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Familial syndromes associated with testicular and paratesticular neoplasms: a comprehensive review

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Abstract

A syndromic association between a subset of testicular/paratesticular neoplasms is well established. Such examples include Carney complex and large cell calcifying Sertoli cell tumor, Peutz-Jeghers syndrome and intratubular large cell hyalinizing Sertoli cell neoplasia, and VHL syndrome and clear cell papillary cystadenoma of the epididymis.

However, recent studies proposed potential novel links between some testicular and paratesticular neoplasms with certain tumor syndromes. While more studies are still needed to solidify these associations, recent research suggests that a subset of Leydig cell tumors may arise in patients with hereditary leiomyomatosis and renal cell carcinoma syndrome or that some seminomas may occur in Lynch syndrome patients. Additionally, an association between testicular sex cord stromal tumors and paratesticular sarcomas with Familial adenomatous polyposis syndrome and DICER1 syndrome, respectively, has been proposed as well. This review provides a comprehensive overview of the intricate relationship between familial syndromes and associated testicular and paratesticular tumors, shedding light on their clinicopathological and molecular characteristics.

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References:

  1. Correa R, Salpea P, Stratakis CA (2015) Carney complex: an update. Eur J Endocrinol 173:M85-97

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kirschner LS, Carney JA, Pack SD, Taymans SE, Giatzakis C, Cho YS, Cho-Chung YS, Stratakis CA (2000) Mutations of the gene encoding the protein kinase A type I-alpha regulatory subunit in patients with the Carney complex. Nat Genet 26:89–92

    Article  CAS  PubMed  Google Scholar 

  3. Bouys L, Bertherat J (2021) MANAGEMENT OF ENDOCRINE DISEASE: Carney complex: clinical and genetic update 20 years after the identification of the CNC1 (PRKAR1A) gene. Eur J Endocrinol 184:R99-r109

    Article  CAS  PubMed  Google Scholar 

  4. Kacerovská D, Michal M, Síma R, Grossmann P, Kazakov DV (2011) Carneyho komplex [Carney complex]. Cesk Patol 47(4):192–7. Czech

  5. Stratakis CA, Kirschner LS, Carney JA (2001) Clinical and molecular features of the Carney complex: diagnostic criteria and recommendations for patient evaluation. J Clin Endocrinol Metab 86:4041–4046

    Article  CAS  PubMed  Google Scholar 

  6. Gourgari E, Saloustros E, Stratakis CA (2012) Large-cell calcifying Sertoli cell tumors of the testes in pediatrics. Curr Opin Pediatr 24:518–522

    Article  PubMed  PubMed Central  Google Scholar 

  7. Anderson WJ, Gordetsky JB, Idrees MT, Al-Obaidy KI, Kao CS, Cornejo KM, Wobker SE, Cheville JC, Vargas SO, Fletcher CDM et al (2022) Large cell calcifying Sertoli cell tumour: a contemporary multi-institutional case series highlighting the diagnostic utility of PRKAR1A immunohistochemistry. Histopathology 80:677–685

    Article  PubMed  Google Scholar 

  8. Petersson F, Bulimbasic S, Sima R, Michal M, Hora M, Malagon HD, Matoska J, Hes O (2010) Large cell calcifying Sertoli cell tumor: a clinicopathologic study of 1 malignant and 3 benign tumors using histomorphology, immunohistochemistry, ultrastructure, comparative genomic hybridization, and polymerase chain reaction analysis of the PRKAR1A gene. Hum Pathol 41:552–559

    Article  CAS  PubMed  Google Scholar 

  9. Tatsi C, Faucz FR, Blavakis E, Carneiro BA, Lyssikatos C, Belyavskaya E, Quezado M, Stratakis CA (2019) Somatic PRKAR1A Gene Mutation in a Nonsyndromic Metastatic Large Cell Calcifying Sertoli Cell Tumor. J Endoc Soc 3:1375–1382

    Article  CAS  Google Scholar 

  10. Spoto CPE, Gullo I, Carneiro F, Montgomery EA, Brosens LAA (2018) Hereditary gastrointestinal carcinomas and their precursors: An algorithm for genetic testing. Semin Diagn Pathol 35:170–183

    Article  PubMed  Google Scholar 

  11. Ulbright TM, Amin MB, Young RH (2007) Intratubular large cell hyalinizing sertoli cell neoplasia of the testis: a report of 8 cases of a distinctive lesion of the Peutz-Jeghers syndrome. Am J Surg Pathol 31:827–835

    Article  PubMed  Google Scholar 

  12. Ylikorkala A, Avizienyte E, Tomlinson IP, Tiainen M, Roth S, Loukola A, Hemminki A, Johansson M, Sistonen P, Markie D et al (1999) Mutations and impaired function of LKB1 in familial and non-familial Peutz-Jeghers syndrome and a sporadic testicular cancer. Hum Mol Genet 8:45–51

    Article  CAS  PubMed  Google Scholar 

  13. WHO Classification of Tumours Editorial Board (2020) Female genital tumours [Internet]. Lyon (France): International Agency for Research on Cancer; 2020 [cited 2024/04/10]. (WHO classification of tumours series, 5th edn.; vol 4). Available from: https://www.tumourclassification.iarc.who.int/chapters/34

  14. WHO Classification of Tumours Editorial Board (2022) Urinary and male genital tumours [Internet]. Lyon (France): International Agency for Research on Cancer; 2022 [cited 2024/04/10]. (WHO classification of tumours series, 5th edn.; vol 8). Available from: https://www.tumourclassification.iarc.who.int/chapters/36

  15. Berney DM, Cree I, Rao V, Moch H, Srigley JR, Tsuzuki T, Amin MB, Comperat EM, Hartmann A, Menon S et al (2022) An introduction to the WHO 5th edition 2022 classification of testicular tumours. Histopathology 81:459–466

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ham S, Meachem SJ, Choong CS, Charles AK, Baynam GS, Jones TW, Samarajeewa NU, Simpson ER, Brown KA (2013) Overexpression of aromatase associated with loss of heterozygosity of the STK11 gene accounts for prepubertal gynecomastia in boys with Peutz-Jeghers syndrome. J Clin Endocrinol Metab 98:E1979-1987

    Article  CAS  PubMed  Google Scholar 

  17. Venara M, Rey R, Bergadá I, Mendilaharzu H, Campo S, Chemes H (2001) Sertoli cell proliferations of the infantile testis: an intratubular form of Sertoli cell tumor? Am J Surg Pathol 25:1237–1244

    Article  CAS  PubMed  Google Scholar 

  18. Coen P, Kulin H, Ballantine T, Zaino R, Frauenhoffer E, Boal D, Inkster S, Brodie A, Santen R (1991) An aromatase-producing sex-cord tumor resulting in prepubertal gynecomastia. N Engl J Med 324:317–322

    Article  CAS  PubMed  Google Scholar 

  19. Ceccamea Alberto, Cozzi Francesco, Farragiana Tullio, Boscherini Brunetto, Pierro Agostino (1985) Feminizing Sertoli cell tumor associated with Peutz-Jeghers syndrome. Tumori 71:379–385

    Article  CAS  PubMed  Google Scholar 

  20. Cantú JM, Rivera H, Ocampo-Campos R, Bedolla N, Cortés-Gallegos V, González-Mendoza A, Díaz M, Hernández A (1980) Peutz-Jeghers syndrome with feminizing sertoli cell tumor. Cancer 46:223–228

    Article  PubMed  Google Scholar 

  21. Dubois RS, Hoffman WH, Krishnan TH, Rising JA, Tolia VK, Sy DA, Chang CH (1982) Feminizing sex cord tumor with annular tubules in a boy with Peutz-Jeghers syndrome. J Pediatr 101:568–571

    Article  CAS  PubMed  Google Scholar 

  22. Ros P, Nistal M, Alonso M, Calvo de Mora J, Yturriaga R, Barrio R (1999) Sertoli cell tumour in a boy with Peutz-Jeghers syndrome. Histopathology 34:84–86

    Article  CAS  PubMed  Google Scholar 

  23. Smit DL, Mensenkamp AR, Badeloe S, Breuning MH, Simon ME, van Spaendonck KY, Aalfs CM, Post JG, Shanley S, Krapels IP et al (2011) Hereditary leiomyomatosis and renal cell cancer in families referred for fumarate hydratase germline mutation analysis. Clin Genet 79:49–59

    Article  CAS  PubMed  Google Scholar 

  24. Clark GR, Sciacovelli M, Gaude E, Walsh DM, Kirby G, Simpson MA, Trembath RC, Berg JN, Woodward ER, Kinning E et al (2014) Germline FH mutations presenting with pheochromocytoma. J Clin Endocrinol Metab 99:E2046-2050

    Article  CAS  PubMed  Google Scholar 

  25. Muller M, Ferlicot S, Guillaud-Bataille M, Le Teuff G, Genestie C, Deveaux S, Slama A, Poulalhon N, Escudier B, Albiges L et al (2017) Reassessing the clinical spectrum associated with hereditary leiomyomatosis and renal cell carcinoma syndrome in French FH mutation carriers. Clin Genet 92:606–615

    Article  CAS  PubMed  Google Scholar 

  26. Castro-Vega LJ, Buffet A, De Cubas AA, Cascón A, Menara M, Khalifa E, Amar L, Azriel S, Bourdeau I, Chabre O et al (2014) Germline mutations in FH confer predisposition to malignant pheochromocytomas and paragangliomas. Hum Mol Genet 23:2440–2446

    Article  CAS  PubMed  Google Scholar 

  27. Carvajal-Carmona LG, Alam NA, Pollard PJ, Jones AM, Barclay E, Wortham N, Pignatelli M, Freeman A, Pomplun S, Ellis I et al (2006) Adult leydig cell tumors of the testis caused by germline fumarate hydratase mutations. J Clin Endocrinol Metab 91:3071–3075

    Article  CAS  PubMed  Google Scholar 

  28. Rizzo NM, Sholl LM, Idrees MT, Cheville JC, Gupta S, Cornejo KM, Miyamoto H, Hirsch MS, Collins K, and Acosta AM (2021) Comparative molecular analysis of testicular Leydig cell tumors demonstrates distinct subsets of neoplasms with aggressive histopathologic features. Modern pathol: official J United States and Canad Acad Pathol Inc 34 1935–1946

    Article  CAS  Google Scholar 

  29. Ju JY, Mills AM, Mahadevan MS, Fan J, Culp SH, Thomas MH, Cathro HP (2018) Universal Lynch Syndrome Screening Should be Performed in All Upper Tract Urothelial Carcinomas. Am J Surg Pathol 42:1549–1555

    Article  PubMed  Google Scholar 

  30. Pivovarcikova K, Pitra T, Alaghehbandan R, Buchova K, Steiner P, Hajkova V, Ptakova N, Subrt I, Skopal J, Svajdler P et al (2023) Lynch syndrome-associated upper tract urothelial carcinoma frequently occurs in patients older than 60 years: an opportunity to revisit urology clinical guidelines. Virchows Archiv : intl J Pathol 483:517–526

    Article  CAS  Google Scholar 

  31. Lobo J, Pinto C, Pinheiro M, Lobo F, Sousa N, Lopes P, Looijenga LH, Jerónimo C, Teixeira MR, Henrique R (2020) Widening the spectrum of Lynch syndrome: first report of testicular seminoma attributable to MSH2 loss. Histopathology 76:486–489

    Article  PubMed  Google Scholar 

  32. Dum D, Steurer S, Simon R, Zimmermann PV, Burandt E, Clauditz TS, Fisch M, Rink M, Dahlem R, Höppner W et al (2021) Mismatch repair deficiency occurs very rarely in seminomas. Transl Androl Urol 10:1048–1055

    Article  PubMed  PubMed Central  Google Scholar 

  33. Waller A, Findeis S, Lee MJ (2016) Familial Adenomatous Polyposis. J Pediatr Gen 5:78–83

    CAS  Google Scholar 

  34. Groen EJ, Roos A, Muntinghe FL, Enting RH, de Vries J, Kleibeuker JH, Witjes MJ, Links TP, van Beek AP (2008) Extra-intestinal manifestations of familial adenomatous polyposis. Ann Surg Oncol 15:2439–2450

    Article  PubMed  PubMed Central  Google Scholar 

  35. Perrone F, Bertolotti A, Montemurro G, Paolini B, Pierotti MA, Colecchia M (2014) Frequent mutation and nuclear localization of β-catenin in sertoli cell tumors of the testis. Am J Surg Pathol 38:66–71

    Article  PubMed  Google Scholar 

  36. Parker TW, Neufeld KL (2020) APC controls Wnt-induced β-catenin destruction complex recruitment in human colonocytes. Sci Rep 10:2957

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Rizzo NM, Sholl LM, Kao CS, Cornejo KM, Sangoi AR, Hirsch MS, Collins K, Gordetsky JB, Reyes Curcio FA, Fletcher CDM, et al. (2023). Molecular Correlates of Aggressive Behavior and Biological Progression in Testicular Sertoli Cell Tumors. Modern pathology : J United States and Canad Acad Pathol Inc 36, 100152.

    Article  Google Scholar 

  38. Siegmund SE, Sholl LM, Tsai HK, Yang Y, Vasudevaraja V, Tran I, Snuderl M, Fletcher CDM, Cornejo KM, Idrees MT, et al (2022) Clinicopathologic and molecular spectrum of testicular sex cord stromal tumors not amenable to specific histopathologic subclassification. Modern pathology : official J US Canad Acad Pathol Inc 35 1944–1954.

  39. Necchi A, Bratslavsky G, Shapiro O, Elvin JA, Vergilio JA, Killian JK, Ngo N, Ramkissoon S, Severson E, Hemmerich AC et al (2019) Genomic Features of Metastatic Testicular Sex Cord Stromal Tumors. Eur Urol Focus 5:748–755

    Article  PubMed  Google Scholar 

  40. Siegmund S, Ricci C, Kao CS, Sangoi AR, Mohanty S, Fletcher CDM, Colecchia M, Acosta AM (2023) Germline APC Alterations May Predispose to Testicular Sex Cord-Stromal Tumors. Am J Surg Pathol 47:1432–1437

    Article  PubMed  Google Scholar 

  41. Xiao GQ, Granato RC, Unger PD (2012) Bilateral Sertoli cell tumors of the testis-a likely new extracolonic manifestation of familial adenomatous polyposis. Virchows Archiv : an intl J Pathol 461:713–715

    Article  CAS  Google Scholar 

  42. Heffner DK (1989) Low-grade adenocarcinoma of probable endolymphatic sac origin A clinicopathologic study of 20 cases. Cancer 64:2292–2302

    Article  CAS  PubMed  Google Scholar 

  43. Cox R, Vang R, Epstein JI (2014) Papillary cystadenoma of the epididymis and broad ligament: morphologic and immunohistochemical overlap with clear cell papillary renal cell carcinoma. Am J Surg Pathol 38:713–718

    Article  PubMed  Google Scholar 

  44. Yang L, Xu WS, Melamed J, Zhou M, Deng FM (2015) Solid variant of papillary cystadenoma of the epididymis. Histopathology 67:138–141

    Article  PubMed  Google Scholar 

  45. Soria Gondek A, Julià Masip V, Jou Muñoz C, Salvador Hernández H, Rovira Zurriaga C, Tarrado Castellarnau X (2018) Adolescent Hydrocele Carrying a Surprise: A Case of Papillary Cystadenoma of the Epididymis. Urology 112:172–175

    Article  CAS  PubMed  Google Scholar 

  46. Tsuda H, Fukushima S, Takahashi M, Hikosaka Y, Hayashi K (1976) Familial bilateral papillary cystadenoma of the epididymis: report of three cases in siblings. Cancer 37:1831–1839

    Article  CAS  PubMed  Google Scholar 

  47. de Souza Andrade J, Bambirra EA, Bicalho OJ, de Souza AF (1985) Bilateral papillary cystadenoma of the epididymis as a component of von Hippel-Lindau’s syndrome: report of a case presenting as infertility. J Urol 133:288–289

    Article  PubMed  Google Scholar 

  48. Gläsker S, Tran MG, Shively SB, Ikejiri B, Lonser RR, Maxwell PH, Zhuang Z, Oldfield EH, Vortmeyer AO (2006) Epididymal cystadenomas and epithelial tumourlets: effects of VHL deficiency on the human epididymis. J Pathol 210:32–41

    Article  PubMed  Google Scholar 

  49. Mehta GU, Shively SB, Duong H, Tran MG, Moncrief TJ, Smith JH, Li J, Edwards NA, Lonser RR, Zhuang Z et al (2008) Progression of epididymal maldevelopment into hamartoma-like neoplasia in VHL disease. Neoplasia (New York, NY) 10:1146–1153

    Article  CAS  Google Scholar 

  50. Mandriota SJ, Turner KJ, Davies DR, Murray PG, Morgan NV, Sowter HM, Wykoff CC, Maher ER, Harris AL, Ratcliffe PJ et al (2002) HIF activation identifies early lesions in VHL kidneys: evidence for site-specific tumor suppressor function in the nephron. Cancer Cell 1:459–468

    Article  CAS  PubMed  Google Scholar 

  51. Gläsker S, Lonser RR, Tran MG, Ikejiri B, Butman JA, Zeng W, Maxwell PH, Zhuang Z, Oldfield EH, Vortmeyer AO (2005) Effects of VHL deficiency on endolymphatic duct and sac. Can Res 65:10847–10853

    Article  Google Scholar 

  52. Vortmeyer AO, Tran MG, Zeng W, Gläsker S, Riley C, Tsokos M, Ikejiri B, Merrill MJ, Raffeld M, Zhuang Z et al (2006) Evolution of VHL tumourigenesis in nerve root tissue. J Pathol 210:374–382

    Article  CAS  PubMed  Google Scholar 

  53. Michal M, Vanecek T, Sima R, Mukensnabl P, Boudova L, Brouckova M, Koudepa K (2004) Primary capillary hemangioblastoma of peripheral soft tissues. Am J Surg Pathol 28:962–966

    Article  PubMed  Google Scholar 

  54. Jonathan I Epstein, CMG Ming Zhou, and Antonio L. Cubilla. 2020 AFIP Atlases of Tumor and Non-Tumor Pathology: Tumors of the Prostate Gland, Seminal Vesicles, Penis, and Scrotum American Registry of Pathology Arlington, Virginia

  55. Datta MW, Ulbright TM, Young RH (2001) Renal cell carcinoma metastatic to the testis and its adnexa: a report of five cases including three that accounted for the initial clinical presentation. Int J Surg Pathol 9:49–56

    Article  CAS  PubMed  Google Scholar 

  56. Aydin H, Young RH, Ronnett BM, Epstein JI (2005) Clear cell papillary cystadenoma of the epididymis and mesosalpinx: immunohistochemical differentiation from metastatic clear cell renal cell carcinoma. Am J Surg Pathol 29:520–523

    Article  PubMed  Google Scholar 

  57. Gilcrease MZ, Schmidt L, Zbar B, Truong L, Rutledge M, Wheeler TM (1995) Somatic von Hippel-Lindau mutation in clear cell papillary cystadenoma of the epididymis. Hum Pathol 26:1341–1346

    Article  CAS  PubMed  Google Scholar 

  58. Torikata C (1994) Papillary cystadenoma of the epididymis. An ultrastructural and immunohistochemical study. J Submicrosc Cytol Pathol 26:387–393

    CAS  PubMed  Google Scholar 

  59. Geenen RW, Bevers RF, Gielis C, Boon TA (1997) Papillary cystadenoma located in the spermatic cord. J Urol 158(2):546

  60. Kragel PJ, Pestaner J, Travis WD, Linehan WM, Filling-Katz MR (1990) Papillary cystadenoma of the epididymis. A report of three cases with lectin histochemistry. Arch Pathol Lab Med 114:672–675

    CAS  PubMed  Google Scholar 

  61. Mehta GU, Shively SB, Gläsker S, Bechert CJ, Zhuang Z, Raffeld M, Lonser RR, Oldfield EH, Vortmeyer AO (2007) von Hippel-Lindau disease: epididymal cystadenoma targeted by metastatic events. Urology 69:1209.e1209-1212

    Article  Google Scholar 

  62. Foulkes WD, Priest JR, Duchaine TF (2014) DICER1: mutations, microRNAs and mechanisms. Nat Rev Cancer 14:662–672

    Article  CAS  PubMed  Google Scholar 

  63. González IA, Stewart DR, Schultz KAP, Field AP, Hill DA, and Dehner LP (2022) DICER1 tumor predisposition syndrome: an evolving story initiated with the pleuropulmonary blastoma. Modern pathology : official J US Canad Acad Pathol Inc 35, 4–22.

  64. Apellaniz-Ruiz M, Cullinan N, Grant R, Marrano P, Priest JR, Thorner PS, Goudie C, Foulkes WD (2020) DICER1 screening in 15 paediatric paratesticular sarcomas unveils an unusual DICER1-associated sarcoma. J Pathol Clin Res 6:185–194

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Bean GR, Anderson J, Sangoi AR, Krings G, and Garg K (2019) DICER1 mutations are frequent in müllerian adenosarcomas and are independent of rhabdomyosarcomatous differentiation. Modern pathology : official J US Canad Acad Pathol Inc 32, 280–289.

  66. de Kock L, Yoon JY, Apellaniz-Ruiz M, Pelletier D, McCluggage WG, Stewart CJR, Dickson BC, Rouzbahman M, Clarke BA, and Foulkes WD (2020). Significantly greater prevalence of DICER1 alterations in uterine embryonal rhabdomyosarcoma compared to adenosarcoma. Modern pathology : official J U S and Canad Acad Pathol Inc 33, 1207–1219.

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This work was supported by the Cooperatio Program, research area SURG, and by Institutional Research Fund FN 00669806.

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Andrea Strakova-Peterikova – wrote the manuscript draft, did review of the literature and figures. Maryna Slisarenko – did review of the literature. Josef Skopal—did review of the literature. Kristyna Pivovarcikova – edited the manuscript. Tomas Pitra – edited clinical information. Mihaela Farcas – wrote parts of the manucsript. Michael Michal – did final editing of the manuscript. Michal Michal – contributed the cases included in the figures. Kvetoslava Michalova – did study design, edited the manuscript.

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Correspondence to Kvetoslava Michalova.

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Strakova-Peterikova, A., Slisarenko, M., Skopal, J. et al. Familial syndromes associated with testicular and paratesticular neoplasms: a comprehensive review. Virchows Arch (2024). https://doi.org/10.1007/s00428-024-03803-x

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