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Strakova-Peterikova A, Slisarenko M, Skopal J, Pivovarcikova K, Pitra T, Farcas M, Michal M, Michal M, Michalova K. Familial syndromes associated with testicular and paratesticular neoplasms: a comprehensive review. Virchows Arch 2024; 484:723-731. [PMID: 38619599 DOI: 10.1007/s00428-024-03803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
A syndromic association between a subset of testicular/paratesticular neoplasms is well established. Such examples include Carney complex and large cell calcifying Sertoli cell tumor, Peutz-Jeghers syndrome and intratubular large cell hyalinizing Sertoli cell neoplasia, and VHL syndrome and clear cell papillary cystadenoma of the epididymis.However, recent studies proposed potential novel links between some testicular and paratesticular neoplasms with certain tumor syndromes. While more studies are still needed to solidify these associations, recent research suggests that a subset of Leydig cell tumors may arise in patients with hereditary leiomyomatosis and renal cell carcinoma syndrome or that some seminomas may occur in Lynch syndrome patients. Additionally, an association between testicular sex cord stromal tumors and paratesticular sarcomas with Familial adenomatous polyposis syndrome and DICER1 syndrome, respectively, has been proposed as well. This review provides a comprehensive overview of the intricate relationship between familial syndromes and associated testicular and paratesticular tumors, shedding light on their clinicopathological and molecular characteristics.
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Affiliation(s)
- Andrea Strakova-Peterikova
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Maryna Slisarenko
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic
- Medical Laboratory CSD, Ltd, Kiev, Ukraine
| | - Josef Skopal
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Kristyna Pivovarcikova
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Tomas Pitra
- Department of Urology, Faculty of Medicine in Plzeň, Charles University, Plzeň, Czech Republic
| | - Mihaela Farcas
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic
- Onco Team Diagnostic, Bucharest, Romania
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Kvetoslava Michalova
- Department of Pathology, Faculty of Medicine in Plzeň, Charles University, Czech Republic, Bioptical Laboratory, Ltd, Plzeň, Czech Republic.
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Tekin B, Erickson LA, Gupta S. von Hippel-Lindau disease-related neoplasia with an emphasis on renal manifestations. Semin Diagn Pathol 2024; 41:20-27. [PMID: 37980175 DOI: 10.1053/j.semdp.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
von Hippel-Lindau (VHL) disease is characterized by biallelic inactivation of the VHL gene leading to abnormal or absent VHL protein function, and constitutive activation of hypoxia-inducible factors (HIF) that leads to pro-tumorigenic signaling. Individuals with VHL disease develop numerous cysts and tumors involving multiple organs including the kidneys, central nervous system, endolymphatic sac, lungs, pancreatobiliary system, adrenal glands, epididymis, and/or broad ligament. On histologic examination, these lesions show morphologic overlap as they are frequently characterized by cells with clear cytoplasm and prominent vascularity. In addition to distinguishing non-renal tumors from metastatic clear cell renal cell carcinoma, understanding site-specific histopathologic and immunophenotypic features of these tumors has several applications. This includes distinguishing VHL-related tumors from those that arise sporadically and lack VHL gene alterations, guiding further genetic workup, and helping distinguish between different genetic predisposition syndromes. In this context, immunohistochemical studies for markers such as paired box 8 (PAX-8), carbonic anhydrase 9 (CA9), and glucose transporter 1 (GLUT-1) have an important role in routine clinical practice and represent cost-effective diagnostic tools. The recent development of targeted therapeutics directed against HIF-mediated signaling represents a significant milestone in the management of VHL disease and highlights the importance of accurately diagnosing and characterizing the wide spectrum of VHL disease-associated lesions.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA.
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Bennett JA, Oliva E. The complex and often confusing history, histology and histogenesis of mesonephric, STK11 adnexal tumour and mesonephric-like neoplasms of the upper female genital tract (including broad ligament). Histopathology 2022; 81:280-296. [PMID: 35395118 DOI: 10.1111/his.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
Mesonephric lesions in the female genital tract are uncommon, with those arising from the upper tract being much less frequent than those developing in the lower tract (mesonephric hyperplasia and carcinoma). The most common upper tract lesions include rete cyst/cystadenoma and female adnexal tumour of Wolffian origin (FATWO). The integration of morphological, immunohistochemical and molecular studies on FATWOs has enabled recognition of a novel entity, the STK11 adnexal tumour, which is often associated with Peutz-Jeghers syndrome (~50%) and frequently has a salivary gland morphology but an unknown origin. Similarly, 'mesonephric-like' adenocarcinoma, an entity with striking similarities to mesonephric carcinoma but currently favoured to be of Müllerian derivation based on its association with other Müllerian tumours and molecular findings, has also been recently described, and may histologically mimic both FATWOs and STK11 adnexal tumours. In this review, we provide a historical overview of upper female genital tract mesonephric proliferations and discuss mesonephric lesions, STK11 adnexal tumour, mesonephric-like adenocarcinoma, and mimickers, the most common being endometrioid carcinoma.
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Affiliation(s)
- J A Bennett
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - E Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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4
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Chatzopoulos K, Aubry MC, Gupta S. Immunohistochemical Expression of Carbonic Anhydrase 9 (CA9), Glucose Transporter 1 (GLUT1), and Paired Box 8 (PAX8) in von Hippel Lindau Disease-Related Lesions. Hum Pathol 2022; 123:93-101. [DOI: 10.1016/j.humpath.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
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5
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AlGhamdi M, AlYami M, Faqeeh S, AlKubeyyer B, AlShabyli N, AlAyed A. Beyond germ cell tumors, unusual testicular and extra-testicular masses and mass-like lesions: MRI and US pictorial review. Clin Imaging 2021; 74:106-122. [DOI: 10.1016/j.clinimag.2020.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
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6
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Papillary Cystadenoma: An Incidental Finding in Tubal Ligation. Case Rep Obstet Gynecol 2018; 2018:7964238. [PMID: 29850319 PMCID: PMC5937565 DOI: 10.1155/2018/7964238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/18/2018] [Indexed: 01/04/2023] Open
Abstract
von Hippel-Lindau disease (vHLD) is a rare autosomal dominant disorder with multiple benign and malignant tumors of different organs. We report a papillary cystadenoma of the mesosalpinx found in close association with an adenomatoid tumor discovered incidentally following tubal ligation in a patient with vHLD.
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Garg K, Karnezis AN, Rabban JT. Uncommon hereditary gynaecological tumour syndromes: pathological features in tumours that may predict risk for a germline mutation. Pathology 2018; 50:238-256. [PMID: 29373116 DOI: 10.1016/j.pathol.2017.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 12/31/2022]
Abstract
The most common hereditary gynaecological tumour syndromes are hereditary breast and ovarian cancer syndrome and Lynch syndrome. However, pathologists also may encounter gynaecological tumours in women with rare hereditary syndromes. Many of these tumours exhibit distinctive gross and microscopic features that are associated with a risk for an inherited gene mutation. The sensitivity and specificity of these tumour pathology features for predicting an inherited mutation vary depending on the syndrome. By recognising these tumour features, pathologists may potentially contribute to the diagnosis of an unsuspected syndrome by recommending referral of the patient for formal risk assessment by genetic counselling. Patients additionally benefit from diagnosis of an inherited syndrome because many also carry a lifetime risk for developing primary malignancies outside of the gynaecological tract. Early diagnosis of an inherited syndrome permits early screening, detection, and management of additional malignancies associated with the syndrome. This review highlights these rare syndromes and their tumour pathology, including Peutz-Jeghers syndrome (gastric type mucinous carcinoma of the cervix; ovarian sex cord tumour with annular tubules); hereditary leiomyoma renal cell carcinoma syndrome (uterine leiomyoma); tuberous sclerosis complex (uterine PEComa; uterine lymphangioleiomyomatosis); DICER1 syndrome (ovarian Sertoli-Leydig cell tumour; cervical embryonal rhabdomyosarcoma); rhabdoid tumour predisposition syndrome 2 (small cell carcinoma of the ovary, hypercalcaemic type); Cowden syndrome (endometrial endometrioid adenocarcinoma); naevoid basal cell carcinoma syndrome (ovarian fibroma); and Von Hippel-Lindau syndrome (clear cell papillary cystadenoma of the broad ligament).
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Affiliation(s)
- Karuna Garg
- University of California San Francisco, Pathology Department, San Francisco, CA, United States
| | - Anthony N Karnezis
- University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, Canada
| | - Joseph T Rabban
- University of California San Francisco, Pathology Department, San Francisco, CA, United States.
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8
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Soria Gondek A, Julià Masip V, Jou Muñoz C, Salvador Hernández H, Rovira Zurriaga C, Tarrado Castellarnau X. Adolescent Hydrocele Carrying a Surprise: A Case of Papillary Cystadenoma of the Epididymis. Urology 2017; 112:172-175. [PMID: 29154985 DOI: 10.1016/j.urology.2017.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/25/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
Papillary cystadenoma of the epididymis (PCE) is a rare benign epithelial tumor remarkable for its association with von Hippel-Lindau disease. A 12-year-old boy consulted for a progressive enlargement of the left testicle. At time of surgery, the whole epididymis was enlarged. Pathologic diagnosis was PCE with a focus on borderline malignancy. Scrotal left epididymectomy was performed. von Hippel-Lindau disease screening was negative. No relapse has been detected 2 years later. In case of atypical clinical examination of a hydrocele, unusual presentations such as PCE should be considered. The main differential diagnoses were adenomatoid tumor, nonpapillary cystadenoma, and metastatic clear cell renal carcinoma.
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Affiliation(s)
- A Soria Gondek
- Department of Pediatric Surgery, Hospital, Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
| | - V Julià Masip
- Department of Pediatric Surgery, Hospital, Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - C Jou Muñoz
- Department of Pathology, Hospital, Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - H Salvador Hernández
- Department of Oncology, Hospital, Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - C Rovira Zurriaga
- Department of Pathology, Hospital, Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - X Tarrado Castellarnau
- Department of Pediatric Surgery, Hospital, Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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9
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Abstract
This review covers gynecologic manifestations that may occur in rare hereditary syndromes. Recent advances in disorders, such as hereditary leiomyomatosis, renal cell carcinoma syndrome and tuberous sclerosis complex, are discussed as well as lesions that occur in von Hippel-Lindau syndrome, nevoid basal cell carcinoma syndrome, Cowden syndrome, Ollier disease/Maffucci syndrome, and Carney complex. Characteristic clinicopathologic features of each of these syndromes are discussed with an emphasis on the key features that enable pathologists to identify patients at highest risk for these diseases.
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10
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Imaging and angiography in male factor infertility. Fertil Steril 2016; 105:1432-42. [DOI: 10.1016/j.fertnstert.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 02/07/2023]
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Manuel N, Ricardo P, Pilar GP, Miguel RM. Perspectives in Pediatric Pathology, Chapter 12. Congenital Epididymal Anomalies. Pediatr Dev Pathol 2016; 19:12-23. [PMID: 25119979 DOI: 10.2350/14-04-1473-pb.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Nistal Manuel
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Paniagua Ricardo
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - González-Peramato Pilar
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Reyes-Múgica Miguel
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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12
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Heller DS. Lesions of the Broad Ligament: A Review. J Minim Invasive Gynecol 2015; 22:1163-8. [PMID: 26140828 DOI: 10.1016/j.jmig.2015.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/17/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
Abstract
The differential diagnosis of lesions arising in the broad ligament is quite large. Many of these lesions can be clinically interpreted before surgery as adnexal or uterine neoplasms. Although some lesions are similar to those arising in other müllerian sites, there are unique lesions as well. The lesions are uncommon and may prove challenging to clinicians. The purpose was to review the scope of lesions affecting the broad ligament. A literature review was conducted. A Medline search was performed using the terms broad ligament, mesosalpinx, and mesovarium. A review of the scope of broad ligament lesions is presented to assist in developing a differential diagnosis if a patient with such a lesion is encountered.
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Affiliation(s)
- Debra S Heller
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
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13
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Yang L, Xu WS, Melamed J, Zhou M, Deng FM. Solid variant of papillary cystadenoma of the epididymis. Histopathology 2014; 67:138-41. [PMID: 25406742 DOI: 10.1111/his.12617] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Long Yang
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Wei-Sheng Xu
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Jonathan Melamed
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Ming Zhou
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Fang-Ming Deng
- Department of Pathology, New York University School of Medicine, New York, NY, USA
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Seok JY, Kang M, An J, Kim H, Lee KB, Cho HY. Papillary cystadenoma of the fallopian tube not associated with von hippel-lindau disease: a case report. KOREAN JOURNAL OF PATHOLOGY 2014; 48:382-6. [PMID: 25366076 PMCID: PMC4215966 DOI: 10.4132/koreanjpathol.2014.48.5.382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/18/2013] [Accepted: 10/24/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Jae Yeon Seok
- Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Myunghee Kang
- Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jungsuk An
- Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyunchul Kim
- Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang-Beom Lee
- Departments of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyun Yee Cho
- Departments of Pathology, Gachon University Gil Medical Center, Incheon, Korea
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Rao P, Monzon F, Jonasch E, Matin SF, Tamboli P. Clear cell papillary renal cell carcinoma in patients with von Hippel-Lindau syndrome--clinicopathological features and comparative genomic analysis of 3 cases. Hum Pathol 2014; 45:1966-72. [PMID: 25081542 DOI: 10.1016/j.humpath.2014.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 12/17/2022]
Abstract
Clear cell papillary renal cell carcinoma (CCPRCC) is a renal neoplasm that has recently received widespread recognition in the literature. There have been several reports of this tumor arising in a sporadic setting and in patients with end-stage renal disease; however, there is limited information available about the clinical, pathologic, and genetic characteristics of this tumor in the setting of von Hippel-Lindau (VHL) disease. We herein report a series of 3 patients who developed CCPRCC in this unique clinical setting. The histology and immunohistochemical profile for all 3 cases was similar to that which has been previously reported for CCPRCC. All tumors were diffusely and strongly positive for cytokeratin 7, negative for α-methyl-CoA-racemase, and showed at least focal staining for CD10. Comparative genomic analysis was performed on tumors from all 3 patients. One tumor demonstrated monosomy 3, and the other 2 tumors showed normal chromosomal content. All 3 patients were alive without evidence of disease progression 5, 3, and 3 years after surgery. CCPRCC represents a distinct tumor type that may occur in the setting of VHL disease and should be considered in the differential diagnosis of extensively cystic renal tumors arising in this clinical setting. Molecular analysis in our series of cases suggests that CCPRCC does indeed represent a unique histologic subtype and must be distinguished from clear cell renal cell carcinoma due to different biological potentials. Ancillary studies for accurate classification are recommended due to significant morphologic overlap with clear cell renal cell carcinoma.
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Affiliation(s)
- Priya Rao
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Federico Monzon
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eric Jonasch
- Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030,USA
| | - Surena F Matin
- Urologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Pheroze Tamboli
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Schweyer S. [Rare tumors and tumor-like lesions of the testis and paratesticular structures]. DER PATHOLOGE 2014; 35:256-65. [PMID: 24705999 DOI: 10.1007/s00292-014-1902-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumors and tumor-like lesions of the testes and paratesticular structures are rare neoplasms often documented solely in case reports but are morphologically similar to their counterparts in other organ systems. According to the World Health Organization (WHO) classification, miscellaneous tumors of the testis, tumors of collecting ducts and rete testis, tumors of paratesticular structures are differentiated from mesenchymal tumors of the spermatic cord and testicular adnexa. In the differential diagnostics of a space-occupying mass in the testis or paratesticular region, tumor-like lesions should be considered because these lesions represent a large collection pot and occur more often than was originally assumed.
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Affiliation(s)
- S Schweyer
- Gemeinschaftspraxis Pathologie Starnberg, Am Fuchsengraben 3, 82319, Starnberg, Deutschland,
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18
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Abstract
The International Society of Urological Pathology convened a consensus conference on renal cancer, preceded by an online survey, to address issues relating to the diagnosis and reporting of renal neoplasia. In this report, the role of biomarkers in the diagnosis and assessment of prognosis of renal tumors is addressed. In particular we focused upon the use of immunohistochemical markers and the approach to specific differential diagnostic scenarios. We enquired whether cytogenetic and molecular tools were applied in practice and asked for views on the perceived prognostic role of biomarkers. Both the survey and conference voting results demonstrated a high degree of consensus in participants' responses regarding prognostic/predictive markers and molecular techniques, whereas it was apparent that biomarkers for these purposes remained outside the diagnostic realm pending clinical validation. Although no individual antibody or panel of antibodies reached consensus for classifying renal tumors, or for confirming renal metastatic disease, it was noted from the online survey that 87% of respondents used immunohistochemistry to subtype renal tumors sometimes or occasionally, and a majority (87%) used immunohistochemical markers (Pax 2 or Pax 8, renal cell carcinoma [RCC] marker, panel of pan-CK, CK7, vimentin, and CD10) in confirming the diagnosis of metastatic RCC. There was consensus that immunohistochemistry should be used for histologic subtyping and applied before reaching a diagnosis of unclassified RCC. At the conference, there was consensus that TFE3 and TFEB analysis ought to be requested when RCC was diagnosed in a young patient or when histologic appearances were suggestive of the translocation subtype; whereas Pax 2 and/or Pax 8 were considered to be the most useful markers in the diagnosis of a renal primary.
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Toutziaris C, Kampantais S, Perdikis I, Gourvas V, Laskaridis L, Gkagkalidis K, Lakis S, Ioannidis S. Papillary cystadenoma of epididymis: Is there a need for further investigation in unilateral cases? Int J Surg Case Rep 2013; 4:616-8. [PMID: 23708309 DOI: 10.1016/j.ijscr.2013.03.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/14/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The presence of a mass in the epididymis is not a common entity. The papillary cystadenoma of epididymis is a benign tumor which may occur sporadically or as a characteristic of von Hippel-Lindau disease. PRESENTATION OF CASE We present a case of a 27-year-old man with a right scrotal mass who was treated with surgical excision. Histopathological examination revealed a clear cell epididymal papillary cystadenoma. A computed tomography scan that was performed later showed no other abnormality or any signs of von Hippel-Lindau disease. DISCUSSION In this report, a case of a young man suffering from this rare tumor is discussed, focusing on the need of further evaluation in order to determinate if it occurs as a feature of VHL disease or as a sporadic form. CONCLUSION In unilateral cases of papillary cystadenoma of epididymis such as our patient's, literature advocates that no further examinations and expensive genetic testing is required.
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Clear cell carcinoma of the female genital tract (not everything is as clear as it seems). Adv Anat Pathol 2012; 19:296-312. [PMID: 22885379 DOI: 10.1097/pap.0b013e31826663b1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clear cell carcinoma has a storied history in the female genital tract. From the initial designation of ovarian clear cell adenocarcinoma as "mesonephroma" to the linkage between vaginal clear cell carcinoma and diethylstilbestrol exposure in utero, gynecologic tract clear cell tumors have puzzled investigators, posed therapeutic dilemmas for oncologists, and otherwise presented major differential diagnostic challenges for pathologists. One of the most common errors in gynecologic pathology is misdiagnosis of clear cell carcinoma, on both frozen section and permanent section. Given the poor response to platinum-based chemotherapy for advanced-stage disease and increased risk of thromboembolism, accurate diagnosis of clear cell carcinoma is important in the female genital tract. This review (1) presents the clinical and pathologic features of female genital tract clear cell carcinomas; (2) highlights recent molecular developments; (3) identifies areas of potential diagnostic confusion; and (4) presents solutions for these diagnostic problems where they exist.
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A Detailed Immunohistochemical Analysis of 2 Cases of Papillary Cystadenoma of the Broad Ligament. Int J Gynecol Pathol 2012; 31:133-40. [DOI: 10.1097/pgp.0b013e318228f577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Nogales FF, Goyenaga P, Preda O, Nicolae A, Vieites B, Ruiz-Marcellan MC, Pedrosa A, Merino MJ. An analysis of five clear cell papillary cystadenomas of mesosalpinx and broad ligament: four associated with von Hippel-Lindau disease and one aggressive sporadic type. Histopathology 2012; 60:748-57. [PMID: 22296276 DOI: 10.1111/j.1365-2559.2011.04151.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS Clear cell papillary cystadenoma (CCPC) is associated with von Hippel-Lindau disease (VHLD), but rarely involves mesosalpinx and broad ligament (M/BL). This study provides new data about its behaviour and immunophenotype. METHODS AND RESULTS We performed an analysis of four benign cases of CCPC of M/BL with either characteristic clinical features or genetic markers [loss of heterozygosity (LOH)] of VHLD in patients ranging from 24 to 36 years and a sporadic case in a 52-year-old presenting with peritoneal metastases. All CCPCs were papillary but had solid and tubular areas. Haemorrhage, thrombosis and scarring were constant features and related to an unusual pattern of sub-epithelial vascularity. All clear or oxyphilic cells co-expressed cytokeratin 7 (CK7), CAM5.2 and vimentin, with strong apical CD10 and nuclear paired box gene 2 (PAX2) immunoreactivity. Three cases also showed positivity for VHL40, epithelial membrane antigen (EMA), Wilms' tumour suppressor gene (WT-1) and cancer antigen 125 (CA125) but only one expressed renal cell carcinoma (RCC) antigen. Vascular plexus overexpressed nuclear and cytoplasmic WT-1. CONCLUSION The VHLD-associated cases appeared to be benign, but the sporadic case exhibited a low malignant potential. CCPCs show histological and immunophenotypical similarities with the recently reported clear cell papillary RCC, although the previously unreported apical CD10 and nuclear PAX2 expression may be related to their mesonephric origin. CCPC has a distinctive sub-epithelial vascular pattern that is consistent with its pathogenesis.
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Affiliation(s)
- Francisco F Nogales
- Departments of Pathology, Hospital Universitario San Cecilio, Granada, Spain.
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Bell D, Gidley P, Levine N, Fuller GN. Endolymphatic sac tumor (aggressive papillary tumor of middle ear and temporal bone): sine qua non radiology-pathology and the University of Texas MD Anderson Cancer Center experience. Ann Diagn Pathol 2011; 15:117-23. [PMID: 21167761 DOI: 10.1016/j.anndiagpath.2010.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 08/19/2010] [Indexed: 02/03/2023]
Abstract
Endolymphatic sac tumor (ELST) is a rare lesion of the skull base for which the origin has recently been ascertained. The endolymphatic sac is derived from neuroectoderm and is located subjacent to the posteromedial surface of the temporal bone. Patients characteristically present with hearing loss, tinnitus, and vertigo; facial nerve paralysis occurs less commonly. An indolent clinical course and long-standing symptom history is typical. Endolymphatic sac tumors are known to occur more frequently in patients with von Hippel-Lindau disease, but this is not a prerequisite for diagnosis because sporadic occurrence is common. Morphologically, all of the ELSTs showed a papillary and glandular architecture. The papillary and glandular structures were lined by a single layer of flattened cuboidal-to-columnar cells that were variably ciliated. Surgery is the treatment of choice for small ELST. Remission may last for years, but local recurrence after surgery, likely secondary to incomplete resection, can occur. Radiotherapy has a 50% cure rate with large or residual tumors. Endolymphatic sac tumor is a rare tumor that can easily be confused with other papillary lesions on histopathologic grounds, with significant treatment implications. Precise preoperative anatomic localization and computed tomography and magnetic resonance imaging feature interpretation play a paramount role in achieving an accurate final diagnosis.
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Affiliation(s)
- Diana Bell
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, USA.
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The use of immunohistochemistry in the diagnosis of metastatic clear cell renal cell carcinoma: a review of PAX-8, PAX-2, hKIM-1, RCCma, and CD10. Adv Anat Pathol 2010; 17:377-93. [PMID: 20966644 DOI: 10.1097/pap.0b013e3181f89400] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The diagnosis of metastatic clear cell renal cell carcinoma may be difficult in some cases, particularly in the small image-guided biopsies that are becoming more common. As targeted therapies for renal cell carcinoma are now standard treatment, the recognition and diagnosis of renal cell carcinoma has become even more critical. Many adjunctive immunohistochemical markers of renal epithelial lineage such as CD10 and RCCma have been proposed as aids in the diagnosis of metastatic renal cell carcinoma, but low specificities often limit their utility. More recently described markers (PAX-2, PAX-8, human kidney injury molecule-1, hepatocyte nuclear factor-1-β, and carbonic anhydrase-IX) offer the potential for greater sensitivity and specificity in this diagnostic setting; however, knowledge of their expected staining in other neoplasms and tissues is critical for appropriate use. In this review, we discuss the most widely used immunohistochemical markers of renal lineage with an emphasis on their sensitivity and specificity for metastatic clear cell renal cell carcinoma. Subsequently, we present a variety of organ-specific differential diagnostic scenarios in which metastatic clear cell renal cell carcinoma might be considered and we propose immunopanels for use in each situation.
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Abstract
Papillary cystadenoma is a rare benign neoplasm of the epididymis, occurring mainly in young adult males. More than one-third of the cases reported in the literature have occurred in patients with von Hippel-Lindau disease. Conversely, epididymal nodules presumed to be papillary cystadenomas are found in one-third of males with von Hippel-Lindau disease. The association is stronger for bilateral tumors. The pathogenesis involves loss of the von Hippel-Lindau gene resulting in overexpression of the angiogenic protein "hypoxia-inducible factor." Papillary cystadenoma is of mesonephric derivation. It originates in the efferent ductules of the head of the epididymis in the form of tiny precursor lesions. Histologically, papillary cystadenoma is characterized by cystic spaces with intracystic papillary projections lined by clear cells, with a resultant resemblance to renal cell carcinoma. Immunohistochemical markers may facilitate the distinction between the 2 tumors. Treatment consists of surgical excision and the prognosis is excellent.
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Affiliation(s)
- Karen J Odrzywolski
- Department of Internal Medicine, State University of New York Upstate Medical University, Syracuse, 13210, USA
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Bilateral papillary cystadenoma of the mesosalpinx: a rare manifestation of Von Hippel-Lindau disease. Arch Gynecol Obstet 2010; 282:343-6. [PMID: 20157715 DOI: 10.1007/s00404-010-1386-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 01/25/2010] [Indexed: 02/07/2023]
Abstract
We report a rare case of a woman with bilateral papillary cystadenomata of the broad ligament with von Hippel-Lindau disease (VHL) (other manifestations: capillary hemangioblastomas of the spinal cord). Patient surveillance is important, because in the course of VHL-associated tumors malignant lesions may arise that are relevant for the prognosis.
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Lane Z, Epstein JI. Small blue cells mimicking small cell carcinoma in spermatocele and hydrocele specimens: a report of 5 cases. Hum Pathol 2010; 41:88-93. [DOI: 10.1016/j.humpath.2009.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/29/2009] [Accepted: 06/30/2009] [Indexed: 12/19/2022]
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Müllerian serous cystadenoma of the scrotum following orchiopexy. Adv Urol 2009:610453. [PMID: 19343186 PMCID: PMC2662405 DOI: 10.1155/2009/610453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 01/12/2009] [Indexed: 11/17/2022] Open
Abstract
A 24-year-old man presented himself with a nodular lesion of about 1 cm diameter at the site of a previous orchiopexy associated with surgery for cryptorchism. Histopathology revealed the lesion to be adenomatous and confined to the scrotum. Histological and immunohistological features were not consistent neither with median raphe cysts or cutaneous adenomas nor with the intrascrotal adenomas of the rete testis, epididymis, nor with (malignant) mesotheliomas. However, the lesion did compare well with serous (papillary) cystadenomas of the testis or paratestis. These adenomas are thought to originate in remnants of the Müllerian system or of peritoneal lining altered by Müllerian metaplasia. This implies that the scrotal adenoma may have developed from an implant of such elements during orchiopexy 14 years ago. Complete excision of the lesion appears to be an adequate therapy.
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Gokden N, Gokden M, Phan DC, McKenney JK. The Utility of PAX-2 in Distinguishing Metastatic Clear Cell Renal Cell Carcinoma From its Morphologic Mimics. Am J Surg Pathol 2008; 32:1462-7. [DOI: 10.1097/pas.0b013e318176dba7] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Skalova A, Šíma R, Bohuš P, Čuřík R, Lukáš J, Michal M. Endolymphatic sac tumor (aggressive papillary tumor of middle ear and temporal bone). Pathol Res Pract 2008; 204:599-606. [DOI: 10.1016/j.prp.2008.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/24/2008] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
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Kasiyanov A, Fujii N, Tamamura H, Xiong H. Modulation of network-driven, GABA-mediated giant depolarizing potentials by SDF-1alpha in the developing hippocampus. Dev Neurosci 2007; 30:285-92. [PMID: 18073458 DOI: 10.1159/000112520] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 09/07/2007] [Indexed: 11/19/2022] Open
Abstract
Chemokine stromal cell-derived factor-1 (SDF-1, or CXCL12) plays an important role in brain development and functioning. Whole-cell patch clamp recordings were conducted on CA3 neurons in hippocampal slices prepared from neonatal rats between postnatal days 2 and 6 to study the modulatory effects of SDF-1alpha on network-driven, gamma-aminobutyric-acid-mediated giant depolarizing potentials (GDPs), a hallmark of the developing hippocampus. We found that SDF-1alpha, the only natural ligand for chemokine CXC motif receptor 4 (CXCR4), decreased GDP firing without significant effects on neuronal passive membrane properties in neonatal hippocampal neurons. The SDF-1alpha-mediated decrease in GDP firing was blocked by T140, a CXCR4 receptor antagonist, suggesting that SDF-1alpha modulates GDP firing via CXCR4. We also showed that endogenous SDF-1 exerts a tonic inhibitory action on GDPs in the developing hippocampus. As SDF-1/CXCR4 are highly expressed in the developing brain and GDPs are involved in activity-dependent synapse formation and functioning, the inhibitory action of SDF-1alpha on GDPs may reflect a potential mechanism for chemokine regulation of neural development in early neonatal life.
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Affiliation(s)
- Alexander Kasiyanov
- Neurophysiology Laboratory, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
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Oliva E, Garcia-Miralles N, Vu Q, Young RH. CD10 Expression in Pure Stromal and Sex Cord-Stromal Tumors of the Ovary. Int J Gynecol Pathol 2007; 26:359-67. [PMID: 17885484 DOI: 10.1097/pgp.0b013e318064511c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CD10 has been recently advocated as a good immunohistochemical marker for endometrial stromal tumors. Metastatic endometrial stromal tumors to the ovary and primary endometrioid stromal sarcomas may show overlapping histological features with pure stromal and sex cord-stromal tumors (SCSTs). We investigated CD10 expression in a large series of pure stromal and SCSTs of the ovary to ascertain whether CD10 may aid in this differential diagnosis. Archival material from 11 fibromas, 10 thecomas, 10 sclerosing stromal tumors (SSTs), 10 adult granulosa cell tumors (AGCTs), 4 luteinized AGCTs, 9 juvenile granulosa cell tumors (JGCTs), 9 Sertoli cell tumors, 9 Sertoli-Leydig cell tumors, 11 sex cord tumors with annular tubules, 10 steroid cell tumors (StCTs), and 8 fibrosarcomas of the ovary were immunostained for CD10. The percentage of cells stained (<5%, 5%-39%, 40%-75%, and >75%) and intensity of staining (1+, 2+, 3+) were evaluated. CD10 was expressed in 7 of 10 thecomas (4 with 5%-75% and mostly 1+), 9 of 10 SSTs (7 with 5%-39% + cells, mostly 1+), 9 of 10 AGCTs (<5%-39%, four 1+, five 2+), 1 of 4 luteinized AGCTs (<5% and 1+), 8 of 9 JGCTs (mostly <5% to 39% and +1), 4 of 9 Sertoli cell tumors (either focal or >75% with variable intensity), 4 of 9 Sertoli-Leydig cell tumors (mostly <10% with variable staining), with the Leydig cells being positive in only 1 tumor (1+ and <5%), and 7 of 10 StCTs (4 tumors with more than 75% + cells, from 1+ to 3+). All fibromas, all but 1 fibrosarcoma (<5% and 1+), and all sex cord tumors with annular tubules were CD10 negative. CD10 expression was frequently seen in StCTs, SSTs, and thecomas of the ovary, although the latter 2 categories usually showed only faint immunoreactivity. In conclusion the frequency and intensity of CD10 immunoreactivity in pure stromal and sex cord-stromal ovarian tumors are low and contrast with the typical strong and diffuse immunostaining seen in endometrial stromal tumors; however, faint CD10 positivity is consistent with the diagnosis of ovarian SCST. Steroid cell tumors are often positive for CD10, but these tumors do not pose problems in differential diagnosis with endometrial stromal tumors. CD10 may play a useful role in aiding the differential between endometrial stromal tumors in the ovary and SCST and stromal tumors.
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Affiliation(s)
- Esther Oliva
- Pathology Department, Massachusetts General Hospital, Boston, MA 02114, USA.
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Klein J, Zhuang Z, Lubensky I, Colby TV, Martinez F, Leslie KO. Multifocal microcysts and papillary cystadenoma of the lung in von Hippel-Lindau disease. Am J Surg Pathol 2007; 31:1292-6. [PMID: 17667557 DOI: 10.1097/pas.0b013e3180377aaf] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
von Hippel-Lindau disease is an autosomal dominant inherited disorder characterized by a predisposition to multiple neoplasms. Renal cell carcinoma and hemangioblastomas of the retina and cerebellum are the most common of these, but other neoplasms and cysts also occur throughout the body. We report a distinctive, yet never described lung lesion in a 43-year-old woman with von Hippel-Lindau disease. Molecular genetic studies confirmed the presence of a VHL gene mutation in the cells of this lesion. We discuss the salient features of this novel lesion, and hypothesize on its origin and nature.
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Affiliation(s)
- Julianne Klein
- St Boniface General Hospital, Winnipeg, Manitoba, Canada.
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Mehta GU, Shively SB, Gläsker S, Bechert CJ, Zhuang Z, Raffeld M, Lonser RR, Oldfield EH, Vortmeyer AO. von Hippel-Lindau disease: epididymal cystadenoma targeted by metastatic events. Urology 2007; 69:1209.e9-12. [PMID: 17572225 DOI: 10.1016/j.urology.2007.03.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 02/08/2007] [Accepted: 03/12/2007] [Indexed: 11/24/2022]
Abstract
Cases of renal clear cell carcinoma in patients with von Hippel-Lindau disease often exhibit extensive metastasis. Several investigators have shown these tumors to specifically invade central nervous system hemangioblastomas, which are commonly associated with the disease. We report on multiple metastatic events within a single von Hippel-Lindau disease-associated tumor outside the central nervous system, epididymal cystadenoma. The multiplicity of these metastatic events suggests the epididymal cystadenoma as a preferential site of metastasis for von Hippel-Lindau disease-associated renal clear cell carcinoma.
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Affiliation(s)
- Gautam U Mehta
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1414, USA
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Uppuluri S, Bhatt S, Tang P, Dogra VS. Clear cell papillary cystadenoma with sonographic and histopathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1451-3. [PMID: 17060433 DOI: 10.7863/jum.2006.25.11.1451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Sarada Uppuluri
- Department of Radiology, University of Rochester School of Medicine, Rochester, NY 14642 USA
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