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Large-Cell Calcifying Sertoli Cell Tumor of the Testis: Case Report and Review of the Literature
2024
DIAGNOSTIC UROLOGY AND TESTIS CANCER
testicle is recommended. In patients for whom future fertility is an important issue, follow-up including repeated biopsies can be offered for a period of at least 10 years.
Editorial Comment: Carcinoma in situ of the testis was initially described in 1972.1 Controversy exists as to how frequently carcinoma in situ progresses to standard germ cell malignancy. Skakkebaek reported progression to invasive tumor defined as invasion of the basement membrane in about 5wo of cases within 5 years. A smaller percentage of patients will have clinically apparent testicular tumors. Treatment of carcinoma in situ with radiation therapy has been advocated but clearly has an impact on fertility. The authors reported on 33 patients with disseminated germ cell tumors and associated carcinoma in situ of the testis. Biopsy of the testis 30 to 95 months after chemotherapy revealed relapse of carcinoma in situ. These findings may be logical in view of the fact that some chemotherapeutic agents may not cross the blood-testis barrier. The authors recommend radiation therapy in a dose of 2,000 cGy. to eradicate carcinoma in situ. Clearly, this dose will impact on fertility and may or may not impact on hormonal production. The authors do not satisfactorily address my concerns about over treatment of carcinoma in situ. Jerome P. Richie, M.D. 1. Skakkebaek, N. E.: Possible carcinoma-in-situof the testis. Lancet, 2: 516, 1972.
Large-Cell Calciwng Sertoli Cell Tumor of the Testis: Case Report and Review of the Literature B. CHANG, J. G. BORER,P. E. TANAND D. A. DIAMOND, Department of Urology, Boston University Medical Center, Departments of Urology and Pathology, Children's Hospital and Harvard Medical School, Boston, Massachusetts Urology, 5 2 520-523, 1998 Large-cell calcifying Sertoli cell tumor (LCCSCT) is a rare sex cord-stromal tumor found predominantly in the pediatric population. This tumor has distinctive histopathologic features and clinical associations. LCCSCT has also been noted in association with the Carney complex, and in patients with Peutz-Jeghers syndrome. The propensity to metastasize is low, and radical orchiectomy has traditionally been the treatment of choice.
Editorial Comment: Sertoli cell tumor is a sex cord stromal tumor that comprises approximately 4% of prepubertal testicular tumors. The large cell calcifying subtype was described in 1980 with 30 subsequent cases reported in the literature to date. The authors report on an 11-year-old boy with 3 nodules, of which the largest was 1.1 cm. involving both testes. The patient underwent bilateral radical orchiectomy. The authors reviewed the distinctive microscopic features and described the association with other endocrine and nonendocrine disorders, such as the Carney complex of myxomas, spotty pigmentation and endocrine overactivity. Jerome P. Richie, M.D.
Postchemotherapy Residual Masses in Germ Cell Tumor Patients. Content, Clinical Features, and Prognosis S. P. STENNING, M. C. PARKINSON, C. FISHER,G. M. MEAD,P. A. COOK,S. D. FOSSA,A. HORWICH, W. G. JONES, E. S . NEWLANDS, R. T. OLIVER, A. E. STENWIG AND P. M. WILKINSON FOR THE MEDICAL RESEARCH COUNCIL TJBTICULAR %OUR WORKING PARTY, Medical Research Council Cancer Trials Office, Cambridge, University College London Trust, Institute of Urology and Nephrology, Histopathology Department, Royal Marsden Hospital, Charing Cross Hospital and School of Medicine, London, Royal South Hants Hospital, Southampton, Royal Marsden Hospital, Surrey, Cookridge Hospital, Leeds and Christie Hospital, Manchester, United Kingdom, and Norwegian Radium Hospital, Oslo, Norway Cancer, 83: 1409-1419, 1998 BACKGROUND. In a retrospective study that included a detailed histopathologic review, the clinicopathologic features of patients with germ cell tumors (GCT) and resectable residual masses after chemotherapy were assessed. METHODS. Histologic material from 153 patients was available for review. Recorded details included primary histologic diagnosis, location, size and number of metastases, marker levels before and after chemotherapy, and completeness of surgical excision. A median of seven histologic sections per resection were reviewed by two pathologists independently (and together when disagreement occurred). In each case, details were recorded regarding fibrosis, necrosis, hemorrhage, embryonal carcinoma (undifferentiated teratoma), yolk sac tumor, choriocarcinoma (trophoblastic tumor), differentiated teratoma (mature and
DIAGNOSTIC UROLOGY AND TESTIS CANCER
testicle is recommended. In patients for whom future fertility is an important issue, follow-up including repeated biopsies can be offered for a period of at least 10 years.
Editorial Comment: Carcinoma in situ of the testis was initially described in 1972.1 Controversy exists as to how frequently carcinoma in situ progresses to standard germ cell malignancy. Skakkebaek reported progression to invasive tumor defined as invasion of the basement membrane in about 5wo of cases within 5 years. A smaller percentage of patients will have clinically apparent testicular tumors. Treatment of carcinoma in situ with radiation therapy has been advocated but clearly has an impact on fertility. The authors reported on 33 patients with disseminated germ cell tumors and associated carcinoma in situ of the testis. Biopsy of the testis 30 to 95 months after chemotherapy revealed relapse of carcinoma in situ. These findings may be logical in view of the fact that some chemotherapeutic agents may not cross the blood-testis barrier. The authors recommend radiation therapy in a dose of 2,000 cGy. to eradicate carcinoma in situ. Clearly, this dose will impact on fertility and may or may not impact on hormonal production. The authors do not satisfactorily address my concerns about over treatment of carcinoma in situ. Jerome P. Richie, M.D. 1. Skakkebaek, N. E.: Possible carcinoma-in-situof the testis. Lancet, 2: 516, 1972.
Large-Cell Calciwng Sertoli Cell Tumor of the Testis: Case Report and Review of the Literature B. CHANG, J. G. BORER,P. E. TANAND D. A. DIAMOND, Department of Urology, Boston University Medical Center, Departments of Urology and Pathology, Children's Hospital and Harvard Medical School, Boston, Massachusetts Urology, 5 2 520-523, 1998 Large-cell calcifying Sertoli cell tumor (LCCSCT) is a rare sex cord-stromal tumor found predominantly in the pediatric population. This tumor has distinctive histopathologic features and clinical associations. LCCSCT has also been noted in association with the Carney complex, and in patients with Peutz-Jeghers syndrome. The propensity to metastasize is low, and radical orchiectomy has traditionally been the treatment of choice.
Editorial Comment: Sertoli cell tumor is a sex cord stromal tumor that comprises approximately 4% of prepubertal testicular tumors. The large cell calcifying subtype was described in 1980 with 30 subsequent cases reported in the literature to date. The authors report on an 11-year-old boy with 3 nodules, of which the largest was 1.1 cm. involving both testes. The patient underwent bilateral radical orchiectomy. The authors reviewed the distinctive microscopic features and described the association with other endocrine and nonendocrine disorders, such as the Carney complex of myxomas, spotty pigmentation and endocrine overactivity. Jerome P. Richie, M.D.
Postchemotherapy Residual Masses in Germ Cell Tumor Patients. Content, Clinical Features, and Prognosis S. P. STENNING, M. C. PARKINSON, C. FISHER,G. M. MEAD,P. A. COOK,S. D. FOSSA,A. HORWICH, W. G. JONES, E. S . NEWLANDS, R. T. OLIVER, A. E. STENWIG AND P. M. WILKINSON FOR THE MEDICAL RESEARCH COUNCIL TJBTICULAR %OUR WORKING PARTY, Medical Research Council Cancer Trials Office, Cambridge, University College London Trust, Institute of Urology and Nephrology, Histopathology Department, Royal Marsden Hospital, Charing Cross Hospital and School of Medicine, London, Royal South Hants Hospital, Southampton, Royal Marsden Hospital, Surrey, Cookridge Hospital, Leeds and Christie Hospital, Manchester, United Kingdom, and Norwegian Radium Hospital, Oslo, Norway Cancer, 83: 1409-1419, 1998 BACKGROUND. In a retrospective study that included a detailed histopathologic review, the clinicopathologic features of patients with germ cell tumors (GCT) and resectable residual masses after chemotherapy were assessed. METHODS. Histologic material from 153 patients was available for review. Recorded details included primary histologic diagnosis, location, size and number of metastases, marker levels before and after chemotherapy, and completeness of surgical excision. A median of seven histologic sections per resection were reviewed by two pathologists independently (and together when disagreement occurred). In each case, details were recorded regarding fibrosis, necrosis, hemorrhage, embryonal carcinoma (undifferentiated teratoma), yolk sac tumor, choriocarcinoma (trophoblastic tumor), differentiated teratoma (mature and