Abstract

The last 25 years have seen great strides in the treatment of germ cell tumors of the testis; one needs only to follow the results of the annual “Tour de France” to appreciate the magnitude of this success. These therapeutic improvements have been paralleled by our growth in understanding of the pathogenesis of testicular tumors and our ability to more precisely assign testis tumors to diagnostic categories of therapeutic and prognostic importance. The papers in this issue of Pathology Case Reviews summarize this progress. We begin with an article by Drs. Henley and Ulbright on seminoma—the most common type of germ cell tumor of the testis. The treatment approach to seminoma differs from that for the other germ cell tumors so recognition of its morphologic patterns and alertness to its differential diagnosis are of great clinical importance. Somewhat surprisingly, although at the mention of “seminoma” a static, textbook image usually comes to mind, this tumor has a protean morphology that may mimic other germ cell tumors, sex cord tumors, or cause it to be overlooked. Next, Dr. Eble summarizes our current knowledge regarding the most enigmatic of testicular neoplasms—spermatocytic seminoma. First recognized by Pierre Masson in 1946 in his classic paper, “Étude sur le séminome”, spermatocytic seminoma's place in the family of germ cell tumors remains fascinating but incompletely understood. It is a uniquely testicular neoplasm with no known counterpart at other anatomic sites or in females. Despite its alarming appearance it behaves in an almost uniformly benign fashion unless complicated by sarcomatous transformation. While the morphologic diversity of germ cell tumors has long been recognized, their capacity to develop components of somatic neoplasia, usually arising in various organs and tissues at metastatic sites, has come to be appreciated only relatively recently. Dr. Michael reviews the nature and clinical implications of this phenomenon in the next article. We now recognize that independent overgrowth of somatic-type elements should be recognized as a form of secondary malignancy that may behave quite differently from the tumors that lack this finding. A few decades ago, yolk sac tumor was lumped with embryonal carcinoma. Through the work of Teilum and others, yolk sac tumor came to be recognized as a specific type of germ cell tumor that often differentiates in the direction of extrafetal tissues supporting gestation. Dr. Roth draws on his 30 years of experience with germ cell tumors at Indiana University to explain and illustrate the diagnostically challenging variants of yolk sac tumor. The stunning success of the treatment of germ cell tumors of the testis has made imperative the recognition of other testicular tumors that do not respond to these therapies. Dr. Young next reviews the principal other family of neoplasms arising in the testis—the sex cord tumors. These uncommon tumors present challenges of classification and sometimes have appearances that can be confused with germ cell tumors. Furthermore, some are associated with genetic syndromes that have their own biologic significance, and the proper diagnosis of the testicular tumor may permit the recognition of the syndrome. The most common tumor of the testicular adnexa is the adenomatoid tumor. Its histogenesis was long debated and its varied morphology can present diagnostic difficulty. Drs. Delahunt and Kenwright review our knowledge of adenomatoid tumor and provide diagnostic tips in the next article. While the common teratoma of the testis is composed of a variety of types of tissues, there are uncommon tumors which are less complex, and their relationship to teratoma has been controversial. In the final paper, Drs. Poulos and Cheng review epidermoid cyst of the testis and bring the reader up-to-date on our understanding of these peculiar tumors, including important criteria for their separation from teratoma, an essential task for the surgical pathologist, given the malignant potential of the latter but the absolutely benign nature of epidermoid cyst. We sincerely thank the contributors for their efforts in producing a series of papers that we feel provide important and current information for the practicing surgical pathologist.FigureFigure

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