Testicular Sex Cord-stromal Tumors Research Articles

Management of Ovarian and Testicular Sex Cord-stromal Tumors in Children and Adolescents

Pediatric ovarian and testicular sex cord-stromal tumors are distinct from germ cell neoplasms and may present with palpable mass or signs of hormone production. Both may be associated with specific genetic syndromes. Staging for ovarian sex cord-stromal tumors is based on the International Federation of Gynecology and Obstetrics classification for ovarian carcinoma. Treatment for those with high risk disease includes multiagent chemotherapy. Testicular stromal tumors often, though not always, follow a benign course. Additional research will help to define optimal treatment strategies for children with these rare tumors.

Intra-Abdominal Testicular Seminoma in a Woman with Testicular Feminization Syndrome

We report a case of intra-abdominal testicular tumor in a 36-year-old married lady presenting with chief complaints of primary amenorrhea. The patient was later diagnosed with testicular feminization syndrome, a form of male pseudohermaphroditism. This testicular tumor was histologically proven as seminoma. Due to rarity, imaging findings in patients with testicular feminization syndrome and intraabdominal testicular tumor have been poorly documented. So far, only one case report had described the combined role of CT and MR imaging in intraabdominal testicular sex-cord stromal tumor. To our knowledge, this case is first to document USG and MR imaging in addition to MR spectroscopy features in intraabdominal testicular seminoma.

Sex cord-stromal tumors of the testis in children. A clinicopathologic report from the Italian TREP project

Purpose Testicular sex cord-stromal tumors (SCSTs) are very rare in children and include a variety of neoplasms with different clinical features and biologic behavior. Aim of the study was to report the clinical findings and results observed in a series of patients with testicular SCST, registered in a multi-institutional Italian network on rare tumors in children and adolescents. Materials and Methods The records of 11 patients, enrolled in 6 Italian centers from January 2000 to December 2008, were reviewed. The Children's Oncology Group (COG) staging system was adopted. Chemotherapy was recommended in patients with incomplete surgery or metastatic disease. Results A testicular mass was the most common symptom. All patients underwent primary removal of the tumor; orchiectomy with high ligation of spermatic cord was performed in 7 and tumor enucleation in 4. At histology, 4 patients had Leydig cell tumors, 4 juvenile granulosa cell tumors, 1 Sertoli cell tumor, 1 incompletely differentiated SCST, and 1 SCST with an intermediate pattern Sertoli cell tumor/mixed form. The histology of 8 of 11 cases was reviewed and investigated through immunohistochemical stains. Ten children were in stage I; 1 patient, who did not undergo hemiscrotectomy after enucleation through a transscrotal access, was considered stage II. All the patients are in first complete remission (mean follow-up, 59 months; range, 8-94). Conclusions Our experience confirmed the rarity of testicular SCST. They have to be considered in the differential diagnosis of testicular solid masses, taking into account that hormonal signs are present in a minority of cases. All patients were cured with surgery alone. The sparing surgery represented a choice in selected cases.

Histologic and Immunohistochemical Characterization of a Testicular Mixed Germ Cell Sex Cord-Stromal Tumor and a Leydig Cell Tumor in a Dog

Mixed germ cell sex cord-stromal tumors (MGSCTs) of the testis are rare in dogs. We describe the histopathology and immunohistochemical characteristics of an MGSCT associated with a Leydig cell tumor in a cryptorchid testis. Histologically, MGSCT consisted of two nodules of seminiferous tubules lined by germ cells and Sertoli cells in variable proportions. Germ cells had variable size and nuclear features, with frequent giant cells. Germ cells were evenly mixed with Sertoli cells or located in the center of tubules. Markers that labeled mainly germ cells and few or no Sertoli or Leydig cells were calretinin, KIT, and PGP 9.5. E-cadherin, GATA-4, inhibin-alpha (INH-alpha), and neuron-specific enolase (NSE) were predominantly detected in Sertoli cells, whereas melan A was particularly expressed in Leydig cells and vimentin in all three cell types. OCT3/4 was not detected in any cell type. Although more cases of canine MGSCT need to be examined, our results suggest that an immunohistochemical panel of E-cadherin, GATA-4, INH-alpha, KIT, NSE, PGP 9.5, and melan A will help distinguish the three main cell types in canine testicular germ cell and sex cord-stromal tumors.

Expression of galectin-3 in gonads and gonadal sex cord stromal and germ cell tumors

Galectin-3, a beta-galactoside-binding lectin, has been implicated in many human malignancies, but has seldom been studied in human gonads and gonadal tumors. The aim of our study was to investigate galectin-3 mRNA and protein expression in normal ovaries and testes as well as in a variety of 51 gonadal sex cord stromal and germ cell tumors, and two testicular seminomatous and non-seminomatous cell lines, using either real-time PCR or immunohistochemistry. In human testes, galectin-3 is specifically expressed in mature Sertoli cells and Leydig cells, and is absent from fetal and pre-pubertal testes, suggesting a hormone-dependence of this gene. In human ovaries, galectin-3 is absent from granulosa cells, as well as from granulosa cell and Sertoli-Leydig cell tumors, and is not a useful marker in distinguishing granulosa cell from Sertoli-Leydig cell tumors. In testicular tumorigenesis, galectin-3 has a dual function according to the histological type of tumors and their hormone dependency. In malignant testicular Sertoli cell tumors, the expression of galectin-3 is down-regulated while, in benign Leydig cell tumors, this expression is maintained, indicating the possible implication of this gene in the development of more aggressive testicular sex cord stromal tumors. In contrast to sex cord stromal tumors, galectin-3 expression is up-regulated in testicular germ cell tumors. By real-time PCR, we demonstrated a significant elevation of the galectin-3 mRNA level in non-seminomatous testicular germ cell tumors and cell line as compared to normal testes and seminomas (p=0.0432 and p=0.0247, respectively), indicating the possible role of this gene in the non-seminomatous differentiation of germ cell tumors.

Testicular Sex Cord–Stromal Tumours: The Edinburgh Experience 1988–2002, and a Review of the Literature

Sex cord-stromal tumours of the testis are uncommon tumours, accounting for around 5% of testicular neoplasms. Treatment is primarily surgical, with no adjuvant therapy of proven benefit. We present a single-centre experience over a period of 15 years. From 1988 to 2002, 18 patients with a diagnosis of sex cord-stromal tumour were referred to our centre. A retrospective analysis of their case notes was made and a pathological review undertaken. Sixteen were Leydig-cell tumours and two were Sertoli cell. For the Leydig-cell tumours, the median age at presentation was 42 years, 50% presented with a testicular mass and 31% with gynaecomastia. Two patients followed a malignant course: one revealing disease dissemination at initial staging, and a second 12 months after potentially curative orchidectomy. Salvage retroperitoneal lymphadenectomy in the latter patient proved unsuccessful. Clinical outcome correlated strongly with the presence of adverse pathological features described previously in the literature. After a median follow-up of 46 months, two patients have developed progressive disease, and two patients have died, one of metastatic Leydig-cell tumour. No patient defined as being of low malignant potential on pathological examination has relapsed outside our review period of 2 years. We confirm the overall excellent prognosis for most of the patients with sex cord-stromal tumours of the testis. Compared with most previous reports, pathological features seem to predict with reasonable accuracy the risk of malignant behaviour, and can adequately inform the subsequent review policy.

Granulosa Cell Tumor of the Adult Type

Abstract We report a case of testicular granulosa cell tumor of the adult type in a 48-year-old man. Microscopically, the tumor consisted of round to ovoid cells with grooved nuclei that were arranged in several patterns, including microfollicular, macrofollicular, insular, trabecular, gyriform, solid, and pseudosarcomatous. These cells demonstrated strong immunopositivity with MIC2 (O13) antibody, vimentin, and smooth muscle actin and focal positivity with cytokeratin. Although this type of sex cord–stromal tumor is relatively common in the ovaries, it is still extremely unusual in the testis, and it probably represents the rarest type of testicular sex cord–stromal tumor.

Granulosa cell tumor of the adult type: a case report and review of the literature of a very rare testicular tumor.

We report a case of testicular granulosa cell tumor of the adult type in a 48-year-old man. Microscopically, the tumor consisted of round to ovoid cells with grooved nuclei that were arranged in several patterns, including microfollicular, macrofollicular, insular, trabecular, gyriform, solid, and pseudosarcomatous. These cells demonstrated strong immunopositivity with MIC2 (O13) antibody, vimentin, and smooth muscle actin and focal positivity with cytokeratin. Although this type of sex cord-stromal tumor is relatively common in the ovaries, it is still extremely unusual in the testis, and it probably represents the rarest type of testicular sex cord-stromal tumor.

Author reply

The comments by Dr. Renshaw raise the interesting question of whether the described tumor should be classified as an intratesticular leiomyosarcoma or a gonadal stromal tumor. It refers to the difficulty in classifying a group of spindle cell tumors within the category of testicular sex cord-stromal tumors. These tumors have been reported under a wide variety of synonyms.1 Renshaw et al.1 found in some of these tumors an intimate association with the rete testis. Reticulin-enveloped nests of epitheloid cells, cells with prominent nuclear grooves, and strong immunoreactivity for S-100 protein and smooth muscle actin were further characteristics suggesting the classification of these neoplasms as granulosa cell tumors. Because of these findings, we studied the illustrated neoplasm again. We could not identify an association with the rete testis. Immunohistochemically, there was a strong reactivity for desmin, muscle specific actin, and smooth muscle actin and no reactivity for cytokeratin and S-100 protein (Fig. 1). Reticulin stain revealed fibers surrounding the individual cells but not groups of cells. Using these findings, we are convinced that the original classification of the tumor as a leiomyosarcoma was correct. Immunohistochemical staining for S-100 protein. The tumor cells are negative. The arrow indicates positive S-100 protein staining in a nerve fiber. (original magnification ×180). From a theoretic point of view, a histiogenesis from undifferentiated gonadal stromal cells is possible. However, there also are arguments for a smooth muscle descent. Leiomyosarcomas arising from spermatic cord or epididymal smooth muscle elements are among the most common urologic sarcomas in adults.2, 3 Such elements also are present in the tunica albuginea, blood vessels, and the testicular parenchyma and could be a site of origin of smooth muscle tumors. Michael Froehner M.D.*, Rainer Fischer M.D. , Manfred P. Wirth M.D. , * Department of Urology, Department of Pathology, Department of Urology, University Clinics “Carl Gustav Carus”, Technical University of Dresden, Dresden, Germany

Loss of the Y-Chromosome in the Primary Metastasis of a Male Sex Cord Stromal Tumor: Pathogenetic Implications

The first published chromosomal pattern of the retroperitoneal lymph node metastasis of a malignant gonadal stroma cell tumor of the adult testis is presented. Karyotyping showed structural chromosomal abnormalities and loss of the Y-chromosome. This loss was confirmed in primary tumor and metastasis using fluorescence in situ hybridization (FISH). The characteristic chromosomal abnormality of adult testicular germ cell tumors, an i(12p), was not present. The results are compared with other data of testicular and ovarian sex cord stromal tumors. From the comparison of the male tumors, it is concluded that loss of the Y-chromosome might have a pathogenetic significance.

Immunohistochemical study of testicular sex cord-stromal tumors, including staining with anti-inhibin antibody.

Inhibin is a peptide hormone produced by ovarian granulosa cells and testicular Sertoli cells. Ovarian granulosa cell and other sex cord-stromal tumors usually exhibit positive immunohistochemical staining with antiinhibin antibodies, and this may be valuable in differentiating these neoplasms from histologic mimics. In the present study, we investigated the immunohistochemical staining of testicular sex cord-stromal tumors using antiinhibin. Immunostaining with CAM5.2, vimentin, S-100 protein, desmin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), and placental alkaline phosphatase (PLAP) also was performed because few studies have investigated in detail the immunophenotype of testicular sex cord-stromal tumors. Fifteen of 16 Leydig cell tumors exhibited strong positive staining with antiinhibin. A proportion of Leydig cell tumors also stained positively with CAM5.2 (7 of 16), vimentin (14 of 16), S-100 protein (10 of 16), desmin (2 of 16) and epithelial membrane antigen (4 of 16). Four of six testicular sex cord-stromal tumors with varying degrees of Sertoli or granulosa cell differentiation were positive with antiinhibin, as were two of three sex cord-stromal tumors that were unclassified. Some of these tumors were positive with CAM 5.2, vimentin, S-100 protein, desmin, and epithelial membrane antigen. All tumors were negative with carcinoembryonic antigen and placental alkaline phosphatase. The immunohistochemical findings show that, analogous to their ovarian counterparts, most testicular sex cord-stromal tumors are immunoreactive with antiinhibin. Immunohistochemistry using this antibody as part of a panel may be valuable in confirming a diagnosis of testicular sex cord-stromal tumor and in differentiating these neoplasms from others that may mimic them.

Testicular Sex Cord-Stromal Tumors in Children: Clinicopathologic Study of Sixteen Children with Review of the Literature

Testicular Sex Cord-Stromal Tumors in Children: Clinicopathologic Study of Sixteen Children with Review of the Literature

Testicular sex cord-stromal tumors in children: clinicopathologic study of sixteen children with review of the literature.

Sex cord-stromal tumors of the pediatric testis present diagnostic and therapeutic challenges. This study examines the clinicopathologic features of 16 testicular sex cord-stromal tumors from children less than 18 years of age. Four juvenile granulosa cell tumors and five tumors of Sertoli or incomplete differentiation in this study had high mitotic rates and/or sarcomatoid areas that suggested malignancy, but none of these children developed recurrence or metastases. Some of these tumors had been initially misdiagnosed as yolk sac tumors or rhabdomyosarcomas because of the presence of areas superficially resembling these neoplasms. These morphologic pitfalls have received little attention in the literature. Even incompletely differentiated sex cord-stromal tumors have at least focal areas characteristic of juvenile granulosa or Sertoli cell differentiation. In addition, immunohistochemical negativity for alpha-fetoprotein, muscle specific actin, and desmin are useful for ruling out yolk sac tumor and rhabdomyosarcoma. Four patients had Leydig cell tumors and three had large cell calcifying Sertoli cell tumors. Children with Leydig cell tumors are not at risk for metastasis, but children with large cell calcifying Sertoli cell tumors are at risk for endocrine syndromes as illustrated by one of our cases. The differential diagnosis of these tumors is also discussed.

Immunohistochemical Evaluation of Intermediate Filaments in Testicular Sex-Cord Stromal Tumors and Non-Neoplastic Testes

Four testicular sex cord stromal tumors (3 Leydig cell tumors and 1 Sertoli-Leydig cell tumor) and the Sertoli and Leydig cells of 10 nonneoplastic testes were studied for their immunohistochemical reactivity to intermediate filaments. Low molecular weight cytokeratin positivity was present in the Sertoli cell component of the Sertoli-Leydig cell tumor and in Sertoli cells in atrophic seminiferous tubules of 4 of 10 nonneoplastic testes. Vimentin reactivity was present in the majority of Sertoli and Leydig cells in neoplastic and nonneoplastic testes. There was uniformly no reactivity for epithelial membrane antigen, carcinoembryonic antigen, and S-100 protein in either cell type. Our studies suggest that expression of intermediate filament may distinguish testicular Sertoli from Leydig cells and neoplasms derived from them. (The J Histotechnol 17:119, 1994)

Immunohistochemical Evaluation of Intermediate Filaments in Testicular Sex-Cord Stromal Tumors and Non-Neoplastic Testes

Immunohistochemical Evaluation of Intermediate Filaments in Testicular Sex-Cord Stromal Tumors and Non-Neoplastic Testes

Testicular sex cord-stromal lesions: immunohistochemical analysis of cytokeratin, vimentin and steroidogenic enzymes.

We have studied immunolocalization of all steroidogenic enzyme involved in sex steroids biosynthesis, P-450 side chain cleavage (P-450scc), 3 beta hydroxy steroid dehydrogenase (3 beta-HSD), P-450 17 alpha hydroxylase (P-450(17 alpha)) and P-450 aromatase (P-450arom) and that of vimentin and cytokeratin in 14 cases of testicular sex cord-stromal tumours (6 Leydig cell tumours, 5 Sertoli cell tumours, 2 fibromas and 1 granulosa cell tumour) as well as 4 cases of hyperplasia (2 Leydig and 2 Sertoli). Leydig cell tumour expressed all four steroidogenic enzymes examined, indicating that this tumour can synthesize oestrogen from cholesterol. In 2 cases of Sertoli cell tumour, the tumour cells with clear cytoplasm and without Reinke's crystals expressed P-450ssc, 3 beta-HSD and P-450(17 alpha), suggesting the capability of androgen production in these tumour cells. Fibromas and granulosa cell tumour were negative for the enzymes examined. In immunohistochemistry of intermediate filaments, Leydig cell tumours demonstrated only vimentin. Sertoli cells in hyperplasia and non-neoplastic testis expressed only vimentin but Sertoli cell tumours expressed both cytokeratin and vimentin. Cytokeratin immunoreactivity was correlated with morphological epithelial differentiation in Sertoli cell tumour. These findings in testicular Sertoli cell tumour are considered to represent the multiple differentiation capacity of this neoplasm. Immunohistochemical study of steroidogenic enzymes and intermediate filaments provided new insight into neoplastic steroidogenesis and the differentiation capacity of testicular sex cord-stromal neoplasms.