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Dieckmann KP, Tharun L, Angerer M, Harms A, Wülfing C. Myoid gonadal stromal tumor of the testis-the novel subtype of testicular gonadal stromal tumors: a case report and review of the literature. J Med Case Rep 2024; 18:71. [PMID: 38383445 PMCID: PMC10882757 DOI: 10.1186/s13256-024-04393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Sex cord gonadal stromal tumors compose less than 10% of all testicular neoplasms and consist of a variety of histological subtypes. In 2016, the World Health Organization introduced a novel subtype, the myoid gonadal stromal tumor, that consists of spindle-shaped cells with immunohistologic features of muscle cells. Only few cases have been reported to date. Due to its rarity and owing to its only recent introduction, the current knowledge about myoid gonadal stromal tumor is limited, and particularly, appropriate clinical management is still ill-defined. CASE PRESENTATION A 47-year-old man of Caucasian descent presented with nonspecific scrotal discomfort. A roundish and well demarcated hypoechoic mass of 8.5 mm in diameter was detected in the cranial region of the left testis. Serum tumor marker levels were within normal ranges. Testis-sparing surgery revealed a 9-mm whitish, hard mass with sharp surgical margin. Histologically, the neoplasm consisted of microfibrillar tissue with spindle-shaped cells harboring elongated nuclei. Immunohistochemical work-up disclosed expression of desmin, small muscle actin, and S100 protein giving evidence for the myogenic nature of the neoplastic cells. There was no indication of malignancy, neither histologically nor clinically. Follow-up of 1 year was uneventful. CONCLUSION A literature survey revealed 22 previous cases of myoid gonadal stromal tumor. The median age was 37 years, the median size of the neoplasm was 20 mm, and there was no side-preponderance. Myoid gonadal stromal tumor is not much different from other subtypes of gonadal stromal tumors nor from testicular gem cell tumors regarding age and laterality; however, tumor size is smaller in myoid gonadal stromal tumors than in germ cell tumors. Although rarely performed so far, testis-sparing surgery probably constitutes an appropriate treatment of this neoplasm. Myoid gonadal stromal tumor represents an emerging novel entity of benign testicular new growths that caregivers of patients with testicular tumors should be aware of.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany.
| | - Lars Tharun
- Medizinisches Versorgungszentrum Hanse Histologikum, Fangdieckstrasse 75a, 22547, Hamburg, Germany
| | - Markus Angerer
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany
| | - Alexander Harms
- Medizinisches Versorgungszentrum Hanse Histologikum, Fangdieckstrasse 75a, 22547, Hamburg, Germany
| | - Christian Wülfing
- Testicular Cancer Unit, Department of Urology, Asklepios Klinik Altona, Paul Ehrlich Strasse 1, 22763, Hamburg, Germany
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Elousrouti LT, Gouzi I, Hammas N, Chbani L, Tazi F, Fareh MH, Elfatemi H. Myoid Gonadal Stromal Tumor: A New Case Report with a Review of the Literature. Int J Surg Pathol 2023; 31:1580-1585. [PMID: 36945833 DOI: 10.1177/10668969231160256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The myoid gonadal stromal tumor is a very rare testicular spindle cell tumor. Few cases have been reported in the literature from 1977 to 2022. It was an emerging entity in the fourth edition of the WHO Classification of Tumors of the Urinary System and Male Genital Organs and has been instated as a full benign entity in the new edition of 2022. We report herein an additional case of a myoid gonadal stromal tumor. It was a 27-year-old man who presented with an asymptomatic mass in his left testicle for 2 months. The mass was confirmed by ultrasound as a 3 cm solid well-circumscribed lesion for which orchiectomy has been performed. The histological analysis of the specimen and the immunohistochemistry staining was consistent with a myoid gonadal stromal tumor. The characteristics of this tumor are summarized in well-circumscribed, nonencapsulated masses of uniform spindle cells, and immunohistochemically, tumor cells coexpress SMA and S-100 protein. The benign behavior of this tumor is demonstrated by our results and those presented in the previous cases reported in the literature.
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Affiliation(s)
- Layla Tahiri Elousrouti
- Department of Pathology, Hospital University Hassan II, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
- Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
| | - Imane Gouzi
- Department of Pathology, Hospital University Hassan II, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
| | - Naoual Hammas
- Department of Pathology, Hospital University Hassan II, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
- Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
| | - Laila Chbani
- Department of Pathology, Hospital University Hassan II, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
- Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
| | - Fadl Tazi
- Department of Urology, Hospital University Hassan II, Fez, Morocco
| | | | - Hinde Elfatemi
- Department of Pathology, Hospital University Hassan II, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
- Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacology, Sidi Mohamed Ben Abdellah University, KM 2.200 Sidi Harazem Street, 30070 Fez, Morocco
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3
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Myoid gonadal tumor. Case series, systematic review, and Bayesian analysis. Virchows Arch 2020; 478:727-734. [PMID: 33140129 DOI: 10.1007/s00428-020-02957-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
Myoid gonadal stromal tumor represents a rare testicular neoplasm displaying smooth muscular and gonadal stromal differentiation. This entity has very few cases reported in the literature that describe heterogeneous clinical and pathological characteristics. Bayesian statistics provides a useful framework to combine information from diverse sources. We here presented a case series-the largest so far reported-of myoid gonadal stromal tumor (4 cases) with extensive morphologic, immunohistochemical, and molecular characterization, performed a systematic review of the literature (that identified 9 papers), and used a Bayesian data analysis to understand the characteristics of this disease. Our study collectively described 16 cases. This neoplasm is mainly found in adults (mean age about 40 years) and often has a size of about 3 cm. By morphology, the tumor can infiltrate testicular tubules and is composed of spindle cells; few mitoses can be seen (usually 2/10 HPF). Neoplastic cells are diffusely positive with α-smooth muscle actin with a tram-track staining pattern. S100 protein, FOXL2, and SF1 are also characteristically positive. Moreover, this neoplasm can display epithelial differentiation, in about half of the cases. In conclusion, we foresee the use of this statistical approach in pathology: our analysis allowed a more precise description of this rare entity.
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4
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Saal C, Jeandel R, Boukamel S, Yver M. [Fibrothecoma of the testis: A case report in an adult]. Ann Pathol 2018; 38:249-252. [PMID: 29803360 DOI: 10.1016/j.annpat.2018.04.001] [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: 06/19/2016] [Accepted: 04/03/2018] [Indexed: 12/01/2022]
Abstract
Fibrothecal tumors belong to sex cord/stromal tumors (SCSTS). They represent 1 to 4.7 % of the organics tumors of ovary (Chechia et al., 2008) but are extremely rare in the testis, with only a few cases described in the literature. We report a new case of a fibrothecoma in the testis in an adult. The extemporaneous diagnosis was made in the same time of the surgical intervention. The castration has been avoided.
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Affiliation(s)
- Caroline Saal
- Service de pathologie, centre hospitalier de Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France.
| | - Roland Jeandel
- Service de pathologie, centre hospitalier de Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
| | - Samir Boukamel
- Service d'urologie, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77104 Meaux, France
| | - Matthieu Yver
- Service de pathologie, centre hospitalier de Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
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Bharti JN, Dey B, Mittal A, Arora P. A case of fibrous pseudotumor of the paratesticular region. World J Mens Health 2013; 31:262-4. [PMID: 24459661 PMCID: PMC3888897 DOI: 10.5534/wjmh.2013.31.3.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/16/2013] [Accepted: 10/01/2013] [Indexed: 11/15/2022] Open
Abstract
A 78-year-old male patient presented with an inguinoscrotal nodule that had lasted for 3 years. The patient reported a past medical history of hydrocele formation. The final diagnosis was fibrous pseudotumor of the paratesticular region, which was based on a histopathological examination and immunohistochemical findings. The aim of this case report is to spread awareness and recognition of neoplastic and non-neoplastic entities that occur in the paratesticular region.
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Affiliation(s)
| | - Biswajit Dey
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Ashna Mittal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Prerna Arora
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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6
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Datta S, Dey S, Mukherjee S, Chandra Paul P, Bhattacharyya A, Biswas S, Tudu B. Testicular fibroma of gonadal stromal origin with minor sex cord elements, presenting with hydrocele. Rare Tumors 2013; 5:e34. [PMID: 24179646 PMCID: PMC3804809 DOI: 10.4081/rt.2013.e34] [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: 01/04/2013] [Revised: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 11/23/2022] Open
Abstract
Testicular fibroma of gonadal stromal origin is a rare benign tumor of testis which usually presents as a slow growing testicular mass. Only 25 cases of testicular fibroma have been reported in the literature. Presence of minor sex cord elements in this tumor is even rarer. We report a case of testicular fibroma with minor sex cord elements that involved almost the entire testis and tunica vaginalis. The patient presented with hydrocele, a rare presentation for this entity. The rarity of the diagnosis and the clinical presentation prompted this case report.
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Affiliation(s)
- Saikat Datta
- Department of Pathology, Nilratan Sircar Medical College , Kolkata, India
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8
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Chou DS, Andrawis R, Soofer S, Sidawy MK, Rhee J, Manyak MJ. BENIGN INTRATESTICULAR TUMOR. J Urol 2004; 171:1624. [PMID: 15017236 DOI: 10.1097/01.ju.0000116803.66676.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D S Chou
- George Washington University Medical Center, Washington, DC, USA
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9
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Deveci MS, Deveci G, Ongürü O, Kilciler M, Celasun B. Testicular (gonadal stromal) fibroma: case report and review of the literature. Pathol Int 2002; 52:326-30. [PMID: 12031091 DOI: 10.1046/j.1440-1827.2002.01345.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 25-year-old man presented with complaint of a painless enlargement in his left testis. The solid, encapsulated, circumscribed and grayish-white testicular mass displayed the characteristics of testicular fibroma histologically. It was composed of acellular collagenized plaques and hypercellular areas of fibroblastic spindle cells. Immunohistochemically, the neoplastic cells were positive for vimentin and smooth muscle actin, but not for cytokeratin, S-100 protein, desmin, CD99/MIC2 (a protein expressed by Sertoli cells and granulosa cells) and CD34. Only 18 cases of testicular (gonadal stromal) fibroma composed exclusively of spindle cells have been reported to date. An additional case of fibroma, which lacks definite neoplastic sex cord elements, and its differential diagnosis from other mesenchymal lesions of testis are discussed here, together with other cases in the literature.
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Affiliation(s)
- M Salih Deveci
- Department of Department of Pathology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey.
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10
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de Pinieux G, Glaser C, Chatelain D, Perie G, Flam T, Vieillefond A. Testicular fibroma of gonadal stromal origin with minor sex cord elements: clinicopathologic and immunohistochemical study of 2 cases. Arch Pathol Lab Med 1999; 123:391-4. [PMID: 10235496 DOI: 10.5858/1999-123-0391-tfogso] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To report the histologic and immunohistochemical features of 2 cases of intratesticular fibromatous tumors. RESULTS Microscopically, these tumors were composed of short, randomly interweaving fascicles of spindle cells dispersed within a fibrocollagenous stroma. A sex cord component was detected in one case by microscopic examination and in both cases by immunohistochemical study using MIC2 and anti-inhibin antibodies. CONCLUSIONS The presence of minor sex cord elements, morphologically or by immunohistochemistry, suggests that these fibromatous tumors are related to and are a subset of sex cord-stromal tumors. Intratesticular fibromatous tumors, of which 11 other cases lacking sex cord elements have been reported, could be considered as the testicular equivalent of ovarian fibroma. These tumors could then be referred to as testicular fibroma of gonadal stromal origin, with or without minor sex cord component.
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Affiliation(s)
- G de Pinieux
- Service d'anatomie pathologique, Hôpital Cochin, Paris, France
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11
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Jones MA, Young RH, Scully RE. Benign fibromatous tumors of the testis and paratesticular region: a report of 9 cases with a proposed classification of fibromatous tumors and tumor-like lesions. Am J Surg Pathol 1997; 21:296-305. [PMID: 9060599 DOI: 10.1097/00000478-199703000-00005] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Benign intrascrotal fibrous proliferations are uncommon, with most arising from the paratesticular region and falling into the category of so-called fibrous pseudotumor. We describe two neoplastic forms of benign fibrous tumor of the testis and its adnexa: fibroma of gonadal stromal origin and fibroma of the testicular tunics. Three patients with gonadal stromal fibroma were 28, 33, and 35 years of age and presented with painless masses. The tumors were circumscribed, intratesticular, yellow-white or white lesions 0.9 to 4.0 cm in diameter and had microscopic features identical to those of the ovarian fibroma. Immunohistochemically, the tumor cells were strongly positive for vimentin (3/3 cases), focally positive for actin and desmin (2/3 cases) and negative for S-100, keratin, and CD34 (3/3 cases). Six fibromas of the testicular tunics arose in patients 22, 34, 60, 68, 70, and 74 years old and were also asymptomatic masses. Four of them were circumscribed, whorled, white masses arising from the tunica albuginea with variable areas of myxoid change; one was pedunculated and grew exclusively into the cavity of the tunica vaginalis, whereas the other three at least partially extended into the testis as well. The other two tumors were unattached to the tunica albuginea and presented as circumscribed, white-tan paratesticular masses, partially covered by tunica vaginalis. Microscopically, the tumors were slightly to moderately cellular, with bland spindle or stellate cells lying in a myxoid or collagenous stroma with prominent vessels. The two paratesticular tumors had features typical of solitary fibrous tumor. Immunohistochemically, the fibromas of the testicular tunics were negative for S-100, keratin, and desmin. Focal, weak reactivity for actin was present in one case. CD34 was positive in three cases; in the two tumors resembling solitary fibrous tumors it was strong, and in the other it was focal and was limited to the region just below the tunica vaginalis. Eight tumors were treated by radical orchiectomy and one by excision of the mass alone. The outcome was benign in the seven cases in which followup information is available.
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Affiliation(s)
- M A Jones
- Department of Pathology, Maine Medical Center, Portland 04102, USA
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12
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Abstract
A testicular fibroma in a 67-year-old man is reported. The tumor presented with expansive growth and myxoid areas. Atypias were absent. Differential diagnosis was made with immunohistochemical techniques that are useful for the diagnosis of nonspecialized gonadal stromal tumors. The origin of the tumor was probably in the interstitial or peritubular myofibroblasts.
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Affiliation(s)
- M Nistal
- Department of Morphology, School of Medicine, Autonomous University of Madrid, Spain
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