyalin globules and Call-Exner bodies in the epithelial tumor nests, coupled with the ultrastructural appearance of the sex cord cells is more consistent with them being immature granulosa rather than Sertoli cells. The immaturity of the sex cord cells in gonadoblastoma of this infant suggest that they are responsive to normal regulatory hormonal influences.

XY females with enzyme deficiencies of steroid metabolism. A brief review

The literature on XY females with enzyme deficiencies (17 alpha-hydroxylase, 17 beta-reductase and 17, 20-desmolase) is reviewed. The main features of these individuals are briefly compared with those of XY females with pure gonadal dysgenesis and with testicular feminization.

Testicular tumor in male pseudohermaphrodite with X/XY chromosomal mosaicism

A case of testicular tumor in an intersex patient is presented. Knowledge of the potential of gonadal malignancy is important in the management of disorders of sexual differentiation. These patients, in whom the fields of oncology, embryology, endocrinology, and genetics intersect, provide a fruitful ground for clinical investigation.

Germ cell neoplasms arising in gonadoblastomas

Gonadoblastomas have a propensity to give rise to germ cell neoplasms. This study analyzes the clinicopathologic findings in six phenotypic females with features of 46,XY pure gonadal dysgenesis who developed germinomas and other germ cell tumors in gonadoblastomas. All stages in the evolution of germinoma from the germ cells of gonadoblastoma were observed, including in situ, incipient, microinvasive, and metastatic varieties. Admixtures with teratoma and endodermal sinus tumor occurred in two patients. Germ cell tumors which originate in gonadoblastomas appear to have the same clinical behavior and response to therapy as those that arise de novo in the ovary, testis or extragonadal sites. Although it is debatable whether gonadoblastomas are true neoplasms or blastomatoid dysgenetic malformations, their potential for giving rise to fully malignant germ cell neoplasms must be recognized.

Ultrastructure of gonadoblastoma and disgerminoma (seminoma) in a patient with XY gonadal dysgenesis

The gross and fine morphology of gonadoblastoma and disgerminoma in a young phenotypic female with male karyotype and gonadal dysgenesis is described. Both the rudimentary gonads contain gonadoblastomas on the left side in association with a disgerminoma. In the light microscope the gonadoblastomas show peculiar hyaline masses, surrounded by Sertoli-like cells. In some areas a direct continuation between hyaline masses and basement membranes of round nests or large anomalous seminiferous tubules is obvious. At the ultrastructural level the hyaline masses consist of densely packed, largely concentric membranes closely similar to basement membranes or basal laminae of seminiferous tubules. These observations and the finding of transitional zones with gonadoblastoma elements in enlarged tubular structures suggest that gonadoblastomas originate inside tubules of dysgenetic testes. The peculiar hyaline masses with their concentric membranes might reflect hyperplasia and death of the Sertoli cells, each new generation of cells producing a basement membrane outside the preceding one.

A clinico-pathological study of gonadoblastoma

The clinico-pathological features of 12 patients with a gonadoblastoma are analyzed.

Dysgerminoma in Turner's syndrome

The importance of the Y-chromosome for the germ cell tumour development in gonadal dysgenesis has been emphasized many times. In contrast, only two cases of dysgerminoma or gonadoblastoma had been published so far in the XO-Turner's syndrome. With this report, another case of Turner's syndrome developing a dysgerminoma in a gonadal streak is presented. No Y-chromosome containing stemline could be detected in the patient nor in the tumour. A primary genetic etiology or a mechanism related to early secondary regression or dysgenesis of the gonad are discussed as causative factors in germ cell tumour development within gonadal streaks.

Gonadoblastoma: ultrastructural evidence for testicular origin

A gonadoblastoma arising in the dysgenetic gonad of a virilized 17-year-old Caucasian with a female phenotype and with a 45,X0/46, X-ring-Y genotype was studied by light microscopic histochemistry, electron microscopy, and ultrastructural histochemistry. The gonadoblastoma was composed of nests of cells containg large germ cells and small "granulosa-Sertoli-like cells," and stromal tissue containing "Leydig-like cells." The germ cells were identical to those found in normal fetal gonads and in germ cell tumors. Charcot-Böttcher crystalloids present in the "granulosa-Sertoli-like cells" strongly suggest that they are, in fact, Sertoli cells. Multilayered basal laminae located in the periphery of the tumor nests and in "hyaline bodies" were identical to those surrounding the seminiferous tubules of the adult testis. The "Leydig-like cells" present in the stroma contained occasional dense bodies and crystalloids which characterize the Leydig cells of the fetal testis. Delta 5-3 beta hydroxysteroid dehydrogenase activity was demonstrated in the periphery of lipid droplets and lysosome-like dense bodies of the Leydig cells, and in some Sertoli cells. The findings support the theory that gonadoblastoma arises in a dysgenetic testis rather than in a dysgenetic ovary.

Gonadoblastoma associated with embryonal carcinoma in an anatomically normal man

A case of gonadoblastoma associated with embryonal carcinoma in a normally decended testis of an anatomically normal 20-year-old man is reported. The patient had enlargment of the supraclavicular lymph nodes, which contained metastatic yolk sac tumor. Pulmonary and abdominal metatases were present. Despite chemotherapy and radiotherapy the patient died 9 months after presentation. Review of the literature concerning gonadoblastoma in phenotypic male patients is presented.