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Segura SE, Young RH, Oliva E, Ulbright TM. Malignant Gonadal Germ Cell Tumors (Other Than Pure Germinoma) in Patients With Disorders of Sex Development: A Report of 21 Cases Based Largely on the Collection of Dr Robert E. Scully, Illustrating a High Frequency of Yolk Sac Tumor With Prominent Hepatoid and Glandular Features. Am J Surg Pathol 2022; 46:664-676. [PMID: 34560684 DOI: 10.1097/pas.0000000000001815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe 21 nonpure germinomatous gonadal germ cell tumors (9 with a germinoma component), all but 1 associated with gonadoblastoma, in patients with disorders of sex development who ranged from 7 to 36 years old (average, 20 y). Twenty patients were clinically described as phenotypic females with ambiguous genitalia/virilization and primary amenorrhea. The most common documented peripheral karyotype was 46,XY (10/12; 83%). Fifteen of 16 tumors with available clinicopathologic data were unilateral. They ranged from 7 to 30 cm (mean, 15.5 cm) and were solid and cystic with frequent necrosis and hemorrhage. Gonadoblastoma, in its classic (70%), dissecting (5%), or combined (25%) forms, was identified in all but 1. The malignant germ cell tumors were typically mixed except for 5 pure yolk sac tumors and 1 expansile gonadoblastoma with syncytiotrophoblast cells. When admixed, the most common component was yolk sac tumor (n=10), followed by germinoma (n=9), embryonal carcinoma (n=5), choriocarcinoma (n=4), immature teratoma (n=3), and teratoma (n=2). Typical morphologic patterns of yolk sac neoplasia, including reticular/microcystic, solid (including blastema-like), and endodermal sinus (Schiller-Duval bodies), were seen, as well as glandular (n=10) and hepatoid (n=6) differentiation, with cystically dilated glands and diffuse hepatoid morphology in 3 and 2 tumors, respectively. Two yolk sac tumors showed a sarcomatoid pattern. Somatic-type malignancies (alveolar rhabdomyosarcoma and low-grade spindle cell sarcoma, not otherwise specified) were identified in 1 case each. This is the first large series of germ cell tumors other than typical pure germinoma associated with gonadoblastoma. The high frequency of yolk sac tumor with glandular (especially cystic glandular) and hepatoid morphologies is noteworthy, and their presence should prompt further evaluation for an associated gonadoblastoma and possible disorder of sex development.
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Affiliation(s)
- Sheila E Segura
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Robert H Young
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Esther Oliva
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Thomas M Ulbright
- Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
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Roth LM, Czernobilsky B, Mann SA, Cheng L. Gonadoblastoma versus ovarian mixed germ cell-sex cord stromal tumor in women or girls with no evidence of a disorder of sex development: A problem in differential diagnosis. Pathol Res Pract 2020; 216:153198. [PMID: 33002849 DOI: 10.1016/j.prp.2020.153198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
Gonadoblastoma occurring in a normal girl or woman has been confused with ovarian mixed germ cell-sex cord stromal tumor (MGC-SCST) due to a lack of knowledge that the former occurs occasionally in a normal woman or girl. In this article, we develop histological criteria that facilitate the distinction of gonadoblastoma in an individual with a normal karyotype and no evidence of a disorder of sex development from ovarian MGC-SCST. We reviewed the histological findings of gonadoblastoma occurring in normal individuals and compared them to cases of ovarian MGC-SCST in our files. The histological findings of gonadoblastoma differ substantially from those of ovarian MGC-SCST. Importantly, gonadoblastoma contains two types of transformed germ cells, some histologically benign and others premalignant, whereas MGC-SCST contains only a single type, typically premalignant in the ovary and benign in the testis. Furthermore, degenerative changes of hyalinization and calcification are common in gonadoblastoma, whereas they are extremely rare in MGC-SCST. Although the great majority of cases of gonadoblastoma occur in an individual with a disorder of sex development and an abnormal karyotype, a substantial number arise in a normal woman or girl with no evidence of a disorder of sex development. In the latter circumstance, it is important to distinguish gonadoblastoma from ovarian MGC-SCST. It is very likely that those gonadoblastomas arising in a normal individual develop through a different molecular pathway than the ones that occur in the dysgenetic gonads of an individual with a disorder of sex development.
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Affiliation(s)
- Lawrence M Roth
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Van Nuys Medical Science Building 128, 635 Barnhill Drive, Indianapolis, IN 46240-5120, United States.
| | | | - Steven Alexander Mann
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Van Nuys Medical Science Building 128, 635 Barnhill Drive, Indianapolis, IN 46240-5120, United States
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Van Nuys Medical Science Building 128, 635 Barnhill Drive, Indianapolis, IN 46240-5120, United States; Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46240-5120, United States
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Classic and “Dissecting” Gonadoblastoma in a Phenotypic Girl With a 46, XX Peripheral Karyotype and No Evidence of a Disorder of Sex Development. Int J Gynecol Pathol 2019; 38:581-587. [DOI: 10.1097/pgp.0000000000000551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suzuki M, Ozaki M, Ano N, Nomura K, Ozaki K, Narama I. Testicular gonadoblastoma in two pet domestic rabbits (Oryctolagus cuniculus domesticus). J Vet Diagn Invest 2011; 23:1028-32. [DOI: 10.1177/1040638711406975] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Testicular gonadoblastoma is an uncommon tumor in domestic animals. The current study describes a testicular gonadoblastoma in 2 pet domestic rabbits ( Oryctolagus cuniculus domesticus) based on the histomorphological, immunohistochemical, and ultrastructural characteristics of the tumor. The tumor tissue consisted of discrete tubular structures separated by a fibrous stroma. The tubular structures were composed of large round cells similar in appearance to germ cells in the seminiferous tubules, and small spindle cells with oval or elongated nuclei resembling Sertoli cells. The spindle cells showed peculiar structural patterns arranged in a coronal or follicular pattern, often forming Call–Exner bodies like those in an ovarian granulosa cell tumor. One case was concomitant with seminoma. Immunohistochemistry revealed large round cells that were positive for c-kit and placental alkaline phosphatase, while spindle cells were positive for vimentin and Wilms tumor protein. Ultrastructurally, the spherical eosinophilic material (Call–Exner body) consisted of duplicated basal lamina, and sex cord components surrounded a single degenerative cell similar to a germ cell.
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Affiliation(s)
- Manabu Suzuki
- Sumika Technoservice Corporation, Osaka, Japan (Suzuki, M Ozaki)
- Marupi Lifetech Company Ltd., Ikeda, Osaka, Japan (Ano, Nomura)
- Department of Pathology, Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan (K Ozaki, Narama)
| | - Masakazu Ozaki
- Sumika Technoservice Corporation, Osaka, Japan (Suzuki, M Ozaki)
- Marupi Lifetech Company Ltd., Ikeda, Osaka, Japan (Ano, Nomura)
- Department of Pathology, Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan (K Ozaki, Narama)
| | - Naoko Ano
- Sumika Technoservice Corporation, Osaka, Japan (Suzuki, M Ozaki)
- Marupi Lifetech Company Ltd., Ikeda, Osaka, Japan (Ano, Nomura)
- Department of Pathology, Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan (K Ozaki, Narama)
| | - Koji Nomura
- Sumika Technoservice Corporation, Osaka, Japan (Suzuki, M Ozaki)
- Marupi Lifetech Company Ltd., Ikeda, Osaka, Japan (Ano, Nomura)
- Department of Pathology, Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan (K Ozaki, Narama)
| | - Kiyokazu Ozaki
- Sumika Technoservice Corporation, Osaka, Japan (Suzuki, M Ozaki)
- Marupi Lifetech Company Ltd., Ikeda, Osaka, Japan (Ano, Nomura)
- Department of Pathology, Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan (K Ozaki, Narama)
| | - Isao Narama
- Sumika Technoservice Corporation, Osaka, Japan (Suzuki, M Ozaki)
- Marupi Lifetech Company Ltd., Ikeda, Osaka, Japan (Ano, Nomura)
- Department of Pathology, Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata, Osaka, Japan (K Ozaki, Narama)
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Ali TZ, Parwani AV. Benign and Malignant Neoplasms of the Testis and Paratesticular Tissue. Surg Pathol Clin 2009; 2:61-159. [PMID: 26838100 DOI: 10.1016/j.path.2008.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Benign and malignant tumors of the testes and paratesticular tissues present an interesting spectrum of diagnostic entities often encountered in routine surgical pathology practice. Germ cell tumors are the most common tumors of the testes and, despite a rising incidence, have excellent prognosis because of their radiosensitivity and/or effective chemotherapeutic agents. The proper classification of these tumors aids in the choice of appropriate treatment options. This article reviews benign and malignant neoplastic entities of the testes and paratesticular tissues and illustrates the classic pathologic characteristics. The differential diagnosis, along with ancillary studies, clinical significance, and presentation are discussed also.
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Affiliation(s)
- Tehmina Z Ali
- Department of Pathology, University of Maryland Medical Center, NBW47, 22 S. Greene Street, Baltimore, MD 21201, USA.
| | - Anil V Parwani
- Pathology Informatics, Shadyside Hospital, University of Pittsburg Medical Center, 5230 Centre Avenue, Suite WG02.10, Pittsburgh, PA 15232, USA
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Jorgensen EV, Steffensen T, Gilbert-Barness E, Nora F, Witt LC. Clinical pathologic correlation: primary amenorrhoea and bilateral adnexal tumors. Fetal Pediatr Pathol 2008; 27:245-58. [PMID: 19065322 DOI: 10.1080/15513810802447920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- E Verena Jorgensen
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida, USA
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Costa T, Lambert M, Teshima I, Ray PN, Richer CL, Dallaire L. Monozygotic twins with 45,X/46,XY mosaicism discordant for phenotypic sex. ACTA ACUST UNITED AC 1998. [DOI: 10.1002/(sici)1096-8628(19980106)75:1<40::aid-ajmg9>3.0.co;2-u] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Coppes MJ, Rackley R, Kay R. Primary testicular and paratesticular tumors of childhood. MEDICAL AND PEDIATRIC ONCOLOGY 1994; 22:329-40. [PMID: 8127257 DOI: 10.1002/mpo.2950220506] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Testicular and paratesticular neoplasms are uncommon tumors of childhood. Consequently, the experience gained with regard to their optimal management is limited in any given children's cancer centre. Here we review the classification, diagnosis, and staging of testicular and paratesticular neoplasms and subsequently discuss the more frequently occurring ones: germ cell tumors, gonadal stromal tumors, gonadoblastoma, tumors of the supporting tissue, lymphomas and leukemias, tumor-like lesions, secondary tumors, and tumors of the adnexa.
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Affiliation(s)
- M J Coppes
- Department of Cancer Biology, Cleveland Clinic Foundation, Ohio
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Affiliation(s)
- J L Rutgers
- Department of Pathology, Harbor-UCLA Medical Center, Torrance 90509
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Abstract
Testicular tumors of non-germ cell origin represent from 5 percent to 10 percent of all testicular neoplasms. Included in this group are sex cord/gonadal stromal tumors, most originating from Leydig or Sertoli cells, mixed tumors, and tumors of mesenchymal or hematopoietic origin. In addition, various miscellaneous lesions, tumor-like conditions, and secondary testicular tumors may be classified as non-germ cell tumors. This review covers the presentation, diagnosis, and treatment of these rare lesions.
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Affiliation(s)
- J P Dilworth
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Chapman WH, Plymyer MR, Dresner ML. Gonadoblastoma in an anatomically normal man: a case report and literature review. J Urol 1990; 144:1472-4. [PMID: 2231948 DOI: 10.1016/s0022-5347(17)39772-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gonadoblastoma, a rare gonadal neoplasm, presents most frequently in phenotypic female or phenotypically male patients with dysgenetic gonads or undescended testes. To date, only 2 cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testes. Both of these patients presented with testicular masses and germ cell tumors. We report a case of a genotypically and phenotypically normal, fertile man with descended testes who on evaluation for chronic orchialgia had a gonadoblastoma unaccompanied by a germ cell neoplasm. The tumor was nonpalpable and was initially discovered on scrotal ultrasound.
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Affiliation(s)
- W H Chapman
- General Surgery, Anatomic Pathology and Urology Services, Tripler Army Medical Center, Hawaii
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Affiliation(s)
- M O Savage
- Department of Child Health, St Bartholomew's Hospital, London, UK
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Mostofi F. Editorial Comment. J Urol 1982. [DOI: 10.1016/s0022-5347(17)53768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F.K. Mostofi
- Armed Forces Institute of Pathology Washington, D. C
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Abstract
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.
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Abstract
An exceedingly rare ovarian neoplasm composed of mixed thyroid and Brenner tumor is reported. Review of the literature yielded only one well-documented case previously described. Although the possibility of a "collision" of two different tumors cannot be completely discarded, a possibility of an endodermal teratoma (thyroid-urothelium) is also proposed.
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