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Acosta AM, Idrees MT, Berney DM, Colecchia M. Contemporary Updates on Sex Cord-stromal Tumors of the Testis. Adv Anat Pathol 2024; 31:126-135. [PMID: 38053410 DOI: 10.1097/pap.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Testicular sex cord-stromal tumors (TSCSTs) are relatively rare, representing ~5% of testicular neoplasms overall. Historically, TSCSTs have been classified into 3 major entities: Leydig cell tumor, Sertoli cell tumor, and granulosa cell tumor. In recent years, immunophenotypic and molecular analyses have led to a more detailed understanding of the biological and genomic features of these neoplasms, resulting in the description of new entities, some of which have been included in the latest WHO classification. This review summarizes novel histopathologic, clinical, and molecular findings that may lead to a reappraisal of established concepts and help improve the diagnosis and clinical management of TSCSTs in the coming years.
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Affiliation(s)
- Andrés M Acosta
- Department of Pathology, Indiana University, Indianapolis, IN
| | | | - Daniel M Berney
- Department of Pathology, Centre for Cancer Biomarkers & Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Maurizio Colecchia
- Department of Pathology, Università Vita Salute San Raffaele, Milan, Italy
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2
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Rezzoug F, Chibani H, El Ouardani S, Al Jarroudi O, Brahmi SA, Afqir S. A testicular mass found to be a rare testicular adult-type granulosa cell tumor: A case report and literature review. Int J Surg Case Rep 2024; 115:109259. [PMID: 38237414 PMCID: PMC10828794 DOI: 10.1016/j.ijscr.2024.109259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Granulosa cell tumors (GCTs) are rare tumors, which mostly affect the ovaries. GCTs are classified into two types: juvenile and adult. Adult testicular GCTs are potentially malignant sex cord-stromal tumors. CASE PRESENTATION Here, we report a case of a 63-year-old man who presented with a right testicular nodule. Testicular ultrasound showed a hypoechoic tissue mass, measuring 3 cm and hyper vascularized in the color Doppler. A radical orchidectomy was performed. Histology showed a typical adult-type Granulosa cell tumor. After 12 months follow up, the patient is doing well and disease-free. CLINICAL DISCUSSION According to our case and a review of the literature, this type of tumor is an uncommon and slow-growing neoplasm. The diagnosis is confirmed by histology, treatment is based on surgery, radical orchidectomy. Long-term follow-up of patients is essential because distant metastases may emerge late in the clinical course. CONCLUSION This case report adds valuable insights to the limited literature on adult testicular Granulosa cell tumors. Radical orchidectomy remains the optimal treatment, and early diagnosis, coupled with surgery, significantly enhances prognosis.
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Affiliation(s)
- Fatima Rezzoug
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco.
| | - Hind Chibani
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
| | - Soufia El Ouardani
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
| | - Ouissam Al Jarroudi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
| | - Sami Aziz Brahmi
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohammed I(st) University, Oujda, Morocco
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3
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Abiuso AMB, Varela ML, Raices T, Irusta G, Lazzati JM, Besio Moreno M, Cavallotti A, Belgorosky A, Pignataro OP, Berensztein E, Mondillo C. Histidine decarboxylase inhibitors: a novel therapeutic option for the treatment of leydigioma. J Endocrinol 2022; 255:103-116. [PMID: 36069766 DOI: 10.1530/joe-21-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/07/2022] [Indexed: 11/08/2022]
Abstract
Recent reports indicate an increase in Leydig cell tumor (LCT) incidence. Radical orchiectomy is the standard therapy in children and adults, although it entails physical and psychosocial side effects. Testis-sparing surgery can be a consideration for benign LCT of 2.5 cm or less in size. Malignant LCTs respond poorly to conventional chemotherapy, so new treatment modalities are needed. In this study, we observed increased histidine decarboxylase expression and pro-angiogenic potential in LCT surgically resected from pediatric patients (fetal to pubertal) vs control samples from patients without endocrine or metabolic disorders which were collected at necropsy. We, therefore, evaluated for the first time the antitumor efficacy of two histidine decarboxylase inhibitors (α-methyl-dl-histidine dihydrochloride (α-MHD) and epigallocatechin gallate (EGCG)), alone and combined with carboplatin, in two preclinical models of LCT. MA-10 and R2C Leydig tumor cells, representing two different LCT subtypes, were used to generate syngeneic and xenograft mouse LCT models, respectively. In the syngeneic model, monotherapy with α-MHD effectively reduced tumor growth and angiogenesis. In the xenografts, which showed co-expression of histidine decarboxylase and CYP19, the combination of EGCG plus carboplatin was the most effective therapy, leading to LCT growth arrest and undetectable levels of plasmatic estradiol. Testicular and body weights remained unaltered. On the basis of this study, histidine decarboxylase may emerge as a novel pharmacological target for LCT treatment.
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Affiliation(s)
- Adriana María Belén Abiuso
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - María Luisa Varela
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Trinidad Raices
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Griselda Irusta
- Laboratory of Ovarian Physiology and Tumor Biology, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Juan Manuel Lazzati
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Marcos Besio Moreno
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Alina Cavallotti
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Alicia Belgorosky
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Omar Pedro Pignataro
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
- Department of Biological Chemistry, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Esperanza Berensztein
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Carolina Mondillo
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
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Cheema A, Siddiqui F, Kamran A. Germ Cell Tumor With Somatic-Type Malignancy: A Case Report and Review of the Literature. Cureus 2022; 14:e25879. [PMID: 35844345 PMCID: PMC9278484 DOI: 10.7759/cureus.25879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/05/2022] Open
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Tannous T, Miskovsky J, Keating M. Testicular Germ Cell Tumors: Paraneoplastic Syndromes and the Role of Beta-Human Chorionic Gonadotropin. Cureus 2021; 13:e14286. [PMID: 33968500 PMCID: PMC8096621 DOI: 10.7759/cureus.14286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Choriocarcinoma syndrome is a rare phenomenon that occurs in male patients with testicular choriocarcinoma. Male patients who have a testicular non-seminomatous germ cell tumor (TNSGCT) with at least partial choriocarcinoma histology, and metastases to the lungs and/or other extragonadal sites, as well as a markedly elevated beta-human chorionic gonadotropin (HCG), have been prone to pulmonary bleeding, hypoxia, and acute respiratory distress syndrome (ARDS). The respiratory complications occur immediately after chemotherapy is administered or, in some cases, spontaneously. Paraneoplastic hyperthyroidism is another entity described in patients with testicular choriocarcinoma, whereby high levels of HCG (typically >50,000 mIU/ml) induce clinical and laboratory characteristics of hyperthyroidism. We present the case of a male patient diagnosed with TNSGCT and found to have both choriocarcinoma syndrome and paraneoplastic hyperthyroidism in the setting of only mildly elevated HCG levels. We compare our case with similar cases published previously while questioning the quantitative role of HCG.
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Affiliation(s)
- Toufic Tannous
- Internal Medicine, Roger Williams Medical Center/Boston University, Providence, USA
| | - John Miskovsky
- Department of Medicine, Roger Williams Medical Center, Providence, USA
| | - Matthew Keating
- Division of Hematology and Oncology, University of California Irvine, Irvine, USA
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Spermatogenesis in pre-pubertal boys with Leydig cell neoplasms suggests paracrine stimulation by testosterone. J Pediatr Urol 2021; 17:48.e1-48.e6. [PMID: 33129671 DOI: 10.1016/j.jpurol.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/24/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pediatric Leydig cell tumors (LCTs) represent approximately 4% of pre-pubertal testicular tumors and are known to cause precocious puberty secondary to testosterone production. While gonadotropins and testosterone are known to initiate spermatogenesis beginning in puberty, it is yet to be determined if a similar phenomenon is triggered by isolated testosterone production in prepubescent boys. OBJECTIVE To determine if testicular pathology in pre-pubertal pediatric patients with LCTs exhibit spermatogenesis secondary to paracrine testosterone stimulation. STUDY DESIGN We reviewed patients who underwent orchiectomy for a testicular tumor from 2003-17. We included patients with LCTs and compared them to children with non-LCT pathology (teratomas and epidermoid cysts). We excluded other pathologies and tumors in pubertal patients. Data were collected on the presence of spermatogenesis on pathology, tumor markers and serum hormone results. RESULTS Orchiectomy for testicular tumors were completed in 66 patients, of which 20 were included in the non-LCT group and 9 in the LCT group. Two of the 9 LCT patients had bilateral pathology. Age at presentation was 6.3 ± 5.8 years for the non-LCT group vs. 8.4 ± 1.6 years for LCTs (p = 0.261). Spermatogenesis was detected in 7 (64%) LCT specimens vs 2 (10%) non-LCT specimens (p = 0.002). Age of the spermatogenesis patients in the non-LCT group (11.08 ± 2.5 years) was older than LCT ones (8.3 ± 2.0 years), suggesting that spermatogenesis in the non-LCT group may be due to early pubertal development. The summary figure demonstrates spermatogenesis identified in a pre-pubertal LCT patient. DISCUSSION In this study, pre-pubertal males with LCTs were identified to have pathology evidence of spermatogenesis compared to controls with non-LCT pathology. This represents the first study assessing paracrine testosterone effects on spermatogenesis in pre-pubertal patients with LCTs. In contrast, adult literature on LCTs primarily report on resulting concerns for fertility, gynecomastia and testicular atrophy. CONCLUSION LCTs can induce spermatogenesis in prepubertal patients. This reinforces the hypothesis that paracrine testosterone signaling plays a role in spermatogenesis. Our findings could help explore novel fertility preservation opportunities in children.
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Liang Z, He Z, Chen C, Zhang F, Li J, Wu J. Microscopic testicular sperm extraction or post-operative sperm reversal in functional Leydig cell tumor: case report. Transl Androl Urol 2019; 8:556-561. [PMID: 31807432 DOI: 10.21037/tau.2019.08.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Leydig cell tumors are rare testicular tumors in adults. Hormonal activity is found in 20% of the cases with endocrine abnormalities, which may result in azoospermia. The appropriate management to achieve oncologic control and simultaneously obtain sperm remains a challenge. A patient sought assistance with fertility after a diagnosis of azoospermia accompanied by unilateral suspected Leydig cell tumor. The patient underwent unilateral orchidectomy along with microscopic testicular sperm extraction (mTESE) for sperm identification. Rare teratospermia was found during mTESE, hormones tended to be normal, and sperm reversal appeared postoperatively. Postoperative semen examination revealed oligozoospermia, and the parameters decreased further after 3 months. The androgen rebound effect promoted sperm level over the baseline within 3 months after surgery. The anticipated sperm reversal postoperatively rather than mTESE during routine orchidectomy achieved sperm acquisition. This case particularly highlights the androgen rebound effect, which elevated the sperm level beyond baseline within 3 months after surgery. Sperm cryopreservation is thus strongly recommended 3 months postoperatively and no more than 4 months.
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Affiliation(s)
- Zhongyan Liang
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Zhanwang He
- Department of Reproductive Medicine Center, Ninghai Maternal and Child health Hospital, Ninghai 315600, China
| | - Chong Chen
- Department of Ultrasonography, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Fengbin Zhang
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jingping Li
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jinggen Wu
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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8
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Mukendi AM, Friedman R, Ismail A. Malignant epidural spinal cord compression secondary to testicular cancer (mixed choriocarcinoma and seminoma) in the immediate post radical orchidectomy period. Clin Case Rep 2019; 7:955-959. [PMID: 31110723 PMCID: PMC6509927 DOI: 10.1002/ccr3.2131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/21/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022] Open
Abstract
Acute spinal cord compression in the immediate postoperative period from a possible choriocarcinoma syndrome (CCS) on hemorrhagic epidural spinal metastasis has never been described before and needs to be promptly recognized and managed. A low hemoglobin associated with choriocarcinoma should raise suspicion of this syndrome.
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Affiliation(s)
- Alain Mwamba Mukendi
- Urology Department, Chris Hani Baragwanath Academic HospitalUniversity of the WitwatersrandSowetoSouth Africa
| | - Robin Friedman
- Urology Department, Chris Hani Baragwanath Academic HospitalUniversity of the WitwatersrandSowetoSouth Africa
| | - Abdullah Ismail
- Anatomical Pathology Department, Chris Hani Baragwanath Academic HospitalUniversity of the WitwatersrandSowetoSouth Africa
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Abstract
PURPOSE OF REVIEW In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs). RECENT FINDINGS Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs, with recent evidence showing that the adverse health outcomes of etoposide and cisplatin for four cycles in comparison to bleomycin, etoposide, and cisplatin for three cycles appear to be similar. Recent data showed that multidisciplinary clinic approach and management in experienced academic centers were associated with improved overall survival in GCT patients. There are currently multiple conventional-dose chemotherapy options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy regimens continue to be developed. The role of salvage conventional-dose chemotherapy versus high-dose chemotherapy is currently being investigated prospectively. Recent reports suggested that brentuximab vedotin could be a potential salvage option for cluster of differentiation 30 positive refractory GCTs. On the other hand the results of the first phase II clinical trial investigating pembrolizumab in refractory GCTs were disappointing showing no clinical activity.Finally, deep exploration of the immune profile of GCTs using immunohistochemistry and gene expression profiling has identified that advanced GCT stage was associated with decreased T-cell and Natural killer-cell signatures, whereas T regulatory, neutrophil, mast cell, and macrophage signatures increased with advanced stage. Even though these results indicated that activated T-cell infiltration correlated with seminoma histology and good prognosis, and could be used in the future as a biomarker, this approach needs to be validated in a large cohort. SUMMARY Remaining challenges to be addressed include minimizing therapeutic toxicity, and improving outcomes in patients with refractory/recurrent GCTs.
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ZENGIN MEHMET. Pure leydig cell tumor: A rare case report. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2018. [DOI: 10.32322/jhsm.453515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Hale GR, Teplitsky S, Truong H, Gold SA, Bloom JB, Agarwal PK. Lymph node imaging in testicular cancer. Transl Androl Urol 2018; 7:864-874. [PMID: 30456189 PMCID: PMC6212624 DOI: 10.21037/tau.2018.07.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Testicular cancer is a rare malignancy mainly affecting young men. Survival for testicular cancer remains high due to the effectiveness of multimodal treatment options. Accurate imaging is imperative to both treatment and follow-up. Both computed tomography (CT) and magnetic resonance imaging (MRI) suffer from size cut-offs as the only distinguishing characteristic of benign vs. malignant lymph nodes and may miss up to 30% of micro-metastatic disease. While functional [positron emission tomography (PET)] imaging may rule out disease in patients with seminoma who have undergone chemotherapy, there is insufficient evidence to recommend its use in other settings. This review highlights the uses and pitfalls of conventional imaging during staging, active surveillance, and post-treatment phases of both seminomatous and non-seminomatous germ cell tumors (NSGCT).
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Affiliation(s)
- Graham R Hale
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Seth Teplitsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hong Truong
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Samuel A Gold
- SUNY Downstate College of Medicine, Downstate Medical Center, Brooklyn, NY, USA
| | - Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Piyush K Agarwal
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Chaker K, Sellami A, Ouanes Y, Chehida MAB, Bibi M, Krarti M, Abid K, Rhouma SB, Nouira Y. Leydig cell testicular tumors: About a case report. Urol Case Rep 2018. [PMID: 29541582 PMCID: PMC5849939 DOI: 10.1016/j.eucr.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kays Chaker
- Departement of Urology La Rabta Hospital, Tunisia
| | | | | | | | - Mokhtar Bibi
- Departement of Urology La Rabta Hospital, Tunisia
| | - Mahdi Krarti
- Departement of Urology La Rabta Hospital, Tunisia
| | - Karem Abid
- Departement of Urology La Rabta Hospital, Tunisia
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Gonzales-Viera OA, Sánchez-Sarmiento AM, Fernandes NCCDA, Guerra JM, Ressio RA, Catão-Dias JL. Fatal haemorrhage and neoplastic thrombosis in a captive African lion (Panthera leo) with metastatic testicular sex cord-stromal tumour. Acta Vet Scand 2017; 59:69. [PMID: 29029632 PMCID: PMC5640962 DOI: 10.1186/s13028-017-0337-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 10/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study of neoplasia in wildlife species contributes to the understanding of cancer biology, management practices, and comparative pathology. Higher frequencies of neoplasms among captive non-domestic felids have been reported most commonly in aging individuals. However, testicular tumours have rarely been reported. This report describes a metastatic testicular sex cord-stromal tumour leading to fatal haemorrhage and thrombosis in a captive African lion (Panthera leo). CASE PRESENTATION During necropsy of a 16-year-old male African lion, the left testicle and spermatic cord were found to be intra-abdominal (cryptorchid), semi-hard and grossly enlarged with multiple pale-yellow masses. Encapsulated haemorrhage was present in the retroperitoneum around the kidneys. Neoplastic thrombosis was found at the renal veins opening into the caudal vena cava. Metastases were observed in the lungs and mediastinal lymph nodes. Histology revealed a poorly differentiated pleomorphic neoplasm comprised of round to polygonal cells and scattered spindle cells with eosinophilic cytoplasm. An immunohistochemistry panel of inhibin-α, Ki-67, human placental alkaline phosphatase, cytokeratin AE1/AE3, cKit, vimentin and S100 was conducted. Positive cytoplasmic immunolabeling was obtained for vimentin and S100. CONCLUSIONS The gross, microscopic and immunohistochemical findings of the neoplasm were compatible with a poorly differentiated pleomorphic sex cord-stromal tumour. Cause of death was hypovolemic shock from extensive retroperitoneal haemorrhage and neoplastic thrombosis may have contributed to the fatal outcome. To our knowledge, this is the first report of sex cord-stromal tumour in non-domestic felids.
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Abstract
PURPOSE OF REVIEW In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs). RECENT FINDINGS Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs. Recent data show that patients with large retroperitoneal lymph node metastases are at increased risk of venous thromboembolism and may benefit from prophylactic anticoagulation. Predictive models have been developed to identify patients with residual retroperitoneal lymph node masses who are more likely to benefit from surgical resection. However, their clinical use remains hampered by relatively low accuracy. There are currently multiple conventional-dose chemotherapy (CDCT) options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy (HDCT) regimens continue to be developed. The role of salvage CDCT versus HDCT is currently being prospectively investigated.Finally, intratumoral heterogeneity is a common finding in cancer and an obvious observation in GCTs. Despite intratumoral heterogeneity, recent studies on nonseminomatous GCT have identified distinct histological subgroups and a potentially lethal clinical phenotype. Importantly, comprehensive molecular profiling so far has not elucidated the biologic basis or the clinical underpinnings of intratumoral heterogeneity in GCTs. SUMMARY Remaining challenges to be addressed include minimizing therapeutic toxicity and improving outcomes in patients with refractory/recurrent GCTs or malignant transformation of teratomas.
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Elbachiri M, Taleb A, Derrabi N, Bouchbika Z, Benchakroun N, Jouhadi H, Tawfiq N, Sahraoui S, Benider A. Adult-type granulosa cell tumor of the testis: report of a case and review of literature. Pan Afr Med J 2017; 26:198. [PMID: 28674591 PMCID: PMC5483374 DOI: 10.11604/pamj.2017.26.198.11523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/02/2017] [Indexed: 12/02/2022] Open
Abstract
Granulosa cell tumors is classified into juvenile and adult types and comprise less than 5% of ovarian tumors in women and are much rarer in men which only 45 have been previously reported. We report here a 40-year young man with a left testicular adult type granulosa cell tumor. The tumor measured 5.5X5X4cm; Immunohistochemical stains showed the tumor diffusely positive for inhibin and vimentin. Post operative CT scans shows a lomboaortic lymphnodes treated by four cycles of chemotherapy type BEP (bleomycin, etoposide, cisplatin). The thoraco abdominal CT scans post chemotherapy shows the disappearance of the right testicular nodule and the lomboaortic lymphnodes. 2 years after treatment, the patient is alive and well with no signs of recurrence. Our report highlights one more case of this very rare tumor of the testis, which is quite problematic In terms of prognosis and management, and for this reason seems to have attracted the interest of many researchers recently.
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Affiliation(s)
| | - Amina Taleb
- Mohamed VI Center of Cancer Treatment, Morocco
| | - Nora Derrabi
- Service d'Anatomie Pathologique, Chu Ibnou Rochd, Casablanca, Morocco
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Maronpot RR, Nyska A, Foreman JE, Ramot Y. The legacy of the F344 rat as a cancer bioassay model (a retrospective summary of three common F344 rat neoplasms). Crit Rev Toxicol 2016; 46:641-75. [PMID: 27278595 PMCID: PMC5020328 DOI: 10.1080/10408444.2016.1174669] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Fischer 344 (F344) rat was used by the National Toxicology Program (NTP) for over 5 decades for toxicity and carcinogenicity studies. However, in 2006, the NTP decided to switch to a different rat stock due largely to high background control incidences of Leydig cell tumors (LCTs) and mononuclear cell leukemia (MNCL), also known as large granular lymphocytic (LGL) leukemia. In the current review, we aim (1) to provide a summary of NTP bioassays with treatment-associated effects involving MNCL and LCTs in addition to male F344-specific tunica vaginalis mesothelioma (TVM); (2) to describe important pathobiological differences between these F344 rat tumor responses and similar target tissue-tumor response in humans; and (3) to present the NTP reasons for switching away from the F344 rat. We show that due to the highly variable background incidence of F344 MNCL, more reliance on historical control data than is usual for most tumor responses is warranted to evaluate potential effect of any chemical treatment in this rat strain. The high spontaneous incidence of LCTs in the testes of male F344 rats has made this tumor endpoint of little practical use in identifying potential testicular carcinogenic responses. TVM responses in F344 rats have a biological plausible relationship to LCTs unlike TVM in humans. Given their high spontaneous background incidence and species-specific biology, we contend that MNCL and LCT, along with TVM responses, in F344 rat carcinogenicity studies are inappropriate tumor types for human health risk assessment and lack relevance in predicting human carcinogenicity.
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Affiliation(s)
| | - Abraham Nyska
- b Sackler School of Medicine, Tel Aviv University, and Consultant in Toxicologic Pathology , Timrat , Israel
| | | | - Yuval Ramot
- d Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Gamboa-Acuña B, Guillén-Zambrano R, Lizzetti-Mendoza G, Soto A. Tumor de Leydig simulando una neoplasia germinal. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Abstract
Management of testicular seminoma has benefited from numerous advances in imaging, radiotherapy, and chemotherapy over the last 50 years leading to nearly 100% disease-specific survival for low-stage seminoma. This article examines the evaluation and management of low-stage testicular seminoma, which includes clinical stage I and IIA disease. Excellent outcomes for stage I seminoma are achieved with active surveillance, adjuvant radiotherapy, and adjuvant single-agent carboplatin. Current areas of research focus on optimizing surveillance regimens and minimizing the morbidity and long-term complications of adjuvant treatment. Radiotherapy continues to be the primary treatment option for patients with clinical stage IIa disease.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, Department of Surgery, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA.
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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Hendry J, Fraser S, White J, Rajan P, Hendry DS. Retroperitoneal lymph node dissection (RPLND) for malignant phenotype Leydig cell tumours of the testis: a 10-year experience. SPRINGERPLUS 2015; 4:20. [PMID: 25625040 PMCID: PMC4300307 DOI: 10.1186/s40064-014-0781-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/30/2014] [Indexed: 11/12/2022]
Abstract
Retroperitoneal lymph node dissection (RPLND) is a prognostic, palliative, and potentially therapeutic procedure for patients with malignant phenotype Leydig cell tumours of the testis. We reviewed the records of patients diagnosed with malignant phenotype Leydig cell tumours of the testis treated by RPLND. Modified template dissection was performed in all cases with extra-template excision of tumour mass in Stage II disease. Routine clinico-radiological follow-up was performed. Six open RPLNDs (1 re-do procedure) were performed on 5 patients diagnosed with Stage I (n = 3) and Stage II (n = 2) malignant phenotype Leydig cell tumour of the testis. Median age = 63 years (range = 55-72). Median peri-operative blood loss = 1500 ml (range = 500-1500 ml). Median operating time = 6 h (range = 4.5-6.5). Two patients with Stage II disease developed post-operative complications of acute kidney injury (n = 1) and pneumonia (n = 1). Median length of stay was 8 days (range = 6-11). RPLND specimens from patients with Stage I were tumour-free, whilst patients with Stage II disease had evidence of metastatic tumour. At latest follow-up (median = 13 months, range = 7-22), no patient with Stage I disease had radiological evidence of recurrence, however the two patients with Stage II disease had died due to tumour recurrence at 13 months and 36 months. RPLND for malignant phenotype Leydig cell testicular tumours appears to be well tolerated. Despite surgery, overall outcomes for Stage II appear to be poor due to the disease phenotype. Larger prospective multi-centre studies are required to determine the definitive criteria for surgery in Stage I disease.
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Affiliation(s)
- Jane Hendry
- Department of Urology, Gartnavel General Hospital, G12 0YN 1053 Great Western Road, Glasgow, UK
| | - Sioban Fraser
- Department of Pathology, Southern General Hospital, G51 4TF 1345 Govan Rd, Glasgow, UK
| | - Jeff White
- Beatson West of Scotland Cancer Centre, G12 0YN 1053 Great Western Road, Glasgow, UK
| | - Prabhakar Rajan
- Department of Urology, Gartnavel General Hospital, G12 0YN 1053 Great Western Road, Glasgow, UK
| | - David S Hendry
- Department of Urology, Gartnavel General Hospital, G12 0YN 1053 Great Western Road, Glasgow, UK
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Nishikawa M, Miyake H, Muramaki M, Fujisawa M. Efficacy and tolerability of TIP (paclitaxel, ifosfamide and cisplatin) incorporated into induction chemotherapy for patients with intermediate- or poor-risk metastatic germ cell tumors. Med Oncol 2014; 31:296. [PMID: 25341372 DOI: 10.1007/s12032-014-0296-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/17/2014] [Indexed: 11/24/2022]
Abstract
The objective of this study was to analyze the clinical outcomes of TIP (paclitaxel, ifosfamide and cisplatin) incorporated into induction chemotherapy for patients with metastatic germ cell tumor (GCT) characterized by unfavorable clinical features. This study included 37 patients, who were categorized into intermediate- or poor-risk GCT according to the International Germ Cell Consensus Classification (IGCCC). All 37 patients received two cycles of bleomycin, etoposide and cisplatin (BEP) followed by several cycles of TIP. Following treatment with TIP, 25 patients achieved the normalization of serum tumor markers. In addition, surgical resection of the residual tumors following TIP was performed in 17 patients who were pathologically diagnosed with no viable cancer cells. At a median follow-up of 36 months, 31 patients were alive, including 27 with no evidence of disease, whereas the remaining six died of disease progression. The 5-year disease-free survival (DFS) and overall survival (OS) rates in these 37 patients were 72.9 and 85.3%, respectively. Despite the lack of a significant predictor of OS, univariate analysis identified the presence of a choriocarcinoma element and IGCCC as significant predictors of DFS, of which only the presence of a choriocarcinoma element appeared to be independently associated with DFS. In this series, treatment-related death did not occur, although 27 patients had at least one adverse event corresponding to grade 3 ≤. Collectively, it would be of worth to pursue the significance of the early incorporation of TIP into induction chemotherapy for patients with intermediate- or poor-risk metastatic GCT in the future.
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Affiliation(s)
- Masatomo Nishikawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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21
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Abstract
The clinicopathologic features of 32 adult granulosa cell tumors (AGCT) of the testis are presented. The patients were from 14 to 87 years of age (mean 40.0 y) and underwent orchiectomy (n=30) or wedge excision (n=2). None had endocrine-related symptoms. The tumors measured 0.5 to 6.0 cm (mean 2.8 cm) and were predominantly well circumscribed and yellow-tan, except for 1, which had infiltrative borders. The predominant pattern was diffuse, but insular, spindled, microfollicular (Call-Exner bodies), trabecular, corded, watered-silk, palisading, and pseudopapillary patterns were also present. The cells contained round to ovoid nuclei with frequent longitudinal nuclear grooves, indistinct cell borders, and varying amounts of eosinophilic cytoplasm. Most tumors contained limited amounts of fibrocollagenous stroma. The mitotic count ranged from 0 to 18/10 high-power fields (HPF) (mean 4.9/10 HPF, ×400). Two tumors had prominent necrosis, and 1 had vessel invasion. Follow-up information was available for 19 patients, with a mean of 51.0 months (range, 1 to 169 mo). All were without evidence of disease except 1 who had lung metastasis at 24 months. Our findings indicate that the morphologic spectrum of testicular AGCT is similar to that of ovarian AGCT. The majority of testicular examples have a good prognosis (compared with a malignant behavior in 2 of 7 cases in 1 prior series). Lymphovascular invasion, infiltrative borders, and size >4 cm may help in identifying cases with aggressive behavior, as these features were present in the one case with metastasis in our series. Mitotic counts varied and do not appear to be of prognostic significance on the basis of our experience.
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Gheorghisan-Galateanu AA. Leydig cell tumors of the testis: a case report. BMC Res Notes 2014; 7:656. [PMID: 25230718 PMCID: PMC4175283 DOI: 10.1186/1756-0500-7-656] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/16/2014] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Leydig cell tumors are the most common non-germ cell gonadal tumors with apparent increased incidence in the last few years. They are usually benign tumors. We report a case of Leydig cell tumor of testis in a patient presenting atypical features. CASE PRESENTATION A 29-year-old Caucasian man, born with right cryptorchidism, corrected without medical treatment before the age of two years, was diagnosed with Leydig cell tumor. Two years after diagnosis was identified moderately elevated estradiol serum level, in the context of a significant overweight, hormonal changes which had maintained after unilateral orchiectomy and after the patient's return to normal weight. Four years after unilateral orchiectomy, elevated value of estradiol persisted and subdiaphragmatic micro lymphadenopathy was observed. CONCLUSIONS Despite the favorable evolution of the patient four years after unilateral orchiectomy, long-term follow-up is necessary to exclude recurrence or metastasis to the testis. The endocrine profile and imaging investigations need to be repeated periodically. The changes in the hormonal assay and any new aspects on computed tomography scan can be used as a marker of tumor recurrence and require careful screening and the correct therapeutic decisions.
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Lin D, Tan AJH, Power T, Singh-Rai R. One lump or two? Concomitant Leydig cell tumour and paratesticular leiomyoma in an adult man. BMJ Case Rep 2014; 2014:bcr-2014-203682. [PMID: 24850554 DOI: 10.1136/bcr-2014-203682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the first reported case of a concomitant Leydig cell tumour (LCT) and paratesticular leiomyoma in an adult man with a history of bilateral cryptorchidism. An 80-year-old man presented with a 2-month history of a left testicular lump associated with mild discomfort and a gradual increase in size on a background of bilateral cryptorchidism requiring multiple orchidopexy procedures as a child. Ultrasound confirmed a lesion suspicious for malignancy and he proceeded to a left radical orchidectomy. Histopathological assessment of the left testis revealed a concomitant testicular LCT with rare malignant features and paratesticular leiomyoma.
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Affiliation(s)
- Diwei Lin
- Division of Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Amanda Jia Hui Tan
- Division of Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Theresa Power
- Division of Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Rajinder Singh-Rai
- Division of Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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Testicular seminomatous mixed germ cell tumor with choriocarcinoma and teratoma with secondary somatic malignancy: a case report. J Med Case Rep 2014; 8:1. [PMID: 24380446 PMCID: PMC3917416 DOI: 10.1186/1752-1947-8-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/07/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction Testicular tumors are a heterogeneous group of neoplasms exhibiting diverse histopathology and can be classified as seminomatous and non-seminomatous germ cell tumor types. Mixed germ cell tumors contain more than one germ cell component and various combinations have been reported. Here, we present a rare case of a mixed germ cell tumor composed of seminoma, choriocarcinoma and teratoma with a secondary somatic malignancy. Case presentation A 31-year-old Caucasian man presented with splenic rupture to our hospital. A right-sided testicular swelling had been present for 6 months and his alpha-fetoprotein, beta-human chorionic gonadotropin, and lactose dehydrogenase were increased. An ultrasound of his scrotum revealed an enlarged right testis with heterogeneous echogenicity. Multiple hypervascular lesions were noted in his liver and spleen. He underwent transcatheter embolization therapy of his splenic artery followed by splenectomy and right-sided orchiectomy. A computed tomography scan also showed metastasis to both lungs. During his last follow up after four cycles of cisplatin-based chemotherapy, the level of tumor markers had decreased, decreases in the size of his liver and pulmonary lesions were noted but new sclerotic lesions were evident in his thoracolumbar region raising concern for bony metastasis. Conclusions Prognosis of testicular tumor depends mainly on the clinical stage, but emergence of a sarcomatous component presents a challenge in the treatment of germ cell tumors and the histological subtype of this component can be used as a guide to specific chemotherapy in these patients.
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Lignitz S, Partsch CJ, Wudy SA, Hartmann MF, Pohlenz J. Clinical and metabolic findings in a 6-year-old boy with a Leydig cell tumour. Acta Paediatr 2011; 100:e280-2. [PMID: 21535128 DOI: 10.1111/j.1651-2227.2011.02338.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To analyse the urinary steroid metabolome in a boy who had true precocious puberty after a Leydig cell tumour. METHOD Case report and detailed description of clinical and metabolic findings in a 7-year-old-boy with a Leydig cell tumour. RESULTS Before surgery, the urinary steroid metabolome showed an activation of an alternative route to gonadal androgens independent of dehydroepiandrosterone (DHEA). After surgery, the boy entered true precocious puberty. Under leuprolide acetate treatment, clinical and laboratory findings normalized. CONCLUSION Central precocious puberty after precocious pseudopuberty may be more common than expected and should be considered in children with persistent or recurrent symptoms after initial treatment of precocious pseudopuberty. Patients with a Leydig cell tumour seem to reactivate the so-called 'back door pathway' of androgen production, which is independent of the classical route via DHEA.
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Affiliation(s)
- S Lignitz
- Department of Pediatrics, Johannes Gutenberg University Medical School, Mainz, Germany
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26
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Leydig cell tumor in two brothers with congenital adrenal hyperplasia due to 11-β hydroxylase deficiency: a case report. Int Urol Nephrol 2011; 44:133-7. [DOI: 10.1007/s11255-010-9890-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 12/16/2010] [Indexed: 10/18/2022]
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Tazi MF, Ahsaini M, Khalouk A, Fassi MJ, Farih MH. Les tumeurs testiculaires à cellules de Leydig: à propos de quatre cas et revue de la littérature. Basic Clin Androl 2011. [DOI: 10.1007/s12610-010-0114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Résumé
Introduction
Les tumeurs testiculaires à cellules de Leydig (TTCL) sont rares, elles représentent entre 1 et 3 % de l’ensemble des tumeurs testiculaires, ce sont les plus fréquentes des tumeurs des cordons sexuels et du stroma. Ces tumeurs se développent le plus fréquemment (55 %) chez les sujets jeunes de 15 à 35 ans, mais elles peuvent se voir aussi chez les enfants lors de la première décennie (20 %) et chez les hommes après 50 ans (25 %). Le mode de révélation le plus fréquent chez l’adulte est la gynécomastie, par contre chez l’enfant, c’est la pseudopuberté précoce isosexuelle. Elles posent le problème de leur diagnostic biologique devant des formes non palpables et du choix de leur traitement chirurgical en raison de la difficulté diagnostique entre les formes bénignes et malignes.
Matériel et méthodes
Nous rapportons quatre présentations différentes de cette pathologie dont les paramètres étudiés seront l’âge, le mode de révélation, le profil hormonal, le type de traitement et le mode évolutif.
Résultats
L’âge moyen de nos patients était de 37 ans et demi. Le mode de révélation était deux fois sur quatre en rapport avec une grosse bourse unilatérale, une fois pour grosse bourse bilatérale, une fois en rapport avec une gynécomastie. Dans tous les cas, la testostérone était normale ou basse et l’estradiol normal ou élevé. Les quatre patients ont subi une orchidectomie associée à une énucléation controlatérale chez un seul des patients. L’évolution était favorable pour tous nos patients, avec un recul moyen de 15 mois.
Conclusion
Le but de cette revue est de présenter, sur la base de quatre observations cliniques différentes et de l’analyse de la littérature, les différents aspects cliniques, biologiques, radiologiques pathologiques et thérapeutiques des TTCL.
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Hanson JA, Ambaye AB. Adult Testicular Granulosa Cell Tumor: A Review of the Literature for Clinicopathologic Predictors of Malignancy. Arch Pathol Lab Med 2011; 135:143-6. [DOI: 10.5858/2009-0512-rsr.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Adult testicular granulosa cell tumors are rare sex cord–stromal tumors of which only 28 have been previously reported. As compared with their ovarian counterparts, these tumors may follow a more aggressive course because the proportion of malignant cases is higher. To date, there are no clinical or pathologic features that definitively predict malignancy. We reviewed all prior case reports for features that may predict their malignant potential. Tumor size greater than 5.0 cm is the only feature statistically associated with malignancy. Mitotic count, tumor necrosis, patient age, and the presence of gynecomastia do not, at present, predict benign versus malignant behavior.
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Terakawa T, Miyake H, Muramaki M, Takenaka A, Fujisawa M. Salvage chemotherapy with methotrexate, etoposide and actinomycin D in men with metastatic nonseminomatous germ cell tumors with a choriocarcinoma component: a preliminary report. Int J Urol 2010; 17:881-5. [PMID: 20731738 DOI: 10.1111/j.1442-2042.2010.02618.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of the present study was to assess the use of salvage chemotherapy using methotrexate, etoposide and actinomycin D (MEA) in men with nonseminomatous germ cell tumor (NSGCT) with a choriocarcinoma component. Nine patients were included. They had initially received bleomycin, etoposide and cisplatin, and high-dose ifosfamide, carboplatin and etoposide as induction chemotherapies. However, they failed to achieve the normalization of ß-human chorionic gonadotropin (ß-HCG). Therefore, MEA therapy (methotrexate: 450 mg/body on day 1, actinomycin D: 0.5 mg/body on days 1–5, etoposide: 100 mg/body on days 1–5) was subsequently administered. After MEA therapy (median: 3 cycles), serum ß-HCG was normalized in five of the nine patients. Of these five, three achieved long-term disease-free survival and one died of disease unrelated to NSGCT, whereas the remaining patient developed disease recurrence and died of disease progression. All four patients who failed to achieve the normalization of ß-HCG died of disease progression. Although several severe toxicities greater than grade 3, which were mainly associated with bone marrow suppression, occurred in all patients, there was no treatment-related death. Considering the current outcomes, MEA regimen could be an attractive option as a salvage chemotherapy for metastatic NSGCT patients with a choriocarcinoma component showing resistance to intensive conventional chemotherapies.
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Affiliation(s)
- Tomoaki Terakawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Hettinger CA, Cheville JC, Lteif AN, Bradley NA, Kramer SA. Precocious puberty in a 7-year-old boy: a novel case. J Pediatr Urol 2009; 5:412-4. [PMID: 19525149 DOI: 10.1016/j.jpurol.2009.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 05/14/2009] [Indexed: 11/17/2022]
Abstract
A 7-year-old boy was referred for evaluation of precocious puberty, evidenced by penile enlargement and pubic hair formation. His testicular size was prepubertal bilaterally. A comprehensive hormonal evaluation showed an elevated serum testosterone value (4.0 nmol/L) and a prepubertal gonadotropin value. A 0.9-cm heterogenous left testicular mass was detected on scrotal ultrasonography. Inguinal exploration was performed with ultrasound-guided open testicular biopsy and orchiectomy. Pathologic evaluation of the orchiectomy specimen showed the unclassified type of a mixed germ cell sex cord stromal tumor (MGCSCST), composed of neoplastic Sertoli cells and seminoma-like germ cells. Isolated previous reports of unclassified MGCSCSTs of the testis are now thought to be reports of sex cord stromal tumors with entrapped non-neoplastic germ cells. In our patient, the germ cells appeared to be neoplastic with aberrant expression of c-kit and placental alkaline phosphatase, a high proliferative rate, and DNA aneuploidy. Postoperatively, the patient's serum testosterone concentrations returned to prepubertal values (<0.2 nmol/L) and puberty was halted. This case represents a novel cause of precocious puberty.
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Tazi MF, Ahallal Y, Znati K, El Fassi MJ, Farih MH. Tumeur testiculaire bilatérale synchrone à cellules de Leydig: à propos d’un cas. Basic Clin Androl 2009. [DOI: 10.1007/s12610-009-0014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Résumé
Les tumeurs testiculaires à cellules de Leydig sont rares, elles représentent entre 1 et 3 % de l’ensemble des tumeurs testiculaires. L’atteinte bilatérale synchrone est exceptionnelle. Découverte dans 20 % des cas lors de la première décennie, elle peut être retrouvée dans toutes les tranches d’âge, le diagnostic étant effectué après 50 ans dans 25 % des cas. Le diagnostic est classiquement suspecté devant une anomalie sécrétoire intéressant les hormones sexuelles et seule l’histologie confirme le diagnostic. Nous rapportons le cas d’un patient âgé de 25 ans qui présente une tumeur bilatérale synchrone à cellules de Leydig traité par orchidectomie unilatérale et tumorectomie controlatérale.
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Sex cord stromal testicular tumors: a clinical series--uniformly stage I disease. J Urol 2009; 181:2090-6; discussion 2096. [PMID: 19286222 DOI: 10.1016/j.juro.2009.01.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Sex cord stromal testicular tumors are rare. Historically 10% of lesions are said to be malignant but to our knowledge there are no clinical or histological features that can accurately predict potential malignant behavior. Because of this, groups at some centers have advocated prophylactic retroperitoneal lymph node dissection in patients with clinical stage I disease. We reviewed our experience with these tumors to determine whether this policy is justified. MATERIALS AND METHODS We retrospectively reviewed the records of all 38 men older than 18 years with sex cord stromal testicular tumors who were referred to the Wessex regional cancer center for treatment or pathological review during the 25-year period of 1982 to 2006. We then compared our series with a malignant sex cord stromal testicular tumor database generated from the world literature. RESULTS All Wessex patients were treated with excision of the primary tumor alone and metastatic disease developed in none. All remained disease-free with an overall median survival of 6.8 years (range 1.4 to 25). Features in the literature favoring malignant behavior, ie metastatic disease, included larger tumors (mean 6.43 vs 1.71 cm), a high mitotic rate, tumor necrosis, angiolymphatic invasion, infiltrative margins and extratesticular extension (each p <0.0001). The malignant group had an overall median survival of 2.3 years (range 0.02 to 17.3). CONCLUSIONS No patient had disease progression in our study, which is to our knowledge the largest reported United Kingdom series of sex cord stromal testicular tumors. Our data suggest that malignancy is uncommon and prophylactic retroperitoneal lymph node dissection is unjustified for clinical stage I disease.
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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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Gilligan T, Kantoff PW. Testis Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Ultrasound is a vital adjunct to clinical examination in diagnosing scrotal disease, as a number of different processes may present similarly. Potential applications range from the acute emergency to long-term screening as well as cases in which a distinct scrotal abnormality may or may not be palpable. Differentiating acute epididymitis/epididymoorchitis from testicular torsion is possible sonographically, thereby guiding appropriate medical or surgical management. Distinguishing between cystic, solid, or complex scrotal masses is readily performed with this modality. It clearly depicts simple versus complex hydroceles and determines the presence of underlying testicular or epididymal disease. Not only is ultrasound the best imaging modality for longitudinal screening in patients (testicular microlithiasis, cryptorchidism) at risk for testicular tumors, it also provides valuable information in the infertile male by documenting the presence or absence of a varicocele.
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Affiliation(s)
- Monica Smith Pearl
- Department of Radiology, The George Washington University Hospital, Washington, DC 20037, USA
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36
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Ditonno P, Lucarelli G, Battaglia M, Mancini V, Palazzo S, Trabucco S, Bettocchi C, Paolo Selvaggi F. Testicular granulosa cell tumor of adult type: A new case and a review of the literature. Urol Oncol 2007; 25:322-5. [PMID: 17628299 DOI: 10.1016/j.urolonc.2006.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 08/09/2006] [Accepted: 08/11/2006] [Indexed: 10/23/2022]
Abstract
Testicular granulosa cell tumor of the adult type is a very rare tumor, and, to date and our knowledge, only 23 cases of this rare testicular tumor have been reported in the literature, 5 of which developed metastases. We report a case of granulosa cell tumor of adult type in a 45-year-old man with a 15-year history of a painless increasing right testicular volume who underwent radical orchiectomy. The patient is disease-free after a 2-year follow-up, without any adjuvant therapy. Our case and a review of the literature indicate that this type of tumor is a rare, slow-growing neoplasm. Because distant metastases may occur late in the clinical course, long-term follow-up of these patients is recommended.
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Affiliation(s)
- Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Division of Urology and Kidney Transplant, University of Bari, Bari, Italy
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Papiani G, Einhorn LH. Salvage chemotherapy with high-dose carboplatin plus etoposide and autologous peripheral blood stem cell transplant in male pure choriocarcinoma: a retrospective analysis of 13 cases. Bone Marrow Transplant 2007; 40:235-7. [PMID: 17563738 DOI: 10.1038/sj.bmt.1705697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Choriocarcinoma of testes is a very rare tumor with poor prognosis, usually presenting with high serum level of human chorionic gonadotropin (hCG>50,000 mIU/ml) and advanced hematogenous metastases. Data with salvage chemotherapy has been sparse, with few long-term survivors. Between April 1996 and October 2004, 184 patients with germ cell tumor were treated at Indiana University with salvage high-dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplant. Thirteen had pure choriocarcinoma or choriocarcinoma syndrome (normal testes by palpation and ultrasound, normal serum alpha-fetoprotein, advanced hematogenous metastases and high level hCG). All patients had progressed following one or two lines of cisplatin combination therapy. HDCT regimen was carboplatin 700 mg/m(2) and etoposide 750 mg/m(2) intravenously given for 3 consecutive days. A second course was given after hematopoietic recovery, usually 3-4 weeks later. The median survival was 19 months (range 5-90). Six patients (46%) are alive and continuously disease free (cNED) at a median follow-up of 37 months (range 19-75). One additional patient who relapsed after HDCT and was treated with third line chemotherapy followed by two surgical resections of choriocarcinoma is currently alive NED at +90 months from HDCT. Long-term disease-free survival and potential cure is possible with HDCT in choriocarcinoma patients that progressed after standard cisplatin combination therapy.
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Affiliation(s)
- G Papiani
- Department of Hematology and Oncology, Istituto Oncologico Romagnolo, Ravenna City Hospital, Ravenna, Italy.
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38
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Neill M, Warde P, Fleshner N. Management of Low-Stage Testicular Seminoma. Urol Clin North Am 2007; 34:127-36; abstract vii-viii. [PMID: 17484918 DOI: 10.1016/j.ucl.2007.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Testicular seminoma represents a modern model of a multidisciplinary approach to a curable neoplasm. Surgeons, radiation oncologists, and medical oncologists play an important role in disease detection, diagnosis, treatment, and follow-up. This article focuses on the management of men who have early-stage seminoma, which represents stage I and IIa (minimal retroperitoneal spread). In stage I disease, the major controversies continue to revolve around surveillance versus adjuvant treatment and more recently adjuvant radiotherapy or carboplatin-based chemotherapy. Focus on long-term complications, such as cardiovascular disease, gastrointestinal disease, and secondary cancers, has led to the concept of increased surveillance with therapy for those who relapse. Radiation therapy remains the mainstay of therapy for patients who have stage IIa disease.
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Affiliation(s)
- Mischel Neill
- Division of Urology, Department of Surgery, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada
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39
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Agnarsson BA, Gudbjartsson T, Einarsson GV, Magnusson K, Thoroddsen A, Bergthorsson JT, Amundadottir L, Barkardottir RB, Björnsson J. Testicular germ cell tumours in Iceland. APMIS 2006; 114:779-83. [PMID: 17078858 DOI: 10.1111/j.1600-0463.2006.apm_468.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to examine the pathology of all germ cell tumours of the testis diagnosed in Iceland 1955-2002. A total of 214 patients were included in the study. The current age-standardized incidence was found to be 6.1 per 100,000 and had increased almost fourfold during the study period. Seminoma was diagnosed in 55% of cases. Non-seminomas were diagnosed in 45%, and these were further classified as mixed germ cell tumours (33%), embryonal carcinoma (8%), teratoma (3%), and yolk sac tumour (n=1). The mean age at diagnosis was significantly higher for the seminomas than the non-seminomas (38 years versus 29 years) (p<0.001) and the non-seminomas were diagnosed at a significantly higher stage than the seminomas (p<0.001). Thus, in seminoma patients the tumour was localized to the testis (stage I) in 81% of cases, in 17% of patients the tumour had spread to the lymph nodes (stage II or III), and only 2% had extranodal metastasis at diagnosis (stage IV). In contrast, in the non-seminoma patients, the tumours were found to be stage I in 56%, stage II or III in 24%, and stage IV in 20% of cases. No significant difference in staging was found between non-seminoma subtypes. Identification of necrosis or vascular invasion was significantly associated with metastatic disease at diagnosis (p=0.002). During the study period a significant increase in stage I tumours was found as well as a decrease in the size of the tumours.
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Affiliation(s)
- Bjarni A Agnarsson
- Department of Pathology, Landspitali-University Hospital, Reykjavik, Iceland.
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40
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Hisano M, Souza FMM, Malheiros DMAC, Pompeo ACL, Lucon AM. Granulosa cell tumor of the adult testis: report of a case and review of the literature. Clinics (Sao Paulo) 2006; 61:77-8. [PMID: 16532229 DOI: 10.1590/s1807-59322006000100013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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41
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Brehm R, Rey R, Kliesch S, Steger K, Marks A, Bergmann M. Mitotic activity of Sertoli cells in adult human testis: an immunohistochemical study to characterize Sertoli cells in testicular cords from patients showing testicular dysgenesis syndrome. ACTA ACUST UNITED AC 2006; 211:223-36. [PMID: 16429274 DOI: 10.1007/s00429-005-0075-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2005] [Indexed: 12/31/2022]
Abstract
During puberty, normal somatic Sertoli cells undergo dramatic morphological changes due to the differentiation of immature pre-Sertoli cells in functionally active adult Sertoli cells. Sertoli cell maturation is accompanied with loss of their mitotic activity before onset of spermatogenesis and loss of pre-pubertal and occurrence of adult immunohistochemical Sertoli cell differentiation markers. Testes of infertile adult patients often exhibit numerous histological signs of testicular dysgenesis syndrome (TDS) such as microliths, Sertoli cell only (SCO) tubules, tubules containing carcinoma in situ and immature seminiferous tubules (Sertoli cell nodules). Sertoli cell tumours, however, are very rare neoplasms possibly due to the fact that the mechanism and temporal origin of neoplastic Sertoli cells underlying Sertoli cell tumourigenesis still remain unknown. To clarify the state of Sertoli cell differentiation in both immature seminiferous tubules of adult patients with TDS and Sertoli cell tumour, we compared the expression of the Sertoli cell differentiation markers vimentin, inhibin-alpha, anti-Muellerian-hormone, cytokeratin 18, M2A-antigen, androgen receptor and connexin43 with that of SCO tubules with hyperplasia. In addition, we demonstrated for the first time the existence of proliferating Sertoli cells by Ki67- and PCNA-immunostaining in Sertoli cell nodules of the adult human testis. Our data indicate that mitotically active Sertoli cells in Sertoli cell nodules will be arrested prior to puberty and, contrary to dogma, do not represent foetal or neonatal cells. Since all markers in Sertoli cell nodules revealed a staining pattern identical to that in neoplastic Sertoli cells, but different to that in Sertoli cells of SCO tubules with hyperplasia, it may be speculated that Sertoli cell tumours in adult men may originate from Sertoli cell nodules.
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Affiliation(s)
- Ralph Brehm
- Institute of Veterinary Anatomy, Histology and Embryology, University of Giessen, Giessen, Germany.
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42
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Lucarelli G, Mancini V, Annunziata G, Trabucco S, Palazzo S, Ditonno P, Battaglia M, Selvaggi F. Adult Type Testicular Granulosa Cell Tumor: Case Report and Review of the Literature. Urologia 2006. [DOI: 10.1177/039156030607300307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Granulosa cell tumors represent a special group of the so-called sex cord-stromal tumors of the gonads, and are divided into 2 histological types: adult and juvenile. Adult type testicular granulosa cell tumor is a rare neoplasia: 22 cases of this testicular tumor only have been described in literature so far. They are often discovered accidentally and exhibit no endocrine-related symptoms. We report a case of adult type granulosa cell tumor in a 45-year-old man likely affected by a 15-year-old painless tumor with increased right testicular size; he underwent radical orchiectomy. This case and a review of the literature indicate that this kind of tumor is a rare, slow-growing neoplasm. Since distant metastases may occur late in the clinical course, long term follow-up of these patients is recommended.
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Affiliation(s)
- G. Lucarelli
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
| | - V. Mancini
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
| | - G. Annunziata
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
| | - S. Trabucco
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
- Dipartimento di Anatomia Patologica e di Genetica, Sezione di Anatomia Patologica II, Università degli Studi di Bari, Bari
| | - S. Palazzo
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
| | - P. Ditonno
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
| | - M. Battaglia
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
| | - F.P. Selvaggi
- Dipartimento dell'Emergenza e dei Trapianti d'Organo, Sezione di Urologia e Trapianto di Rene
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Foppiani L, Bernasconi D, Del Monte P, Marugo A, Toncini C, Marugo M. Leydig cell tumour-induced bilateral gynaecomastia in a young man: endocrine abnormalities. Andrologia 2005; 37:36-9. [PMID: 15644061 DOI: 10.1111/j.1439-0272.2004.00648.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Among the various causes of gynaecomastia, testicular malignancies are an uncommon, life-threatening condition, which require prompt treatment. The case of a 26-year-old healthy man is described, who reported a 6-month painful bilateral gynaecomastia associated with secondary hypogonadism. Normal circulating 17beta-oestradiol (E2) levels showed an enhanced response to human chorionic gonadotrophin (hCG) testing, which led to a reduced testosterone (T)/E2 ratio. Both clinical and hormonal findings normalized following surgical exeresis of a left testicular mass, which proved to be a Leydig cell tumour (LCT) at histology. This report underlines the importance of ultrasonographic evaluation of the testes, whenever breast enlargement occurs in a healthy man, despite unremarkable findings on testicular examination. In addition, our case demonstrates that normal unstimulated circulating E2 levels do not allow the presence of a stromal testicular tumour to be ruled out and that the response of restored T levels to hCG testing can remain blunted up to 1 year after surgery. Finally, we claim that T/E2 ratio may be a useful tool in evaluating derangement of the endocrine milieu secondary to LCT.
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Affiliation(s)
- L Foppiani
- Division of Endocrinology, Galliera Hospital, Genova, Italy.
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44
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Yang DT, Lowichik A, Chen J, Snow BW, Ulbright TM, Chen Z. Cytogenetics of a pediatric unclassified sex cord-stromal tumor of the testis: a case report. ACTA ACUST UNITED AC 2005; 156:80-2. [PMID: 15588862 DOI: 10.1016/j.cancergencyto.2004.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Revised: 04/08/2004] [Accepted: 04/13/2004] [Indexed: 11/18/2022]
Abstract
Unclassified sex cord-stromal tumors account for a small proportion of pediatric testicular tumors and, while most are clinically benign, some have demonstrated malignant potential. Histological findings do not correlate well with clinical behavior and, while cytogenetics may aid in both diagnosis and predicting clinical behavior, these data on sex cord-stromal tumors are scarce. We describe an unclassified sex cord-stromal tumor occurring in the testis of a prepubertal male without evidence of metastasis that had a previously unreported 54,XY,+3,+7,+9,+12,+13,+18,+19,+20 karyotype.
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Affiliation(s)
- David T Yang
- Department of Pathology,University of Utah Health Sciences Center, Room A513, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
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45
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Thomas C, Cans C, Pelletier R, De Robertis C, Hazzouri M, Sele B, Rousseaux S, Hennebicq S. No Long-Term Increase in Sperm Aneuploidy Rates after Anticancer Therapy. Clin Cancer Res 2004; 10:6535-43. [PMID: 15475441 DOI: 10.1158/1078-0432.ccr-04-0582] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Lymphomas and testicular cancers are the most frequent malignancies among young men. With recent improvement of survival rates, for many patients, the question is raised of the consequences of the anticancer treatments on their fertility and more specifically of a potential genetic risk for the offspring. This article presents the study of sperm aneuploidy rates in the largest population of cancer-treated patients studied thus far. EXPERIMENTAL DESIGN In the present study, 38 patients were initially included 7 months to 5 years after a cancer treatment by chemotherapy and/or radiotherapy for testicular cancer (n = 19) or lymphoma (n = 19). Twelve of them were azoospermic. Sperm aneuploidy rates of chromosomes X, Y, 13, 18, and 21 were analyzed by multicolor fluorescent in situ hybridization in the 26 other patients. RESULTS In most cases, the disomy/diploidy rates after cancer therapy did not significantly differ from those observed in the group of control healthy donors. Only five patients (one lymphoma and four testicular cancer) showed significant but still moderate increases in disomic and/or diploid sperm. For the lymphoma patient, the short posttherapeutic delay after the treatment could explain the elevated aneuploidy rates, whereas no risk factor in the clinical, biological, or therapeutic records could be identified in any of the four testicular cancer patients with elevated sperm aneuploidy rates. CONCLUSIONS These data suggest an absence of long-term effect of anticancer therapy on sperm aneuploidy rates, and therefore, no long-term increased risk of aneuploidy for the offspring obtained either spontaneously or after assisted reproductive techniques.
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Affiliation(s)
- Claire Thomas
- Centre d'étude et de Conservation des Oeufs et du Sperme humain, Service de génétique, CHU Grenoble, Grenoble 9, France
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46
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Mosharafa AA, Foster RS, Leibovich BC, Ulbright TM, Bihrle R, Einhorn LH, Donohue JP. HISTOLOGY IN MIXED GERM CELL TUMORS. IS THERE A FAVORITE PAIRING? J Urol 2004; 171:1471-3. [PMID: 15017200 DOI: 10.1097/01.ju.0000116841.30826.85] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Mixed germ cell tumors account for approximately 30% to 50% of testicular tumors. To our knowledge a systematic review with statistical analysis of the associations of histological subtypes in mixed germ cell tumors has not been done previously. It was our impression that such associations exist. Delineating concordant histological types may provide insight into the ontogeny of testicular tumors and also have important clinical implications. MATERIALS AND METHODS We retrospectively reviewed the testis cancer data base at our institution. The primary tumor of orchiectomy specimens was examined in 2589 patients. Of these patients mixed histology was noted in 1765 (68.2%). ORs were calculated for all possible combinations of teratoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma and seminoma. In addition, we evaluated the association of various histological types with teratoma at post-chemotherapy retroperitoneal lymph node dissection. RESULTS Of 10 possible combinations of histological types in the primary tumor, positive correlations were noted in 4. The strongest correlation was found between teratoma and yolk sac tumor (OR 2.58, p <0.001). Teratoma or yolk sac tumor in the testis was associated with teratoma in the pathology specimen at post-chemotherapy retroperitoneal lymph node dissection. CONCLUSIONS The strongest associations of histological subtypes in mixed germ cell tumors were seen between yolk sac tumor and teratoma. Similar associations are seen in late relapse and in some cases of prepubertal tumors. Further study of these associations may prove valuable in understanding the biology and clinical behavior of germ cell tumors.
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Affiliation(s)
- Ashraf A Mosharafa
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Peschel R, Gettman MT, Steiner H, Neururer R, Bartsch G. Management of Adult Leydig-Cell Testicular Tumors: Assessing the Role of Laparoscopic Retroperitoneal Lymph Node Dissection. J Endourol 2003; 17:777-80. [PMID: 14642042 DOI: 10.1089/089277903770802362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Leydig-cell tumors represent <5% of malignant testicular tumors in adults. Orchiectomy is curative in approximately 90% of cases; however, the remaining men can develop metastases refractory to chemotherapy and radiation. We evaluated the role of laparoscopic retroperitoneal lymph node dissection (RPLND) in adult Leydig-cell tumors. PATIENTS AND METHODS Between 1999 and 2001, laparoscopic RPLND was performed with four transperitoneal ports within a unilateral template for six patients with pure Leydig-cell tumors. Presenting signs and symptoms, operative time, blood loss, intraoperative complications, postoperative complications, length of hospitalization, pathology reports, ejaculatory function, and survival were reviewed retrospectively. RESULTS Laparoscopic RPLND was successful, without open conversions or reinterventions. Two vascular injuries occurred during dissection; additional intraoperative complications were not observed. Postoperatively, one patient developed erysipelas, but no other postoperative complications were recorded. The mean operative time was 190 minutes, and the mean length of hospitalization was 4.3 days. Pathologic analysis of lymph nodes revealed no evidence of metastatic Leydig-cell tumor. At 12 months' mean follow-up (range 3-29 months), no recurrences have been identified. CONCLUSIONS Laparoscopic RPLND is a safe, minimally invasive procedure for Leydig-cell tumors. Additional clinical experience is required to evaluate its effectiveness for pathologic stage II tumors and to determine if a therapeutic advantage can be realized with a protocol employing laparoscopic RPLND for adult Leydig-cell tumors.
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48
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Mosharafa AA, Foster RS, Bihrle R, Koch MO, Ulbright TM, Einhorn LH, Donohue JP. Does retroperitoneal lymph node dissection have a curative role for patients with sex cord-stromal testicular tumors? Cancer 2003; 98:753-7. [PMID: 12910519 DOI: 10.1002/cncr.11573] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sex cord-stromal tumors account for < 5% of all adult testicular tumors, and 10% are malignant. Due to the limited reported experience, there is no agreement on the best management, especially in patients who have tumors with malignant pathologic features or who present with metastatic disease. The authors attempt to evaluate the role of retroperitoneal lymph node dissection (RPLND) in the management of patients with these malignant sex cord-stromal tumors. METHODS Reviewing the Indiana University testis cancer registry revealed 17 patients who underwent RPLND for sex cord-stromal tumors. Pathology was reviewed for features suggestive of malignancy. The data examined included clinical and pathologic stage, surgical procedure, additional therapy received, and outcome. RESULTS Pathology included Leydig tumors in six patients, Sertoli tumors in four patients, sex cord-stromal tumors in five patients, a granulosa cell tumor in one patient, and a poorly differentiated non-germ cell tumor in one patient. Nine patients had histologic features suggestive of malignancy. Clinical stage at surgery was Stage I in nine patients and Stage IIA-IIIA in eight patients. Patients underwent modified or bilateral RPLND. Nine patients had pathologic Stage I tumors, and the remaining eight patients and had pathologic Stage IIB-IIIA tumors. Follow-up ranged from 8 months to 11 years. Of the eight patients with Stage II-III disease, six patients eventually died of metastatic disease despite additional radiotherapy and/or chemotherapy. CONCLUSIONS Sex cord-stromal tumors have a potentially aggressive malignant behavior that is difficult to predict based on clinical and pathologic features. Although the therapeutic role of RPLND in patients with small-volume metastatic retroperitoneal tumors is unclear, RPLND remains an option to be performed immediately after orchiectomy, especially in patients who have tumors with malignant features and/or small-volume metastatic disease.
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Affiliation(s)
- Ashraf A Mosharafa
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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49
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Slama A, Elleuch A, Yacoubi MT, Ben Sorba N, Mosbah AT. [Bilateral Leydig cell tumor of the test: a case report]. ANNALES D'UROLOGIE 2003; 37:213-6. [PMID: 12951717 DOI: 10.1016/s0003-4401(03)00045-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Testicular Leydig cell tumours are uncommon. Bilateral synchronous lesions are exceptional. They cause isosexual pseudo precocious puberty in childhood. The histological diagnosis of malignancy is sometimes difficult to establish and it can be made retrospectively when lymph nodes involvement or visceral metastasis appear in the follow-up. We report a case of a 9 year-old boy presenting bilateral Leydig cell tumour of the testis treated by bilateral radical orchiectomy who developed 2 years after the intervention a pulmonary metastasis.
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Affiliation(s)
- Adel Slama
- Service d'urologie, CHU Sahloul 4054 Sousse, Tunisie.
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50
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Han G, Miura K, Takayama T, Tsutsui Y. Primary prostatic endodermal sinus tumor (yolk sac tumor) combined with a small focal seminoma. Am J Surg Pathol 2003; 27:554-9. [PMID: 12657943 DOI: 10.1097/00000478-200304000-00018] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on a primary endodermal sinus tumor (EST) (yolk sac tumor) combined with a focal seminoma of the prostate occurring in a 24-year-old man. The prostate was widely infiltrated with neoplasms that penetrated the capsule and invaded into the bladder wall and urethra. Most areas of the tumor were composed of papillary and glandular epithelium in the fibrous or myxoid stroma. Schiller-Duval bodies and periodic acid-Schiff-positive hyaline bodies were focally present. In addition to yolk sac tumor, solid nests of seminoma were found in some areas. Immunohistochemistry using specific antibodies for alpha-fetoprotein and cytokeratin showed positive reaction on the EST portion, and placental alkaline phosphatase revealed positive staining in the seminoma portion and a part of EST. Tumor cells exhibited negative staining for prostate-specific antigen, prostatic acid phosphatase, carcinoembryonic antigen, vimentin, chromogranin A, and human chorionic gonadotropin. Despite radical surgery and ordinary cisplatin-based chemotherapy, the patient died 8 months after operation. At autopsy, only EST elements had metastasized to the lungs, liver, and brain, and no tumors were found in either testis. To our knowledge, this is the first reported case of a primary EST combined with a focal seminoma in the prostate.
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Affiliation(s)
- Guiping Han
- Department of Pathology, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Hamamatsu-shi, 431-3192 Japan
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