Page 729 - Textbook of Pathology, 6th Edition

3. Teratoma with malignant transformation. This is an Sertoli Cell Tumours (Androblastoma) 713
extremely rare form of teratoma in which one or more of Sertoli cell tumours correspond to arrhenoblastoma of the
the tissue elements show malignant transformation. Such ovary. They may occur at all ages but are more frequent in
malignant change resembles morphologically with typical infants and children. These tumours may elaborate oestrogen
malignancies in other organs and tissues and commonly or androgen and may account for gynaecomastia in an adult,
includes rhabdomyosarcoma, squamous cell carcinoma or precocious sexual development in a child.
and adenocarcinoma.
MORPHOLOGIC FEATURES. Grossly, the tumour is
Mixed Germ Cell Tumours fairly large, firm, round, and well circumscribed. Cut
About 60% of germ cell tumours have more than one of the surface of the tumour is yellowish or yellow-grey.
above histologic types (except spermatocytic seminoma) and Microscopically, Sertoli cell tumour is composed of
are called mixed germ cell tumours. The clinical behaviour benign Sertoli cells arranged in well-defined tubules.
of these tumours is worsened by inclusion of more aggressive
tumour component in a less malignant tumour. Interestingly, Majority of Sertoli cell tumours are benign but about 10%
metastases of the mixed germ cell tumours may not exactly may metastasise to regional lymph nodes.
reproduce the histologic types present in the primary
tumour. Granulosa Cell Tumour
The most common combinations of mixed germ cell This is an extremely rare tumour in the testis and resembles
tumours are as under: morphologically with its ovarian counterpart (Chapter 24).
1. Teratoma, embryonal carcinoma, yolk sac tumour and
syncytiotrophoblast. MIXED GERM CELL-SEX CORD STROMAL TUMOURS
2. Embryonal carcinoma and teratoma (teratocarcinoma).
3. Seminoma and embryonal carcinoma. An example of combination of both germ cells and sex cord
stromal components is gonadoblastoma.
SEX CORD-STROMAL TUMOURS
Gonadoblastoma CHAPTER 23
Tumours arising from specialised gonadal stroma are classi-
fied on the basis of histogenesis. The primitive mesenchyme Dysgenetic gonads and undescended testis are predisposed
which forms the specialised stroma of gonads in either sex to develop such combined proliferations of germ cells and
gives rise to theca, granulosa and lutein cells in the female, sex cord-stromal elements. The patients are commonly
and Sertoli and interstitial Leydig cells in the male. Since the intersexuals, particularly phenotypic females. Most of the
cell of origin of primitive mesenchyme is identical, Sertoli gonadoblastomas secrete androgen and therefore produce
and interstitial Leydig cell tumours may occur in the ovaries virilisation in female phenotype. A few, however, secrete
(in addition to theca cell, granulosa cell and lutein cell oestrogen.
tumours). Likewise, the latter three tumours may occur in
the testis (in addition to Sertoli cell and Leydig cell tumours). MORPHOLOGIC FEATURES. Grossly, the tumour is of
All these tumours secrete various hormones. The biologic variable size, yellowish-white and soft.
behaviour of these tumours generally cannot be determined Microscopically, gonadoblastoma is composed of 2
on histological grounds alone but is related to clinical principal cell types—large germ cells resembling
parameters and hormonal elaboration by these tumours. seminoma cells, and small cells resembling immature
Sertoli, Leydig and granulosa cells. Call-Exner bodies of
Leydig (Interstitial) Cell Tumour a granulosa cell tumour may be present. The Male Reproductive System and Prostate
Leydig cell tumours are quite uncommon. They may occur Prognosis largely depends upon the malignant potential
at any age but are more frequent in the age group of 20 to 50 of the type of germ cell components included.
years. Characteristically, these cells secrete androgen, or both
androgen and oestrogen, and rarely corticosteroids. Bilateral OTHER TUMOURS
tumours may occur typically in congenital adrenogenital
syndrome. Malignant Lymphoma
MORPHOLOGIC FEATURES. Grossly, the tumour Malignant lymphomas comprises 5% of testicular malignan-
appears as a small, well-demarcated and lobulated cies and is the most common testicular tumour in the elderly.
nodule. Cut surface is homogeneously yellowish or Bilaterality is seen in half the cases. Most common are large
brown. cell non-Hodgkin’s lymphoma of B cell type.
Histologically, the tumour is composed of sheets and
cords of normal-looking Leydig cells. These cells contain Rare Tumours
abundant eosinophilic cytoplasm and Reinke’s crystals
and a small central nucleus. In addition to the testicular tumours described above, some
other uncommon tumours in this location include: plasma-
Most of Leydig cell tumours are benign. Only about 10% cytoma, leukaemic infiltration, carcinoid tumour,
may invade and metastasise. haemangioma, primary sarcomas and metastatic tumours.