Gonadoblastoma: structures and background of development

Recent Advances in the Pathology and Classification of Gonadal Neoplasms Composed of Germ Cells and Sex Cord Derivatives

In recent years, our understanding of neoplasms composed of germ cells and sex cord derivatives has increased. In this review, advances in the classification and pathology of ovarian germ cell-sex cord-stromal tumors are discussed. Only 2 neoplasms, each with a distinctive pathogenesis and clinicopathologic features, are included in this category. Gonadoblastoma is a tumor that usually occurs in the dysgenetic gonads of intersex patients that have a Y chromosome, whereas mixed germ cell-sex cord-stromal tumor arises in normal gonads in patients without sex chromosomal abnormalities. Ovarian mixed germ cell-sex cord-stromal tumors differ from their testicular counterparts in their histological appearance, immunohistochemical staining reactions, and biological behavior probably because the latter show a greater degree of maturity of their germ cell component. The introduction of cisplatin-based chemotherapy and the application of tumor markers have dramatically improved the clinical outlook for those patients who develop secondary malignant germ cell neoplasms.

Gonadoblastoid testicular dysplasia in Walker-Warburg syndrome

Two male fetuses (18 and 22 weeks gestation) and a 3-month-old male infant (full sibling of the younger fetus) who were diagnosed with Walker-Warburg syndrome (WWS) on the basis of neuropathologic autopsy findings in brain, eyes, and muscle also had micro-orchia and, microscopically, diffuse gonadoblastoid dysplasia in the testes. Both fetuses also had a miniature left ureter and cystic dysplastic left kidney. Testes from control fetuses of 17-24 weeks gestation with normal karyotype and no central nervous system abnormalities (group A, n = 50), a variety of central nervous system abnormalities (group B, n = 50), or an autosomal aneuploidy syndrome with or without central nervous system abnormalities (group C, n = 30) had no diffuse dysplasia, although a single gonadoblastoid seminiferous tubular profile was present in three controls. Testicular morphology was normal in older fetuses and infants with a wide variety of central nervous system malformations (group D, n = 50). We found no evidence of hypogonadotrophic hypogonadism in the three WWS cases to account for the small penis and incompletely descended testes commonly reported in this condition. We concluded that the apparent specificity of the gonadoblastoid testicular dysplasia to WWS suggests that the gene defect directly affects testicular development.

Ovarian granulosa cell proliferations of pregnancy: a report of nine cases

Granulosa cell proliferations that simulated small neoplasms were incidental findings in the ovaries of nine pregnant women. The lesions were typically multiple and associated with atretic follicles. In eight cases, the granulosa cells were arranged in solid, insular, microfollicular, and trabecular patterns, but in the ninth case, there was a prominent sertoliform tubular pattern. The granulosa cells typically contained scanty cytoplasm and grooved nuclei, resembling the cells of adult-type granulosa cell tumors. However, in one case large nodules of markedly luteinized cells with variably sized, round, nongrooved nuclei were present; the nodules in this case superficially resembled pregnancy luteomas. In the case with a sertoliform pattern, the cells had abundant vacuolated cytoplasm. The lesions described probably reflect an unusual physiological response to the elevated chorionic gonadotropin level of pregnancy rather than early stages of neoplasia.

Ovarian tumorlike structures, biovular follicles, and binucleated oocytes in children: their frequency and possible pathologic significance

The occurrence of microscopic gonadoblastomalike and sex cord tumor with annular tubuleslike structures, biovular follicles, and binucleated oocytes was analyzed in 288 ovaries from 222 consecutive pediatric autopsies. Tumorlike structures were identified in 29% of the autopsies studied, biovular follicles were observed in 52%, and binucleated oocytes in 19%. These changes were not observed in 22 ovaries from adults. Sixteen cases with gonadoblastomalike structures were stained immunohistochemically for placental alkaline phosphatase and were nonreactive for this marker. These tumorlike structures and multiovular follicles are probably an expression of abnormal folliculogenesis that apparently disappears as the child matures and should not be confused with true neoplasms. Although these morphologic structures resemble the patterns of specific types of gonadal neoplasms, there is little evidence to suggest any potential for future neoplastic transformation.

Structures mimicking sex cord-stromal tumours and gonadoblastomas in the ovaries of normal infants and children

A chance finding of structures resembling gonadoblastomas in the ovaries of a child with lissencephaly prompted a detailed review of all ovarian histology obtained at autopsy over a 12 month period. Fifty-five stillbirths, infants and children were studied ranging from 20 weeks gestational age to 2.5 years post-natal age. In 19 infants structures mimicking gonadoblastomas and sex cord tumours with annular tubules were seen. In all but one case these structures were found in association with follicular cysts and they closely resembled the atretic follicles often seen in the stroma surrounding the follicular cysts. They differed from the atretic follicles only by virtue of their being larger. In addition, in several infants structures resembling Sertoli cell tubules or clusters of Leydig cells were found. When present, these structures always co-existed with sex cord tumours with annular tubules and gonadoblastoma-like lesions. The abnormal stromal lesions and follicular cysts were found most frequently at the stage of development when a massive 'physiological' reduction of oocytes occurs. It is suggested that the 'abnormal' structures identified in this report represent the 'first hit' of oncogenesis and could serve as the precursor of many of the sex cord-stromal tumours, and possibly germ cell neoplasms, seen in childhood.