SIGNIFICANCE OF CHROMOSOMAL INVESTIGATION OF SOMATIC CELLS TO DETERMINE THE GENETIC ORIGIN OF GONADOBLASTOMA

Bilateral prepubertal carcinoma in situ of the testis and ambiguous external genitalia

A 10-year-old boy with bilateral carcinoma in situ in maldescended testes and concomitant ambiguous genitalia is presented.

Chromosomal sensitivity to X-rays in lymphocytes from patients with Turner syndrome

Lymphocytes from patients with Turner syndrome were irradiated with X-rays (200 rad) to determine the chromosomal aberration frequency in first-division metaphases. Five patients with 45,X karyotype; three 45,X/46,Xi(X)q mosaics; one 45,X/47,XXX mosaic and 9 female controls were studied. Patients with a 45,X karyotype exhibited a radioinduced chromosomal aberration frequency similar to controls (38.6 +/- 6.37 and 36.2 +/- 5.11 respectively; p = 0.42). In the mosaics, 45,X cells had a mean frequency of 38.75 +/- 2.16; 46,Xi(X)q cells a mean of 38 +/- 2.16 and the control group a rate of 36.25 +/- 4.32. No differences were observed between 45,X and 46,Xi(X)q cells (p = 0.50), 45,X and normal cells (p = 0.24) or 46,Xi(X)q and normal cells (p = 0.35). Apparently neither the X monosomy nor the Xq isochromosome influences the 'in vitro' X-ray-induced chromosomal damage in Turner syndrome lymphocytes.

Carcinoma in situ of the testis in children with 45,X/46,XY gonadal dysgenesis

The frequency of gonadal tumors in intersex patients with a karyotype including a Y chromosome is very high. In other at-risk groups, testicular germ cell tumors have been shown to be preceded by carcinoma in situ (CIS) changes. We investigated gonadal tissue from four children, aged 1 month to 18 years, with 45,X/46,XY gonadal dysgenesis, and with male or ambiguous genitalia, for the presence of CIS germ cells. Twelve gonadal biopsies and gonadectomy specimens were analyzed by means of conventional histology and densitometric DNA measurements. CIS changes were detected in specimens from all four patients, and aneuploid DNA distributions of the CIS germ cells confirmed the malignant potential of these cells. In one case, electron microscopic analysis revealed the same ultrastructural features of the CIS germ cells as previously described in seminoma cells. These observations indicate that in all patients with 45,X/46XY gonadal dysgenesis and a male phenotype, gonadal biopsies should be considered as soon as the syndrome is diagnosed. We believe that the finding of CIS warrants gonadectomy.

True hermaphrodite with multiple gonadal neoplasms: report of a case with cytogenetic study

On account of the functioning bigonads, true hermaphrodites show a wide range of morphological anomalies. The patient under discussion had an ovary on one side and an ovotestis on the other side; both of them functioned to some extent to produce a rudimentary uterus, fallopian tubes and a few Woolfian remnants. The additional point of interest in this report was the presence of three gonadal neoplasms-namely Yolk Sac Carcinoma gonadoblastoma and seminoma. While the ovary on one side was replaced by yolk sac carcinoma, the ovotestis was partly destroyed by the other two. The cytogenetic study revealed a hypodiploid number and a mosaic sex chromosomal pattern. The karyotypic abnormalities noticed in the patient are also reviewed.

Three sisters with gonadoblastoma

Three sisters with gonadoblastoma and an 46,XY karyotype are presented. This observation suggests that heredity may play an important role in the genesis of the tumour.

Dysgerminoma in Turner's syndrome

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

Gonadoblastoma: ultrastructural evidence for testicular origin

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

The age of occurrence of gonadal tumors in intersex patients with a Y chromosome

A total of 320 intersex patients with a Y chromosome were classified into four groups; (1) gonadal dysgenesis, (2) asymmetrical gonadal differentiation, (3) virilizing male hermaphroditism and (4) feminizing male hermaphroditism (testicular feminization syndrome). Of these 320 cases, 98 were from the files of The Johns Hopkins Hospital and the remainder from the literature. The incidence of tumors in relation to age and clinical classification was analyzed by computer. The results were plotted for each group. It was found that the percentage of tumors rose appreciably soon after the age of puberty in the first three groups, and it was concluded that the gonads were best removed before the age of puberty. In the case of testicular feminization patients, procrastination until the age of 25 could be considered, if one were willing to assume the risk of neoplasia of about 3.6 per cent until then.

A cytogenetic study of gonadoblastoma tissue in two cases

The hypothesis that gonadoblastoma (gonocytoma III) arises from gonadal tissue with a male chromosome complement has earlier been forwarded. In the literature there is no case with a well documented diagnosis of gonadoblastoma and absence of a Y chromosome. In the two presented cases, one a phenotypic female, the other a phenotypic male, gonadoblastoma was diagnosed. Cytogenetic studies of the removed gonadoblastomas revealed a Y chromosome in both cases. This is in accordance with the hypothesis.

Gonadoblastoma in a phenotypic female with 45,X-47,XYY mosaicism

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