Spermatocytic Seminoma Research Articles

The contributions of Juan Rosai to testicular pathology with personal remembrances.

SummaryThe authors summarize their personal interactions with someone for whom they had unbounded admiration, Dr. Juan Rosai. This varied from daily review of cases, to sharing the platform at meetings, being under his tutelage as an author, and co-directing postgraduate courses. These all highlighted the remarkable knowledge of medicine Dr. Rosai had, imparting as he did diagnostic pearls and remarks on the literature including the history of our discipline, often laced with a well-honed sense of humor. The contributions he made to the pathology of the testis are then considered beginning with his role in highlighting a tumor, at the time not particularly well publicized, spermatocytic seminoma. He wrote two major papers on it, one on standard clinical and pathologic aspects, and one on its ultrastructure. The first was associated with his diligent investigation of a prior paper reporting an unusually high number of malignant examples of this tumor but on review that was explained by their representing malignant lymphoma. The organizational skills of Dr. Rosai, and attention to detail, were second to none and shown perhaps most notably with his organizing many courses, but they were also illustrated early in his career when he moderated a symposium on germ cell tumors of the testis which laid the framework for the classification and nomenclature of premalignant lesions. Finally, his almost career-long interest in the entity he codiscovered, Rosai-Dorfman disease, was associated with his reporting testicular involvement by that disorder in his later years. This giant figure in pathology will stand forever in the top tier with other greats who have contributed to the field.

Expression of the C-terminal region of the SSX protein is a useful diagnostic biomarker for spermatocytic tumour.

Spermatocytic tumour (ST) is a rare testicular germ cell neoplasm with few confirmatory biomarkers that can be challenging to diagnose. Like normal spermatogonia, STs are known to express SSX proteins. Recently, a novel SSX antibody directed against a conserved C-terminal region of SSX1, SSX2 and SSX4 (SSX_CT) has emerged as a reliable biomarker for these SSX proteins and synovial sarcoma. However, SSX_CT immunostaining has not been demonstrated in ST. The aim of this study was to assess the diagnostic utility of SSX_CT immunohistochemistry in ST and other tumours in the differential diagnosis with ST. SSX_CT, OCT3/4 and c-KIT immunohistochemistry was performed on 15 STs, 38 seminomas, 13 embryonal carcinomas, 12 yolk sac tumours, six choriocarcinomas, four teratomas, seven Sertoli cell tumours, and six lymphomas. Staining was scored as negative, rare, focal, or diffuse. SSX_CT was positive in all (15/15) STs, and diffusely positive in 14 of 15 (93%). SSX_CT was positive in 22 of 38 (58%) seminomas; however, only two cases showed diffuse expression. SSX_CT was negative in all other tumours. OCT3/4 was negative in all STs, but positive in all seminomas and embryonal carcinomas. c-KIT was frequently positive in both STs (12/15; 80%) and seminomas (33/38; 87%). OCT3/4 and c-KIT were negative in all other tumours. SSX_CT is a valuable and highly sensitive biomarker that supports the diagnosis of ST. Diffuse expression of SSX-CT in STs is also highly specific for ST. Nevertheless, SSX_CT is best used in combination with OCT3/4 when ST is in the differential diagnosis.

From late fatherhood to prenatal screening of monogenic disorders: evidence and ethical concerns.

With the help of ART, an advanced parental age is not considered to be a serious obstacle for reproduction anymore. However, significant health risks for future offspring hide behind the success of reproductive medicine for the treatment of reduced fertility associated with late parenthood. Although an advanced maternal age is a well-known risk factor for poor reproductive outcomes, understanding the impact of an advanced paternal age on offspring is yet to be elucidated. De novo monogenic disorders (MDs) are highly associated with late fatherhood. MDs are one of the major sources of paediatric morbidity and mortality, causing significant socioeconomic and psychological burdens to society. Although individually rare, the combined prevalence of these disorders is as high as that of chromosomal aneuploidies, indicating the increasing need for prenatal screening. With the help of advanced reproductive technologies, families with late paternity have the option of non-invasive prenatal testing (NIPT) for multiple MDs (MD-NIPT), which has a sensitivity and specificity of almost 100%. The main aims of the current review were to examine the effect of late paternity on the origin and nature of MDs, to highlight the role of NIPT for the detection of a variety of paternal age-associated MDs, to describe clinical experiences and to reflect on the ethical concerns surrounding the topic of late paternity and MD-NIPT. An extensive search of peer-reviewed publications (1980-2021) in English from the PubMed and Google Scholar databases was based on key words in different combinations: late paternity, paternal age, spermatogenesis, selfish spermatogonial selection, paternal age effect, de novo mutations (DNMs), MDs, NIPT, ethics of late fatherhood, prenatal testing and paternal rights. An advanced paternal age provokes the accumulation of DNMs, which arise in continuously dividing germline cells. A subset of DNMs, owing to their effect on the rat sarcoma virus protein-mitogen-activated protein kinase signalling pathway, becomes beneficial for spermatogonia, causing selfish spermatogonial selection and outgrowth, and in some rare cases may lead to spermatocytic seminoma later in life. In the offspring, these selfish DNMs cause paternal age effect (PAE) disorders with a severe and even life-threatening phenotype. The increasing tendency for late paternity and the subsequent high risk of PAE disorders indicate an increased need for a safe and reliable detection procedure, such as MD-NIPT. The MD-NIPT approach has the capacity to provide safe screening for pregnancies at risk of PAE disorders and MDs, which constitute up to 20% of all pregnancies. The primary risks include pregnancies with a paternal age over 40 years, a previous history of an affected pregnancy/child, and/or congenital anomalies detected by routine ultrasonography. The implementation of NIPT-based screening would support the early diagnosis and management needed in cases of affected pregnancy. However, the benefits of MD-NIPT need to be balanced with the ethical challenges associated with the introduction of such an approach into routine clinical practice, namely concerns regarding reproductive autonomy, informed consent, potential disability discrimination, paternal rights and PAE-associated issues, equity and justice in accessing services, and counselling. Considering the increasing parental age and risks of MDs, combined NIPT for chromosomal aneuploidies and microdeletion syndromes as well as tests for MDs might become a part of routine pregnancy management in the near future. Moreover, the ethical challenges associated with the introduction of MD-NIPT into routine clinical practice need to be carefully evaluated. Furthermore, more focus and attention should be directed towards the ethics of late paternity, paternal rights and paternal genetic guilt associated with pregnancies affected with PAE MDs.

Spermatocytic tumor – case report

Spermatocytic tumor – case report

A Rare Case of Canine Metastatic Spermatocytic Tumor without Sarcomatous and Anaplastic Variants

Abstract Spermatocytic tumor is a rare testicular tumor, which is originated from gonocytes. It is characterized by the histological feature of tripartite which is composed of large, medium, and lymphocyte-like small cells. It is well-known that spematocytic tumor is benign, thus a good prognosis is expected after simple resection. Metastatic spermatocytic tumor is extremely rare and usually accompanied by histological variants including sarcomatous changes and anaplastic variants. In this case, however, we report a canine metastatic spermatocytic tumor without prominent sarcomatous changes and anaplastic variants. The mass was composed of three kinds of cells including large, medium, and small cells with high pleomorphism. The neoplastic cells had an indistinct cytoplasmic border and mitotic figures were frequently observed. The primary spermatocytic tumor metastasized to the abdominal organs one month after the resection, and the dog died 13 months after the surgery. Thus, careful follow-up is recommended after surgical resection of canine spermatocytic tumor even though metastasis in spermatocytic tumors is rare.

Testicular Tumors: A Contemporary Update on Morphologic, Immunohistochemical and Molecular Features

Testicular tumors are incredibly diverse and one of the most challenging areas in surgical pathology. Because of the rarity and overlapping features with numerous entities occurring in the testis and paratestis, these tumors pose a diagnostic challenge even to the most experienced general pathologists. In 2016, the latest "World Health Organization (WHO) classification of testicular tumors" was released, which incorporated several updates to the previous 2004 classification system. These updates involved several entities, including germ cell tumors, sex cord-stromal tumors, tumors containing both germ cells and sex-cord stromal cells, a miscellaneous group of testicular tumors and paratesticular tumors. In addition, significant changes were also introduced in the 2018 AJCC TNM staging (8th edition) regarding testicular tumors. The germ cell tumors are divided into 2 major groups; tumors derived from germ cell neoplasia in situ (GCNIS) and those unrelated to GCNIS. The GCNIS associated tumors include seminomatous and nonseminomatous germ cell tumors, which constitute a heterogeneous group of tumors. Non-GCNIS-associated tumors include prepubertal-type teratoma, prepubertal yolk sac tumor, mixed prepubertal-type teratoma and yolk sac tumor and spermatocytic seminoma. In the sex cord-stromal category, the tumors are classified based on their cells of origin. Most are Leydig cell tumors and Sertoli cell tumors; however, several mixed and diverse entities based on cell types are included in this group. Gonadoblastoma is the only tumor in the mixed germ cell and sex cord-stromal tumor category. Because of recent advances in molecular techniques, abundant new genetic information has emerged which helped classify the tumors based on the molecular alterations and provided insights into the tumor pathogenesis. This review focused on the updates related to testicular germ cell tumors and sex cord-stromal tumors and described the morphologic, immunohistochemical and molecular characteristics with an aim to provide a practical diagnostic approach and an update on relevant recent molecular advances.

Terminal Deoxynucleotidyl Transferase Commonly Expresses in Germ Cell Tumors: Evaluation on a Large Series from Multiple Centers.

AimThe concrete features of expression of terminal deoxynucleotidyl transferase (TdT) are needed to be revealed in male and female germ cell tumors (GCTs).MethodsTdT immunostaining was performed in 195 GCTs, and the tumor and/or tumorous components included seminomas, germ cell neoplasias in situ (GCNISs), dysgerminomas, embryonal carcinomas (ECs), extragonadal germinomas, yolk sac tumors (YSTs), teratomas, and spermatocytic tumors. Twenty-one sex cord-stromal tumors were also added. Expression of the classical germ cell tumor markers (PLAP, OCT4, SALL4, CD117, and D2-40) was compared to that of TDT.ResultsNearly all (tumors or tumorous components) seminomas (99%, 107/108), GCNISs (98%, 51/52), dysgerminomas (94%, 17/18), ECs (100%, 15/15), and extragonadal germinomas (100%, 11/11) were positive for TdT. None of the cells in YSTs (0/38), teratomas (0/19), spermatocytic tumors (0/1), or sex cord-stromal tumors (0/21) were immunoreactive for TdT staining. The normal testicular and ovarian gonadal tissues were also negative for TdT. However, TdT presented with significant loss of antigen immunoreactivity in the paraffin-embedded tissues older than 3 years, giving rise to weak or moderate staining in a subset of cases. The expressions of TdT showed no significances with PLAP, OCT4, SALL4, CD117, and D2-40 during the diagnosis of the most GCTs (P>0.05), except for with PLAP, SALL4, or CD117 in YST (P=0.000 each), and D117 (P=0.000) or D2-40 (P=0.006) in ECs.ConclusionOur findings further verify that TdT can serve as a new GCT marker for seminomas, GCNISs, dysgerminomas, ECs, and extragonadal germinomas, with a highly positive rate. Awareness of TdT positivity in GCTs contributes to the prevention of erroneous diagnoses, particularly in the setting of core needle biopsies. To determine the properties where TdT staining may not be apparent in some old archived paraffin-embedded tissues, one could circumvent the potential misinterpretations of false-negative immunohistochemistry results.

Contemporary Trends in Presentation and Management of Spermatocytic Seminoma

To characterize the presentation and management of spermatocytic seminoma (SS) compared to classic seminoma in adults utilizing a large cancer registry. Patients >18 years of age in the National Cancer Database from 2006 to 2016 who underwent orchiectomy for testicular tumors were identified. Demographics, oncologic characteristics, and treatment patterns were compared between patients with SS and classic seminoma. Of 53,481 adults receiving orchiectomy, 29,208 were diagnosed with classic seminoma and 299 (1%) with SS. Compared to patients with classic seminoma, SS patients were older (57 vs 39 years) and more likely to be African-American (odds ratio (OR) 1.8) and insured by Medicare (OR 2.0; all P <.05). SS patients had larger tumors on presentation (3-6 cm: OR 1.8; >6 cm: OR 1.8), but were less likely to have ≥pT2 stage (OR 0.5), regional nodal involvement (Clinical Stage II: OR 0.3), or distant metastatic disease (Clinical Stage III: OR 0.1; all P <.01). For postorchiectomy management, 73.6% of SS patients underwent surveillance while 24.5% had active treatment (retroperitoneal lymph node dissection, chemotherapy, radiation, or a combination). When stratified by year, there was an increasing trend toward surveillance compared to active treatment. SS is a rare germ cell tumor that typically presents as a larger tumor in older patients. Although these tumors are less likely to be characterized by advanced disease compared to classic seminoma, many patients have undergone aggressive postorchiectomy treatment in the past. Importantly, treatment trends have shifted toward surveillance in recent years with adjuvant therapy limited primarily to higher stage tumors.

Testiküler Germ Hücreli Tümörlerin Prognostik Parametrelerine Olgularımız Eşliğinde Güncel Yaklaşım

Aim: Testicular germ cell tumors (TGCT) are solid neoplasms common in young adult men and an important cause of cancer-related deaths during this period. Revisions in histopathological classification and staging affect prognosis and treatment. The aim of this study was to analyze our TGCT cases, to review prognostic parameters, and their relationship between germ cell neoplasia in situ (GCNIS), intratubular and intertubular tumors.Material and Methods: In this study, Hematoxylin&amp;amp;Eosin-stained sections of 77 TGCTs were re-evaluated. The presence of GCNIS, intratubular and intertubular germ cell tumors were recorded. Histopathological classification and staging were revised based on the changes in the 8th edition of American Joint Committee on Cancer (AJCC).Results: The majority of the patients were diagnosed as seminoma (n=42), followed by mixed germ cell tumors (n=33) and spermatocytic tumors (n=2). Rete testis invasion in 30 cases, epididymal invasion in 6 cases, hilar soft tissue invasion in 10 cases, tunica vaginalis invasion in 1 case, spermatic cord invasion in 4 cases, and lymphovascular invasion in 22 cases were detected. Intertubular seminoma in 25 cases, intratubular carcinoma in 16 cases, and GCNIS in 73 cases were detected.Conclusion: The major criteria to determine treatment choices are histopathological diagnosis, pathological tumor stage, serum tumor markers and presence of metastasis. According to AJCC 8th edition, addition of hilar soft tissue invasion to staging has increased the number of our pT2 cases. Moreover, assuming discontinuous tumor invasion of spermatic cord by vascular invasion as pM1 has also increased the number of metastatic testis tumors.

Testicular tumors in 190 dogs: clinical, macroscopic and histopathological aspects

ABSTRACT: This study aimed to characterize the prevalence and clinical, macroscopic and histopathological aspects of dogs affected by testicular tumors based on biopsy specimens from the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM) over 19 years. Parameters regarding the age, size, and breed of the affected dogs were also established. Of all dogs with some type of neoplasm submitted to histopathological analysis at the LPV over these 19 years (n=1,900), 213 (11.2%) had at least one testicular neoplasm. The tissues of 190 dogs (with 220 neoplasms) were available for histological reassessment. The dogs in this study had different types of testicular tumors with relatively similar frequencies. In descending order, the most frequent testicular neoplasms were seminomas (88/220), Leydig (interstitial) cell tumor (LCT; 64/220), Sertoli cell tumor (SCT; 61/220), and mixed germ cell-sex cord stromal tumor (MGSCT) (07/220). Among the dogs of defined breed (119 cases), large breeds had the largest number of cases (50/119), followed by small (47/119) and medium-sized (22/119) breeds. The ages of dogs affected by testicular tumors ranged from 10 months to 18 years. Increased testicular volume was the most common clinical manifestation. Eleven dogs presented information about clinical signs suggestive of hyperestrogenism syndrome (feminization). In seminomas, the diffuse pattern predominated over the intratubular pattern. Two sites (luminal and basal compartments) suggestive of the onset of neoplastic transformations in germ cells were observed in intratubular seminomas. They corroborate the hypothesis that canine seminomas possibly have pathogenesis similar to that observed in human spermatocytic seminomas. The SCTs and LCTs presented high cell morphology variation. SCTs had neoplastic cells organized in five different histological arrangements. As for LCT, solid-diffuse and cystic-vascular histological patterns were the most commonly observed. Through this study, it was possible to establish some of the leading clinical, macroscopic, and histopathological aspects of testicular neoplasms diagnosed over 19 years in the area covered by the LPV-UFSM.

Novel insights into the mixed germ cell-sex cord stromal tumor of the testis: detection of chromosomal aneuploidy and further morphological evidence supporting the neoplastic nature of the germ cell component.

The existence of a true mixed germ cell-sex cord stromal tumor (MGSCT) of the testis remains controversial. Based on our experience with rare testicular tumors in this spectrum, we sought to perform a detailed clinicopathologic and molecular study of MGCSCT. Eight cases of testicular MGSCT were morphologically reviewed, screened for chromosomal aberrations (using array comparative genomic hybridization (aCGH) and low pass genomic sequencing), and analyzed by next generation sequencing (The Illumina TruSight Tumor 170). Immunohistochemistry for OCT3/4, Nanog, SALL4, DMRT1, and inhibin was performed on the cohort. Clinical data and follow-up were assessed by medical record review. All patients were karyotypically normal men aged 27-74years (median 41). All tumors had a similar biphasic morphology characterized by various proportions of the sex cord component resembling granulosa cell tumor of adult type and the germ cell component cytomorphologically akin to spermatocytic tumor. Germ cells were haphazardly scattered throughout the tumor or arranged in larger groups, without tubular formation. In 4 cases, atypical mitoses were found within the germ cells. Additionally, in 2 cases there was invasion into the spermatic cord, adjacent hilar soft tissue and into the tumor capsule, which contained both tumor components. Immunohistochemically, focal nuclear expression of DMRT1 was found in the germ cell component in 7/7 analyzable tumors, while SALL4 was positive in 6 cases and negative in one case. All tumors were negative with OCT3/4 and Nanog. The sex cord stromal component had immunoreactivity for inhibin in 7/7 analyzable cases. Four of 8 cases were cytogenetically analyzable: 4/8 by low pass genomic sequencing and 2/8 by aCGH. The results of both methods correlated well, revealing mostly multiple chromosomal losses and gains. One case revealed loss of chromosome 21; 1 case had loss of chromosomes 21 and 22 and partial gain of 22; 1 case had loss of chromosomes 22 and Y, partial loss of X, and gain of chromosomes 20, 5, 8, 9, 12, and 13; and the remaining one gain of chromosomes 20, 3, 6, 8, 2x(9), 11, 2x(12), 13, 14, 18, and 19. Three cases were analyzable by NGS; clinically significant activating mutations of either FGFR3 or HRAS were not detected in any case. Follow-up was available for 4 patients (12, 24, 84, and 288months) and was uneventful in all 4 cases. The identification of extratesticular invasion of both the germ cell and sex cord stromal components, the DMRT1 expression, and the presence of atypical mitoses in germ cells argue for the neoplastic nature of the germ cell component. The molecular genetic study revealing multiple chromosomal losses and gains in a subset of the cases provides the first evidence that molecular abnormalities occur in testicular MGSCT. Multiple chromosomal aneuploidies, namely, recurrent losses of chromosomes 21 and 22 and gains of 8, 9, 12, 13, and 20, indicate that the germ cell component might be related to the morphologically similar spermatocytic tumor, which is characterized by extensive aneuploidies including recurrent gains of chromosomes 9 and 20 and loss of chromosome 7. In summary, our data support that rare examples of true MGSCT of the testis do exist and they represent a distinct tumor entity with admixed adult-type granulosa cell tumor and spermatocytic tumor components.

Review of diseases and health management in zebrafish Danio rerio (Hamilton 1822) in research facilities.

The use of zebrafish (Danio rerio) in biomedical research has expanded at a tremendous rate over the last two decades. Along with increases in laboratories using this model, we are discovering new and important diseases. We review here the important pathogens and diseases based on some 20years of research and findings from our diagnostic service at the NIH-funded Zebrafish International Resource Center. Descriptions of the present status of biosecurity programmes and diagnostic and treatment approaches are included. The most common and important diseases and pathogens are two parasites, Pseudoloma neurophilia and Pseudocapillaria tomentosa, and mycobacteriosis caused by Mycobacterium chelonae, M.marinum and M.haemophilum. Less common but deadly diseases are caused by Edwardsiella ictaluri and infectious spleen and kidney necrosis virus (ISKNV). Hepatic megalocytosis and egg-associated inflammation and fibroplasia are common, apparently non-infectious, in zebrafish laboratories. Water quality diseases include supersaturation and nephrocalcinosis. Common neoplasms are spindle cell sarcomas, ultimobranchial tumours, spermatocytic seminomas and a small-cell carcinoma that is caused by a transmissible agent. Despite the clear biosecurity risk, researchers continue to use fish from pet stores, and here, we document two novel coccidia associated with significant lesions in zebrafish from one of these stores.

Epidemiological and overall survival characteristics of testicular cancers in Ege University Hospital database

Amaç: Ege Üniversitesi Hastanesinde 1992-Haziran 2018 arası kanser tanısı konan ve tedavi edilen 26 yıllık testis kanseri hastalarının genel özellikleri, tedavi modaliteleri ve sağ kalım sürelerinin tanımlanması amaçlanmıştır.&#x0D; Gereç ve Yöntem: Ege Üniversitesi Kanserle Savaş Araştırma ve Uygulama Merkezi tarafından toplanan testis kanseri verileri CANREG özel bilgisayar programına kaydedilmiş, DSÖ ve SEER sistemleri temelinde gruplanarak analizler yapılmıştır. İstatistik analizlerde Fisher’s Exact Test, Kaplan-Meier sağ kalım analizleri uygulanmıştır. Sağ kalım analizinde Log Rank (Mantel-Cox), Breslow (Generalized Wilcoxon) ve Tarone-Ware istatistikleri kullanılmıştır. İstatistik analizlerde p

Peculiarities of expression of metalloproteinases in testicular germ cell tumors.

Background. Increasing of the testicular germ cell tumors (TGCT)incidence in combination with the young age of the patients attaches to this problem high medical and social importance. Objective. The aim of investigation was to establish peculiaritiesof MMP-1, MMP-3, MMP-9 and TIMP-1 expression in testicular postpubertal-type yolk sac tumor (YSTPT), postpubertal-type teratoma (TPT), spermatocytic tumor (ST) and teratoma with somatic-type malignancy (TSTM). Methods. YSTPT, TPT, ST and TSTM as well as medical histories of patientswere studied. All TGCTwere divided into groups according to the pTNM classification of WHO. Using antibodies to MMP-1, MMP-3, MMP-9 and TIMP-1 the state of extracellular matrix was investigated. Statistical data processing was performed using the statistical package STATISTICA 13.3 EN trial version. Results. It is proved that MMP are involved in carcinogenesis starting with the early stages of tumor progression.A more expressive expression of MMP in YSTPT indicates its inclination for an aggressive course. It was identified that in patients with YSTPT and TPT who had vascular invasion, lymphogenous and distant metastases the relative area (S) and intensity (L) of expression of all investigated MMP (with the exception of S of MMP-3) were significantly higher than in patients without these signs of tumor aggressiveness. In ST the S of MMP-1 expression was lower than that in YSTPT and TPT, while the S of MMP-3 expression, on the contrary, was higher than the corresponding index in TPT, and was at the same level with the YSTPT. L of MMP-3 expression was at the border of moderate values.S of MMP-9 expression was greater than that in YSTPT and TPT, and its L was at a high level. In TSTM of group «4» S of MMP-1, MMP-3 and MMP-9 expression was higher (p<0,001) than in TSTM of group «1». In all investigated TGCT reaction with TIMP-1 was negative. Conclusion. In YSTPT and TPT at transition from the initial to the late stages of tumorous progression increasing of MMP synthesis, as well as a complete absence of TIMP-1 expression were detected. Increasing of MMP expression leads to the development of vascular invasion, as well as lymphogenous and distant metastases. Parameters of MMP expression may be independent factors in prognosis of metastasis and progression of TGCT.

Intercellular adhesion in testicular germ cell tumors

Testicular germ cell tumors (TGCT) is one of the main causes of oncological mortality in young men. One of the factors determining the prognosis of cancer patients is the determination of molecular biological markers which correlate with a poor prognosis. The purpose of the work. To determine the state of intercellular adhesion in testicular postpubertal-type yolk sac tumor (YSTPT), postpubertal-type teratoma (TPT), spermatocytic tumor (ST) and teratoma with somatic-type malignancy (TSTM). Material and methods. The study was performed on the material of TGCT of patients who have been examined and treated at the Kharkiv Regional Clinical Center of Urology and Nephrology named after V.I Shapoval for the period covering 1998-2017. Groups of investigation were formed according to the pTNM classification of WHO. For assessment of the state of intercellular adhesion in TGCT the relative area (S) and intensity (L) of E-cadherin and β-catenin expression were studied. Results. During the tumorous progression S of E-cadherin expression in YSTPT and TPT was gradually decreasing right up to the complete reduction of this marker expression. These changes were combined with increasing of β-catenin expression. In the case of positive immunohistochemical reaction with E-cadherin and β-catenin in all investigated TGCT instead of the «typical» membrane localization there were «heterogeneities» which were also considered as a loss of intercellular adhesion. In ST the S and L of E-cadherin expression were higher than those in the corresponding groups of investigated TGCT but marker localization was also atypical. As for β-catenin, S and L of its expression were at the level of mean values in YSTPT and higher than analogous indexes in the corresponding group of TPT. Localization of β-catenin was atypical. In TSTM of both groups the reaction with E-cadherin was either negative or marker had an atypical localization. The same situation was observed at investigation of β-catenin. Conclusion. In YSTPT and TPT at tumorous progression a loss of intercellular adhesion occurs what leads to the dissociation of tumor cells, development of vascular invasion and metastatic disease.

Clinicopathological spectrum of testicular lesions over a five-year period in a tertiary hospital

Objectives: To study the clinical pattern and histopathological features of testicular biopsies and orchiectomy specimens in patients presenting to a tertiary hospital. Methods: A 5 year retrospective study was conducted in histopathology section of Department of Laboratory Medicine, ACH from January 2014 to December 2018 on testicular tissue specimens (biopsies and orchiectomies). The histopathological diagnosis was made based on light microscopy followed by special stains and immunohistochemistry wherever indicated. Results: A total of 91 specimens were received in ACH during this 5 year period. The specimens comprised of cryptorchidism (16 cases), trauma (5 cases) , vascular lesions-testicular torsion (17 cases), inflammatory lesions (11 cases), Sertoli cell only syndrome (2 cases), spermatogenic arrest (3 cases), atrophy (3 cases), obstructive causes leading to infertility (3 cases), cyst (2 cases) , tumors (28 cases) and 1 was unremarkable .Inflammatory lesions were predominantly abscess (6 cases ), granulomatous orchitis (5 cases ).Tumors were classified into germ cell tumors –seminomas (10 cases), mixed germ cell tumors (9 cases) , teratomas (3 cases), embryonal carcinoma (2 cases), spermatocytic tumors (3 cases), Leydig cell tumor (1 case). Conclusions: The present study revealed that testicular masses were predominantly neoplastic mostly malignant primarily seen in age group 21-30 years with seminomas constituting 35.7 % of all tumors. Testicular torsion leading to ischemic necrosis were also seen in a large number of cases. Testicular biopsies might help in determining etiology of infertility which could be cryptorchidism, spermatogenic arrest, Sertoli cell only syndrome, atrophy and post testicular obstruction.

A systematic review of treatment outcomes in localised and metastatic spermatocytic tumors of the testis.

Because spermatocytic tumors of the testis are rare, only limited evidence exists regarding the malignant potential and the optimal management of localized and metastatic disease. We performed a systematic review through MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science to identify reports including patients with testicular spermatocytic tumors. From originally 7863 studies, we extracted data of 146 patients of which 99% were treated with radical orchiectomy. Metastases in patients with initially localised disease were diagnosed in 7% of patients and detected after a median follow-up of 5.5months (range 2-21months). Patients with aggressive histology (sarcoma or anaplastic subtype) were more likely to have metastatic disease (6/124 (5%) vs 9/22 (41%), p < 0.001). Patients with metastatic disease had larger primary tumors (92.5 vs 67.5mm, p = 0.05). Life expectancy in patients with metastatic disease ranged from 1 to 25months. The published literature does neither support the use of testis sparing surgery nor adjuvant therapy. Patients with aggressive variants or larger tumors were more likely to have metastases and develop recurrences within the first few years. Patients with metastatic disease have a limited life expectancy and metastatic spermatocytic tumors are not as responsive to chemotherapy as germ cell cancers.

En iyi prognozlu, spermatocytic seminomlu germ hücreli testis tümörü: nadir bir olgu sunumu

The spermatocytic seminoma is a different testicular germ cell neoplasm representing less than 1% of testicular cancers. It has distinctive clinical and pathological features when compared with classical seminoma. Diagnosis of spermatocytic seminoma is difficult, especially in elderly patients, due to its rare occurrence, lack of clinical presentation, and the difficulty of differential diagnosis with morphologically testicular lymphoma and classical seminoma. Here we present the clinical presentation, histopathologic features and prognosis of a spermatocytic seminoma case in the light of literature information.

Pathogenesis of Testicular Germ Cell Neoplasia: A Conceptual Approach.

Testicular germ cell tumors are a diverse group of neoplasms, consisting of the prepubertal type 1 tumors, pure teratoma, and pure yolk sac tumor, the type 2 tumors, which are biologically malignant, preceded by germ cell neoplasia in situ, and harbor chromosome 12p abnormalities, and the type 3 tumor, spermatocytic tumor, which features chromosome 9p amplification. These arise in distinct clinical settings, and harbor distinct genetic abnormalities, immunohistochemical properties, and morphologic features. Here we have attempted to unify embryology, morphology, immunohistochemistry, and genetics in order to distill this fascinating group of neoplasms into what we hope is a useful framework for understanding their classification.

Adjuvant radiotherapy for Stage I seminoma: A Single-institutional experience.

There is no consensus regarding the management of Stage 1 seminomas following inguinal orchiectomy. In this study, we evaluated the treatment results and treatment-related toxicity for patients with Stage 1 seminomas treated with adjuvant radiotherapy (RT) at a single institution. Sixty-five patients who underwent adjuvant RT following orchiectomy for Stage 1 seminomas between January 1996 and December 2007 were retrospectively reviewed. The age, tumor location, histopathological type, stage, tumor size, RT field, and radiation dose were recorded for all patients. The patients' ages ranged from 17 to 61 years (median, 37 years). Sixty-three patients (97%) were diagnosed with classical seminoma and the remaining two patients (3%) had spermatocytic seminoma. After orchiectomy, 37 patients (57%) received para-aortic RT and 28 patients (43%) received dog-leg field RT. RT was applied with 1.8-2 Gy/day fractionation and the median RT dose was 26 Gy (range, 20-38). Follow-up ranged from 0.3 to 18 years (median, 9.5 years). Local control had been achieved in all patients and all of them were alive with no evidence of disease. Fifty-one patients (77%) had at least 5 years of follow-up and 27 patients (41%) had at least 10 years of follow-up. Overall survival at 10 years was 100%. Although retrospective in nature, this single-institutional study provides useful information about the outcomes and toxicities associated with adjuvant RT in patients with Stage 1 seminomas reporting excellent disease control and survival rates at the expense of acceptable toxicity.