Testicular sex cord stromal tumour with granulosa cell differentiation: detection of steroid hormone receptors as a possible basis for tumour development and therapeutic management.

A testicular sex cord stromal tumour with granulosa cell differentiation, typical of granulosa cell tumours of the adult type, was investigated immunohistologically on snap frozen and paraffin wax embedded material. The predominance of vimentin and the additional expression of cytokeratin subtypes 8 and 18, as well as the negative staining for epithelial membrane antigen, accorded with results previously reported, for ovarian granulosa cell tumours; the lack of expression of desmoplakin, however, was a distinctive feature. Together with negative staining for leucocyte common antigen, the antigen pattern facilitates the differential diagnosis between granulosa cell tumour and undifferentiated carcinoma or gonadal lymphoma, although its suitability for differentiating within the group of gonadal stromal tumours seems to be limited. The small growth fraction, shown by the monoclonal antibody Ki-67, is typical of the clinical behaviour of granulosa cell tumours. The expression of oestrogen and progesterone receptors, also recently found in testicular Leydig cell tumours, may provoke new approaches to the management of testicular granulosa cell tumours, as well as a new hypothesis on the development of these tumours.

Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria.

In the glands of cyclic endometria, proliferative activity (PA), as revealed by expression of the Ki-67 antigen, is highest in the proliferative phase (P) and early secretory phase (S1). The PA decreases in the middle secretory phase (S2). In the stroma the PA is low during the whole cycle. In P and S1, the oestrogen receptor (ER) and the progesterone receptor (PR) are strongly expressed in glands and stroma. The number of positive cells and the staining intensity decreases in S2, particularly in the glands. In atrophic endometria, fibro-glandular polyps and in endometria with arrested secretion the PA is low in both glands and stroma. ER and PR can be detected in glands and stroma. The PA in atypical hyperplasias is only slightly higher than in cyclic endometria and endometria with simple hyperplasia. The ER and PR levels are comparable to those in proliferative endometria. The PA of endometrial adenocarcinomas is positively and the ER and PR negatively correlated with the degree of de-differentiation. No ER-negative carcinoma displays the PR. Immunohistologically, non-neoplastic receptor positive tissue can be seen in many ER- and PR-negative carcinomas. These structures may falsify the biochemical receptor analysis.

Characterisation of adenoid cystic carcinoma of the breast by immunohistology.

An adenoid cystic carcinoma of the breast in a 78 year old woman was analysed immunohistologically for the production of type IV collagen, the expression of vimentin, epithelial membrane antigen (EMA) and steroid receptors, and the proliferative activity of the tumour cells. The data were compared with those obtained in eight adenoid cystic carcinomas of salivary glands and in ductal carcinomas of the breast with a cribriform growth pattern. The patients' ages were as follows: 45-80 years (mean 63.2) for the salivary gland carcinomas; 37-69 years (mean 50.6) for the ductal breast carcinomas. In contrast to the cribriform spaces of ductal carcinomas, the pseudocysts in adenoid cystic carcinomas were lined by type IV collagen. The opposite pattern was observed for EMA. Like the myoepithelium of normal breast, the myoepithelium-like cells of adenoid cystic carcinoma stained positive for vimentin while the ductular epithelium-like ones did not. All adenoid cystic carcinomas, including that of the breast, were negative for the oestrogen and progesterone receptors, unlike the ductal carcinomas. Proliferative activity of the adenoid cystic carcinoma of the breast was relatively low. These data broaden the range of antibodies suitable for differential diagnosis of both tumour types. They may explain the differences in prognosis, and they explain why hormonal treatment or radiotherapy of adenoid cystic carcinoma of the breast are often ineffectual.

Immunohistological determination of oestrogen receptor, progesterone receptor, and intermediate filaments in Leydig cell tumours, Leydig cell hyperplasia, and normal Leydig cells of the human testis.

Testicular Leydig cell tumours are able to produce oestrogens and can be induced by exogeneous oestrogen administration. Oestrogen and progesterone receptors, cytokeratin, vimentin, and proliferative activity were determined immunohistologically in human testes in six Leydig cell tumours, 14 cases of Leydig cell hyperplasia, and 13 cases with normal Leydig cells. While both steroid receptors were detected in about 70 per cent of the tumour cells in cryostat sections, no reaction was observed in normal Leydig cells. This supports the hypothesis of an enhanced receptor state in a Leydig cell subpopulation as a basic pathophysiological factor in the development of Leydig cell tumours. On cryostat sections, all tumours co-express cytokeratin and vimentin. Neither the receptors nor the intermediate filaments could be detected reliably in paraffin sections. The low proliferative activity of Leydig cell tumours corresponds to their benign clinical course.

Thymic hyperplasia following chemotherapy of a testicular germ cell tumor. Immunohistological evidence for a simple rebound phenomenon.

Diffuse thymic hyperplasia after chemotherapy of a mixed testicular germ cell tumor is reported in a 16-year-old patient. The immunohistologic investigation of the enlarged thymus revealed a normal distribution and antigen expression of lymphocytes and epithelial cells. There was no evidence of selective proliferation of lymphocytic or nonlymphocytic subpopulations within the thymus. Thus, our data corroborate the identification of thymic enlargement after chemotherapy as a simple rebound phenomenon.

Seminoma testis with elevated serum beta-HCG--a category of germ-cell cancer between seminoma and nonseminoma.

Serum beta-HCG was elevated in 10 of 83 consecutive patients with histologically pure seminoma (12%). Six patients with diagnostic stage I were successfully treated by radiation therapy. One patient with state IIc suffered a mediastinal relapse following retroperitoneal radiotherapy. Two other patients with high tumour burden achieved complete remission after induction chemotherapy followed by surgery and radiotherapy, respectively. One patient with retroperitoneal bulky disease reached permanent complete remission after radiation therapy alone. Beta-HCG-positive seminomas constitute a distinct category of germ-cell tumours on the basis of morphological and clinical features. Corresponding to the intermediate histological position between seminoma and nonseminoma, safe treatment of beta-HCG-positive seminoma can be achieved by radiotherapy in stage I, by retroperitoneal lymphadenectomy plus adjuvant chemotherapy in stages IIa, b and by induction chemotherapy in stages IIc and III.

Immunohistologic detection of estrogen and progesterone receptors in disseminated peritoneal leiomyomatosis.

Disseminated peritoneal leiomyomatosis (DPL) is a rare clinicopathologic entity typically observed in women during pregnancy or immediately postpartum. Immunohistologic examinations of frozen as well as paraffin sections in three cases of DPL confirmed the myocytic character of the lesion and substantiated the hormonal influence on growth and regression of DPL nodules by detection of estrogen and progesterone receptors in the tumor cells. Implications of functional aspects as well as the benign clinical and morphologic feature of DPL are discussed in order to avoid inappropriate therapeutic measures.

[Perineal ectopic testis]. / Perineale Hodenektopie.

The case of a 24-year-old patient is presented who was erroneously presumed to have unilateral testicular aplasia following inguinal exploration in early childhood. At the age of 24 years he underwent surgery for a soft perineal mass, which was found to be perineal testicular ectopia associated with a congenital hernia. Histological examination of the excised testicle revealed atrophy of the germinal epithelium. A survey of the literature yielded approximately 175 more cases of perineal testicular ectopia. This is the most frequent from of testicular ectopia with a relative incidence of less than 1% of all cases of undescended testes. Ectopic testes seem only to differ from undescended testes in terms of topography. Little difference can be observed in terms of histology or the incidence of concomitant hernias.

[Reactive benign thymus hyperplasia following cytostatic chemotherapy]. / Reaktive benigne Thymushyperplasie nach zytostatischer Chemotherapie.

A space-occupying mediastinal mass was discovered in a 16-year-old boy with metastasizing non-seminomatous testicular tumour six months after successful conclusion of cytostatic chemotherapy. Metastases at other sites were excluded. An enlarged thymus was the only finding at operation. Histological and histochemical examination demonstrated diffuse hyperplasia. The findings demonstrate that reactive benign thymic hyperplasia after cytostatic chemotherapy has to be considered in the differential diagnosis of space-occupying mediastinal lesions. They can also occur in adults. They are benign, explainable as immunological rebound phenomena, and do not require operative intervention. In case of doubt, short-term corticoid administration will diminish the size of the mass and thus confirms the diagnosis.

Immunohistological determination of proliferative activity in seminomas.

The proliferative activity and growth pattern of 20 seminomas were determined immunohistologically with the monoclonal antibody Ki-67. A growth fraction of tumour cells between 50 and 80% was found in seminomas with an almost even distribution of proliferating cells in all sections, regardless of tumour size. There was a slight tendency towards a greater growth fraction in tumours at an advanced histopathological stage. No positive correlation could be found between growth fraction and tumour size or lymphocytic infiltration. The results confirm the well known sensitivity of seminomas to radiation and chemotherapy and show that the determination of proliferative activity should be included in the histopathological routine diagnosis of malignant tumours with regard to systemic treatment and prognosis.

Intrascrotal metastasis of renal cell carcinoma. Case reports and review of the literature.

In a series of 235 patients with testicular tumors 2 elderly patients (0.9%) had secondary testicular tumors: 1 from a renal cell carcinoma and 1 from an unclassified anaplastic neoplasm. The pathogenesis of intrascrotal metastases of renal carcinoma is demonstrated by angiography of the dilated spermatic vein. In a literature survey the incidence rate of secondary testicular tumors is found to range from 0.3 to 3.6%. 30 cases of intrascrotal secondaries of renal cell carcinoma have been identified in the literature.

Evidence of interepithelial seminoma spread into the rete testis by immunostaining of paraffin sections with antibodies against cytokeratin and vimentin.

Seminomas are tumors of high proliferative activity and show a marked tendency towards local invasion with the capacity for interepithelial spread within the seminiferous tubules as well as into the rete ductules. Immunohistologic investigations were carried out on paraffin sections of 47 typical seminomas. Immunostaining with antibodies against cytokeratin and vimentin allows the convenient detection of even small rete residuals in cases of subtotal rete destruction as well as the identification of discrete interepithelial seminoma spread within the rete ductules, thus facilitating seminoma staging.

Simultaneous bilateral testicular germ cell tumors with dissimilar histology. Case report and review of the literature.

A 32-year-old male presented with simultaneous bilateral germ cell tumors of the testicles. Histological examination revealed dissimilar histology in both testes showing pure seminoma in the left side and mature teratoma with malignant transformation in the right testicle. A survey of the literature revealed a total of 151 previously described cases of synchronous bilateral germ cell tumors, the majority of which presenting as bilateral seminoma. Treatment of synchronous bilateral germ cell tumors with dissimilar histology should consist of bilateral orchiectomy and bilateral retroperitoneal lymph node dissection.