Congenital Juvenile Granulosa Cell Tumor of the Testis in a Fetus Showing Full 69, XXY Triploidy

Testicular juvenile granulosa cell tumor (TJGCT) occurs predominantly in infancy and may be associated with sex chromosomal abnormalities. We report a fetus aborted because of cytogenetically confirmed complete XXY triploidy. External genitalia of the fetus were female, with a short and patent vagina. The tumor presented as an abdominal multicystic mass with typical histologic and immunohistological features of JGCT. It was connected with a tubular uterus-like structure. The other gonad was an inguinally localized testis that showed histologically a Sertoli cell adenoma. Malformations typical for triploidy were also present: agenesis of the corpus callosum, stenosis of the pulmonary ostium, and hypoplasia of the lungs and adrenals. To our knowledge this is the first case of TJGCT in a triploid fetus.

WKY/Ztm-ter: a new rat inbred strain on the WKY/Ztm genetic background with congenital teratomas

We describe a new rat model for teratomas (WKY/Ztm- ter) which arose through a spontaneous mutation in the inbred WKY/Ztm rat strain. When the tumours of the gonads became clinically apparent, affected males were 14 to 224 days of age, whereas the females only developed tumours between days 21 and 63. Tumour incidence is not gender-dependent. However, almost all females develop bilateral tumours, while 50% of the males show unilateral tumours. Histologically, all examined tumours ( n = 65) represent partially undifferentiated teratocarcinomas.

Congenital juvenile granulosa cell tumor of the testis in newborns

BACKGROUND

Granulosa cell tumor of the testis is a rare intermediate stromal cell tumor that can be distinguished in the adult and juvenile type. The juvenile type is the most common reason for scrotal swelling in newborns under the age of six months. Less than fifty cases of this disease entity have been reported in the literature.

PATIENTS AND METHODS

In the following article, two newborn patients with scrotal swelling and a histological confirmation of juvenile granulosa cell tumor of the testis will be presented.

RESULTS

Case 1: A newborn patient presented with massive scrotal swelling. Sonography of the testicle exhibited a multiple septic and cystic enlargement of the testicle without distinction of the testicular parenchyma being possible. The laboratory findings demonstrated normal testosterone levels, beta-HCG and inhibin-B levels as well as an increased alpha-fetoprotein level of 35.350 ng/dl. Due to clinical and sonographic findings, an inguinal exploration and later, due to the impossibility of distinction of the testicular parenchyma, an inguinal orchiectomy of the right testicle was performed. Case 2: The clinical and sonographic examination of a newborn patient demonstrated a suspicious process of the left testicle. Sonography exhibited an enlarged testicle with cystic formations with the distinction of the testicular parenchyma not being possible. The laboratory findings demonstrated normal testosterone levels, beta-HCG and inhibin-B levels as well as an increased alpha-fetoprotein level of 9.038 ng/dl and LDH of 768 U/I. An inguinal orchiectomy of the left testicle was performed. In both cases, a histological diagnosis of juvenile granulosa cell tumor of the testis was made.

CONCLUSION

These two aforementioned cases demonstrate that juvenile granulosa cell tumor of the testis is a benign disease encountered in newborns, which exhibits an excellent prognosis. Inguinal orchiectomy is the therapy of choice. After surgical removal of the involved testicle is performed no further management is required.

A novel splice mutation in the TP53 gene associated with Leydig cell tumor and primitive neuroectodermal tumor

A 20-month-old boy presented with precocious puberty due to a Leydig cell tumor, and at the age of 6 years with a primitive neuroectodermal brain-tumor (PNET). A novel splice site mutation of the TP53-gene, likely to be associated with a nonfunctional protein, was found in the proband, his father and younger sister, but only the proband has so far developed malignancy. The clinical phenotype in the boy is suggestive of Li-Fraumeni syndrome, but the family does not strictly conform to the canonical definition.

Intrauterine torsion of a testicular teratoma: a case report

Neonatal testicular tumors and intrauterine testicular torsions are very rare. The presented case is the first describing intrauterine torsion of a descended testis with a teratomatous tumor. Immediately after birth, right hemiscrotal swelling was seen in a preterm male newborn. Surgical intervention showed extravaginal testicular torsion and a highly differentiated testicular teratoma with haemorrhagic infarction. The testis was removed (orchiectomy). Over a period of twelve months no signs of tumor recurrence were found. While being extremely rare, testicular tumors should be included in the differential diagnosis of neonatal scrotal swelling.

Paratesticular congenital malignant rhabdoid tumor diagnosed by fine-needle aspiration cytology. a case report

We report the FNA features of a congenital malignant extrarenal rhabdoid tumor (MERT) located in the right paratesticular area of a newborn full-term boy (39 wk gestation), with disseminated metastases in the liver and right parietal region. The diagnosis was suggested two days after birth by fine-needle aspiration biopsy (FNAB) of the parietal mass, which demonstrated an atypical large cell proliferation with vesicular nuclei, prominent nucleoli, and abundant cytoplasm exhibiting paranuclear dense inclusions. The diagnosis was confirmed by histopathologic and immunohistochemical examination of the primary paratesticular tumor. To the best of our knowledge, this is the third MERT reported in the paratesticular region, one of the few congenital extrarenal non-central nervous system cases, and the third congenital case (renal or extrarenal) primarily diagnosed by FNAB. We emphasize the characteristic cytologic features of a congenital rhabdoid tumor, which must be known by pathologists because of the clinical and prognostic implications. Diagn. Cytopathol. 2004;30:46-50.

Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery

PURPOSE

Testicular tumors in the pediatric population are fundamentally distinct from their adult counterparts. We reviewed a contemporary single series from a large pediatric health science center. We also examined our experience with testis conserving surgery and then used it to develop a preoperative management algorithm.

MATERIALS AND METHODS

A retrospective review was performed of all testicular tumors at a single institution from 1984 to 2002. Data were compiled using the American Academy of Pediatrics testis tumor registry data collection form. We further examined partial orchiectomies for indications and outcomes with respect to cancer control and testicular viability.

RESULTS

A total of 51 primary testicular lesions were identified. Patient age was prenatal to 16 years with a scrotal mass the most common presentation (81%). Mature teratoma, rhabdomyosarcoma, epidermoid cyst, yolk sac and germ cell tumors accounted for 43%, 26%, 10%, 8% and 6% of cases, respectively. This distribution was markedly different from the last reported American Academy of Pediatrics data base. Organ preserving surgery was planned and achieved in 13 cases. All surgeries were successful with respect to cancer control and testicular preservation.

CONCLUSIONS

We believe that the higher incidence of teratoma is more representative of this population and yolk sac tumor is a minority diagnosis. The single institution review eliminates the interinstitutional referral heterogeneity that may have skewed larger data bases. Furthermore, the concept of testicular preserving surgery becomes an attractive option since we present its safety and efficacy. The management algorithm should facilitate the preoperative decision to perform less radical surgery and help preserve testicular tissue.

Juvenile granulosal cell tumor of the testicle

This is a case of a newborn with a rare testicular tumor-a juvenile granulosal cell tumor. This is a tumor of stromal origin, which is similar histologically to granulosal cell tumors of the ovaries. The authors present the imaging characteristics and differential diagnoses in this patient.

Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the Prepubertal Testis Tumor Registry

PURPOSE

The Prepubertal Testis Tumor Registry was established by the Urologic Section of the American Academy of Pediatrics in 1980 to record data on a large number of prepubertal testis tumors regarding presentation, treatment and outcome to define appropriate management better. We reviewed the registry data in the context of other modern studies to elucidate the appropriate management of these rare tumors.

MATERIALS AND METHODS

Relevant data in the prepubertal testis tumor registry were tabulated and analyzed.

RESULTS

There were 395 prepubertal patients who had a primary testis tumor. Generally benign tumors accounted for 38% of cases. A significant proportion of tumors were benign regardless of patient age. alpha-Fetoprotein levels for patients with benign and malignant tumors overlapped in children younger than 6 months. Of the patients with yolk sac tumor 80% presented with stage 1 disease and overall survival was excellent. There were no metastases or deaths among the patients with teratoma. Of all patients with stromal tumors metastases developed in only 1.

CONCLUSIONS

We recommend initial excisional biopsy for all amenable prepubertal testis tumors, except those with an alpha-fetoprotein level that is clearly increased for patient age. Patients with benign tumors may be released from oncological followup. Patients with stage I yolk sac tumor should be monitored closely, and those with recurrent or metastatic yolk sac tumor should be treated with chemotherapy. Retroperitoneal lymph node dissection is reserved for patients with recurrent retroperitoneal masses following chemotherapy. Aggressive treatment of metastatic Sertoli cell or undifferentiated stromal tumors is warranted.

Ruptured cystic teratoma of the testis in a neonate

Neonatal testicular tumors are extremely rare. We report the case of a full-term male newborn with right hemiscrotal swelling found immediately after birth. The right hemiscrotal skin gradually turned dusky dark and then adhered to the hard scrotal contents. Missed right testicular torsion was suspected and emergency exploration was not attempted. Right hemiscrotal swelling became aggravated, so right orchiectomy and left orchidopexy were performed. During surgery, severe inflammation of the right testis and the right hemiscrotum were observed and diffuse hemorrhage with focal hematomas was noted within the removed right testis. Histopathology of the specimen revealed a ruptured mature cystic teratoma of the testis. The alpha-fetoprotein concentration was 729 x 10(4) micrograms/L 10 days after the operation, and dropped to 185 x 10(4), 25 x 10(4), and less than 20 x 10(4) micrograms/L 2, 5, and 8 months later, respectively. Postoperative abdominal and pelvic computerized tomography scans revealed neither lymphadenopathy nor distant metastasis. During a follow-up of 8 months, no evidence of tumor recurrence was found. Although extremely rare, testicular tumors should be included in the differential diagnosis of an enlarged hard or firm scrotal mass in the male neonate.

Prepubertal Testicular Tumor Registry

The Prepubertal Testicular Tumor Registry has been in existence for 12 years. Information on 327 patients was collected and registered in the database. Demographic data have been analyzed, leading to a better understanding of these rare tumors. Information regarding the natural history and behavior of the tumors has also evolved from a retrospective review of the tumors. The registry will continue in an effort to collect centrally information on these unusual tumors and to attempt to aid in developing a better understanding of the natural history and behavior of the tumors to provide early detection, consistent treatment and improved survival.

Prepubertal testicular tumor registry

There are 327 patients in the Prepubertal Testicular Tumor Registry, and demographic data and a better understanding of the natural history and behavior of the tumors have evolved. Information on these rare tumors should be collected centrally and treatment using national protocols followed closely. Continuation of the Registry is important to help clarify the knowledge of these unusual tumors and to aid in the management of these patients through information from a large database.

Congenital juvenile granulosa cell tumour of the testis: report of a case showing extensive degenerative changes

Juvenile granulosa cell tumour is a rare neoplasm of the testis which occurs predominantly in infancy and which may be associated with sex chromosomal abnormalities. We report an unusual case with deceptive histological features resulting from extensive degenerative changes. In the pedunculated intra-abdominal mass resected from a 1-month-old male baby with 45,X/46,X,iso(Yq) mosaicism, there were multiple large cystic spaces devoid of cellular lining or lined by flat nondescript cells, mimicking various cystic lesions such as multicystic mesothelioma, cystic lymphangioma and cystic dysplasia. The cysts were separated by a highly vascularized fibrous stroma. Only in very rare cysts and the smaller cysts in the region of the pedicle were granulosa cells identified, permitting a diagnosis of juvenile granulosa cell tumour to be made.

The epidemiology of testicular cancer in upstate New York

In a study of 250 cases of cancer of the testis and of neighborhood- and age-matched controls in upstate New York in 1977-1980, the authors found that risk was enhanced by possession of a number of traits associated with exposure of the testis to heat; occupational exposures to fertilizers, phenols, and fumes or smoke; and trauma to the testis. Risk was also increased for characteristics related to congenital and developmental aberrancies and testis-related abnormalities, e.g., low sperm count, fertility problems, atrophic testis, and cryptorchidism. Several of these risk factors were statistically significant in a multiple regression model that adjusted for all other significant traits, age, and education.

Torsion of an undescended intraabdominal benign testicular teratoma

A 4-year-old well boy was seen because of an asymptomatic left testicle undescended since birth; the testis was not palpable and the right side was normal. After an episode of left lower quadrant and left hip area pain, with some bladder symptoms and left leg limping, a work-up including a CAT scan showed a calcified retroperitoneal pelvic tumor on the left side. At laparotomy, an infarcted mass was found in the pelvis just above the internal ring. It was a torsion of an undescended intraabdominal testis with a benign testicular teratoma. The tumor was removed and his recovery was uneventful.

Congenital testicular juvenile granulosa cell tumor in a neonate with X/XY mosaicism

A congenital sex cord-stromal tumor of the testis with morphologic features of juvenile granulosa cell tumor is reported. The tumor occurred in an abdominal testis of a newborn infant with an X/XY karyotype and ambiguous genitalia and presented as a partially cystic mass associated with ascites. Histologically the tumor was comprised of an admixture of solid, cellular, poorly differentiated lobules mimicking graafian follicles. Residual hypoplastic testicular tissue was present at the periphery. This is the 19th reported case of testicular juvenile granulosa cell tumor and the fourth with an underlying sex chromosome anomaly, further emphasizing the relationship of this uncommon neoplasm to abnormal sexual or gonadal development.

Morphologic analysis of spontaneous teratocarcinogenesis in developing testes of strain 129/Sv-ter mice

Spontaneous teratocarcinogenesis in the mouse testis begins during the early stages of gonad differentiation. Using inbred strain 129/Sv-ter mice which are highly susceptible to these tumors, the authors have examined the morphologic features of the testis during the gestational period defined from Day 13 through birth. Normal inbred mice (129/J) and random bred mice (Swiss Webster, SW) were used as control groups. Serially sectioned gonads were evaluated at the light- and electron-microscopic levels for histologic changes. In agreement with studies by other workers, embryonal carcinoma cells (ECCs) were observed in tumor-susceptible mice. Cellular arrangements varied from vesicular to nodular. Cell death within advanced tumors was labeled "apoptosis" (shrinkage necrosis). Also encountered were syncytial arrangements of gonocytes (atypical gonocytes), which were present in all animal groups. The significance of atypical gonocytes in relation to degeneration and preneoplasia is addressed.

A recessive mutation (ter) causing germ cell deficiency and a high incidence of congenital testicular teratomas in 129/Sv-ter mice

The genetic basis of a germ cell deficiency, accompanied by a high incidence of testicular teratomas, was studied in strain 129/Sv-ter mice (formerly designated "129/terSv"). Germ cell deficiency became more severe with advancing age in males, and they were sterile whether or not they had bilateral teratomas. Germ cell-deficient testes were smaller than normal except when the testes had teratomas. In females the ovaries were smaller than normal, but the germ cell deficiency did not progress and most were fertile. The germ cell deficiency resulted from the homozygous state of a recessive mutant gene designated "teratoma (ter)." Matings between females with small ovaries and homozygous normal males produced no germ cell-deficient offspring. When F1 offspring with normal gonads were mated together, germ cell-deficient F2 animals appeared at a frequency close to 1 in 4. When females with small ovaries (ter/ter) were mated with heterozygous males (ter/+), half of the offspring were germ cell deficient. It was concluded that the genetic factor is a single recessive gene. The incidence of teratomas in +/+ strain 129/Sv-ter males was 1.4% (3/216), and all teratomas were unilateral. Seventeen percent (20/117) of heterozygous males had teratomas, of which 18 were unilateral and 2 were bilateral. Ninety-four percent (167/178) of homozygous ter/ter males had teratomas, of which 75% were bilateral. Introduction of the mutant gene ter onto the C57BL/6 genetic background resulted in germ cell deficiency in homozygotes, but it reduced considerably the teratoma incidence in ter/ter males.

Primordial germ cell proliferation in fetal testes in mouse strains with high and low incidences of congenital testicular teratomas

The development of genital ridges in mouse strains were compared with high and low susceptibility to teratocarcinogenesis. The number of dividing primordial germ cells (PGC) was low at 12 days of gestation. The number increased sharply at 13 days and decreased precipitously by 15 days of gestation. The period of high mitotic activity closely paralleled the period of susceptibility to experimentally induced teratocarcinogenesis. Testes that had a long proliferative period had a higher incidence of teratomas than those that had a short proliferative period. A group of fetuses was identified that had markedly fewer than normal PGC. The incidence of teratomas in this group was very high, and nearly all growths were bilateral.