Skip to main content
SpringerLink
Log in

Testis and Paratesticular Lesions

  • Chapter
  • First Online:
Practical Genitourinary Pathology

Part of the book series: Practical Anatomic Pathology ((PAP))

  • 1120 Accesses

Abstract

A variety of neoplasms can arise in the testis and paratesticular tissue. Germ cell tumors account for the vast majority of testicular tumors, and other tumors, such as sex cord-stromal cell tumors (SCSTs), lymphomas, and soft tissue tumors, can also been seen in the testis. Neoplasms of the paratesticular tissue are extremely rare but demonstrate distinct morphology. In this chapter, we discuss the diagnostic challenges in common germ cell tumors as well as rare entities with a focus on pathologic features and differential diagnoses. Salient clinical features associated with these tumors are highlighted. The application of immunohistochemical, cytogenetic, and molecular tests in the pathologic diagnosis is also discussed. Several actual cases are presented to demonstrate how to use the morphologic analysis with the aid of immunohistochemistry to reach the correct diagnosis in complex cases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Spratt DE, Suresh K, Osawa T, Schipper M, Jackson WC, Abugharib A, Lebastchi A, Smith D, Montgomery JS, Palapattu GS, Priya Kunju L, Wu A, Lew M, Tomlins SA, Chinnaiyan AM, Weizer AZ, Hafez KS, Kaffenberger SD, Udager A, Mehra R. Detailed pathologic analysis on the co-occurrence of non-seminomatous germ cell tumor subtypes in matched orchiectomy and retroperitoneal lymph node dissections. Med Oncol. 2018;35(3):21.

    PubMed  Google Scholar 

  2. Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna MP, Nicolai N. Oldenburg J; European Association of Urology. Guidelines on testicular cancer: 2015 update. Eur Urol. 2015;68(6):1054–68.

    PubMed  Google Scholar 

  3. Alexandre J, Fizazi K, Mahé C, et al. Stage I non-seminomatous germ-cell tumours of the testis: identification of a subgroup of patients with a very low risk of relapse. Eur J Cancer. 2001;37:576–82.

    CAS  PubMed  Google Scholar 

  4. Alvarado-Cabrero I, Hernández-Toriz N, Paner GP. Clinicopathologic analysis of choriocarcinoma as a pure or predominant component of germ cell tumor of the testis. Am J Surg Pathol. 2014;38(1):111–8.

    PubMed  Google Scholar 

  5. Beck SD, Foster RS, Bihrle R, Ulbright T, Koch MO, Wahle GR, Einhorn LH, Donohue JP. Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in post-chemotherapy nonseminomatous testis cancer. J Urol. 2002;168(4 Pt 1):1402–4.

    PubMed  Google Scholar 

  6. Beyer J, Albers P, Altena R, et al. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol. 2013;24(4):878–88.

    CAS  PubMed  Google Scholar 

  7. Boormans JL, Mayor de Castro J, Marconi L, Yuan Y, Laguna Pes MP, Bokemeyer C, Nicolai N, Algaba F, Oldenburg J, Albers P. Testicular tumour size and rete testis invasion as prognostic factors for the risk of relapse of clinical stage I seminoma testis patients under surveillance: a systematic review by the testicular cancer guidelines panel. Eur Urol. 2018;73(3):394–405.

    PubMed  Google Scholar 

  8. Cost NG, Lubahn JD, Adibi M, et al. Risk stratification of pubertal children and postpubertal adolescents with clinical stage I testicular nonseminomatous germ cell tumors. J Urol. 2014;191:1485–90.

    PubMed  Google Scholar 

  9. Dong P, Liu ZW, Li XD, et al. Risk factors for relapse in patients with clinical stage I testicular nonseminomatous germ cell tumors. Med Oncol. 2013;30:494–501.

    PubMed  Google Scholar 

  10. French BL, Zynger DL. Do histopathologic variables affect the reporting of lymphovascular invasion in testicular germ cell tumors? Am J Clin Pathol. 2016;145(3):341–9.

    CAS  PubMed  Google Scholar 

  11. Fung CY, Kalish LA, Brodsky GL, et al. Stage I nonseminomatous germ cell testicular tumor: prediction of metastatic potential by primary histopathology. J Clin Oncol. 1988;6:1467–73.

    CAS  PubMed  Google Scholar 

  12. Hermans BP, Sweeney CJ, Foster RS, et al. Risk of systemic metastases in retroperitoneal lymph node dissection. J Urol. 2000;163:1721–4.

    CAS  PubMed  Google Scholar 

  13. Groll RJ, Warde P, Jewett MA. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol. 2007;64(3):182–97.

    CAS  PubMed  Google Scholar 

  14. Guo CC, Punar M, Contreras AL, Tu SM, Pisters L, Tamboli P, Czerniak B. Testicular germ cell tumors with sarcomatous components: an analysis of 33 cases. Am J Surg Pathol. 2009;33(8):1173–8.

    PubMed  Google Scholar 

  15. Kollmannsberger C, Tandstad T, Bedard PL, Cohn-Cedermark G, Chung PW, Jewett MA, Powles T, Warde PR, Daneshmand S, Protheroe A, Tyldesley S, Black PC, Chi K, So AI, Moore MJ, Nichols CR. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015;33(1):51–7.

    Google Scholar 

  16. Lorch A, Beyer J. How we treat germ cell cancers. Cancer. 2017;123(12):2190–2.

    PubMed  Google Scholar 

  17. Magers MJ, Kao CS, Cole CD, Rice KR, Foster RS, Einhorn LH, Ulbright TM. “Somatic-type” malignancies arising from testicular germ cell tumors: a clinicopathologic study of 124 cases with emphasis on glandular tumors supporting frequent yolk sac tumor origin. Am J Surg Pathol. 2014;38(10):1396–409.

    PubMed  Google Scholar 

  18. Mosharafa AA, Foster RS, Leibovich BC, Ulbright TM, Bihrle R, Einhorn LH, Donohue JP. Histology in mixed germ cell tumors. Is there a favorite pairing? J Urol. 2004;171(4):1471–3.

    PubMed  Google Scholar 

  19. Moul JW, McCarthy WF, Fernandez EB, et al. Percentage of embryonal carcinoma and of vascular invasion predicts pathological stage in clinical stage I nonseminomatous testicular cancer. Cancer Res. 1994;54:362–4.

    CAS  PubMed  Google Scholar 

  20. Oldenburg J, Fosså SD, Nuver J, Heidenreich A, Schmoll HJ, Bokemeyer C, Horwich A, Beyer J, Kataja V, ESMO Guidelines Working Group. Testicular seminoma and non-seminoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi125–32.

    PubMed  Google Scholar 

  21. Powles T, Warde PR, Daneshmand S, Protheroe A, Tyldesley S, Black PC, Chi K, So AI, Moore MJ, Nichols CR. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015;33(1):51–7.

    PubMed  Google Scholar 

  22. Reilley MJ, Pagliaro LC. Testicular choriocarcinoma: a rare variant that requires a unique treatment approach. Curr Oncol Rep. 2015;17(2):2.

    PubMed  Google Scholar 

  23. Stephenson AJ, Bosl GJ, Bajorin DF, et al. Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion. J Urol. 2005;174:557–60.

    PubMed  Google Scholar 

  24. Vergouwe Y, Steyerberg EW, Eijkemans MJ, et al. Predictors of occult metastasis in clinical stage I nonseminoma: a systematic review. J Clin Oncol. 2003;2:4092–9.

    Google Scholar 

  25. Trevino KE, Esmaeili-Shandiz A, Saeed O, Xu H, Ulbright TM, Idrees MT. Pathological risk factors for higher clinical stage in testicular seminomas. Histopathology. 2018;73(5):741–7.

    PubMed  Google Scholar 

  26. Valdevenito JP, Gallegos I, Fernández C, Acevedo C, Palma R. Correlation between primary tumor pathologic features and presence of clinical metastasis at diagnosis of testicular seminoma. Urology. 2007;70(4):777–80.

    PubMed  Google Scholar 

  27. Yilmaz A, Cheng T, Zhang J, Trpkov K. Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors. Mod Pathol. 2013;26(4):579–86.

    PubMed  Google Scholar 

  28. Berney DM, Warren AY, Verma M, Kudahetti S, Robson JM, Williams MW, Neal DE, Powles T, Shamash J, Oliver RT. Malignant germ cell tumours in the elderly: a histopathological review of 50 cases in men aged 60 years or over. Mod Pathol. 2008;21(1):54–9.

    PubMed  Google Scholar 

  29. Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO classification of tumours of the urinary system and male genital organs-part a: renal, penile, and testicular tumours. Eur Urol. 2016;70(1):93–105.

    PubMed  Google Scholar 

  30. Ulbright TM. Recently described and clinically important entities in testis tumors. Arch Pathol Lab Med. 2019;143(6):711–21.

    PubMed  Google Scholar 

  31. Williamson SR, Delahunt B, Magi-Galluzzi C, Algaba F, Egevad L, Ulbright TM, Tickoo SK, Srigley JR, Epstein JI, Berney DM, Members of the ISUP Testicular Tumour Panel. The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology. 2017;70(3):335–46.

    PubMed  Google Scholar 

  32. Genco IS, Ratzon F, Glickman L, Santagada E, Unger P. Intratubular teratoma: a rare form of testicular germ cell neoplasia. Int J Surg Pathol. 2019;24:1066896919836491. https://doi.org/10.1177/1066896919836491. [Epub ahead of print]. PubMed PMID: 30907201.

    Article  Google Scholar 

  33. Roth LM, Lyu B, Cheng L. Perspectives on testicular sex cord-stromal tumors and those composed of both germ cells and sex cord-stromal derivatives with a comparison to corresponding ovarian neoplasms. Hum Pathol. 2017;65:1–14.

    PubMed  Google Scholar 

  34. Ye H, Ulbright TM. Difficult differential diagnoses in testicular pathology. Arch Pathol Lab Med. 2012;136(4):435–46.

    PubMed  Google Scholar 

  35. Ulbright TM. The most common, clinically significant misdiagnoses in testicular tumor pathology, and how to avoid them. Adv Anat Pathol. 2008;15(1):18–27.

    CAS  PubMed  Google Scholar 

  36. Morinaga S, Ojima M, Sasano N. Human chorionic gonadotropin and alpha-fetoprotein in testicular germ cell tumors. An immunohistochemical study in comparison with tissue concentrations. Cancer. 1983;52(7):1281–9.

    CAS  PubMed  Google Scholar 

  37. Butcher DN, Gregory WM, Gunter PA, Masters JR, Parkinson MC. The biologicaland clinical significance of HCG-containing cells in seminoma. Br J Cancer. 1985;51(4):473–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. von Hochstetter AR, Sigg C, Saremaslani P, Hedinger C. The significance of giant cells in human testicular seminomas. A clinico-pathological study. Virchows Arch A Pathol Anat Histopathol. 1985;407(3):309–22.

    Google Scholar 

  39. Hori K, Uematsu K, Yasoshima H, Sakurai K, Yamada A. Contribution of cell proliferative activity to malignancy potential in testicular seminoma. Pathol Int. 1997;47(5):282–7.

    CAS  PubMed  Google Scholar 

  40. Zuckman MH, Williams G, Levin HS. Mitosis counting in seminoma: an exercise of questionable significance. Hum Pathol. 1988;19(3):329–35.

    CAS  PubMed  Google Scholar 

  41. von Hochstetter AR. Mitotic count in seminomas--an unreliable criterion for distinguishing between classical and anaplastic types. Virchows Arch A Pathol Anat Histol. 1981;390(1):63–9.

    Google Scholar 

  42. Kao CS, Ulbright TM, Young RH, Idrees MT. Testicular embryonal carcinoma: amorphologic study of 180 cases highlighting unusual and unemphasized aspects. Am J Surg Pathol. 2014;38(5):689–97.

    PubMed  Google Scholar 

  43. Rajab R, Berney DM. Ten testicular trapdoors. Histopathology. 2008;53(6):728–39.

    CAS  PubMed  Google Scholar 

  44. Nogales FF, Preda O, Nicolae A. Yolk sac tumours revisited. A review of their many faces and names. Histopathology. 2012;60(7):1023–33.

    PubMed  Google Scholar 

  45. Howitt BE, Magers MJ, Rice KR, Cole CD, Ulbright TM. Many postchemotherapy sarcomatous tumors in patients with testicular germ cell tumors are sarcomatoid yolk sac tumors: a study of 33 cases. Am J Surg Pathol. 2015;39(2):251–9.

    PubMed  Google Scholar 

  46. Ulbright TM. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol. 2005;18(Suppl 2):S61–79.

    PubMed  Google Scholar 

  47. Wegman SJ, Parwani AV, Zynger DL. Cytokeratin 7, inhibin, and p63 in testicular germ cell tumor: superior markers of choriocarcinoma compared to β-human chorionic gonadotropin. Hum Pathol. 2019;84:254–61.

    CAS  PubMed  Google Scholar 

  48. Athanasiou A, Vanel D, El Mesbahi O, Theodore C, Fizazi K. Non-germ cell tumours arising in germ cell tumours (teratoma with malignant transformation) in men: CT and MR findings. Eur J Radiol. 2009;69(2):230–5.

    CAS  PubMed  Google Scholar 

  49. Motzer RJ, Amsterdam A, Prieto V, Sheinfeld J, Murty VV, Mazumdar M, Bosl GJ, Chaganti RS, Reuter VE. Teratoma with malignant transformation: diverse malignant histologies arising in men with germ cell tumors. J Urol. 1998;159(1):133–8.

    CAS  PubMed  Google Scholar 

  50. Rice KR, Magers MJ, Beck SD, Cary KC, Einhorn LH, Ulbright TM, Foster RS. Management of germ cell tumors with somatic type malignancy: pathological features, prognostic factors and survival outcomes. J Urol. 2014;192(5):1403–9.

    PubMed  Google Scholar 

  51. Malagón HD, Valdez AM, Moran CA, Suster S. Germ cell tumors with sarcomatous components: a clinicopathologic and immunohistochemical study of 46 cases. Am J Surg Pathol. 2007;31(9):1356–62.

    PubMed  Google Scholar 

  52. Matoso A, Idrees MT, Rodriguez FJ, Ibrahim J, Perrino CM, Ulbright TM, Epstein JI. Neuroglial differentiation and neoplasms in testicular germ cell tumors lack immunohistochemical evidence of alterations characteristic of their CNS counterparts: a study of 13 cases. Am J Surg Pathol. 2019;43(3):422–31.

    PubMed  Google Scholar 

  53. Ulbright TM, Hattab EM, Zhang S, Ehrlich Y, Foster RS, Einhorn LH, Cheng L. Primitive neuroectodermal tumors in patients with testicular germ cell tumors usually resemble pediatric-type central nervous system embryonal neoplasms and lack chromosome 22 rearrangements. Mod Pathol. 2010;23(7):972–80; Gondim DD, Ulbright TM, Cheng L, Idrees MT. Primary cystic trophoblastic tumor of the testis: a study of 14 cases. Am J Surg Pathol. 2017;41(6):788–94.

    Google Scholar 

  54. Idrees MT, Kao CS, Epstein JI, Ulbright TM. Nonchoriocarcinomatous trophoblastic tumors of the testis: the widening spectrum of trophoblastic neoplasia. Am J Surg Pathol. 2015;39(11):1468–78.

    PubMed  Google Scholar 

  55. Ulbright TM, Henley JD, Cummings OW, Foster RS, Cheng L. Cystic trophoblastic tumor: a nonaggressive lesion in postchemotherapy resections of patients with testicular germ cell tumors. Am J Surg Pathol. 2004;28(9):1212–6.

    PubMed  Google Scholar 

  56. Angulo JC, González J, Rodríguez N, Hernández E, Núñez C, Rodríguez-Barbero JM, Santana A, López JI. Clinicopathological study of regressed testicular tumors (apparent extragonadal germ cell neoplasms). J Urol. 2009;182(5):2303–10.

    PubMed  Google Scholar 

  57. Balzer BL, Ulbright TM. Spontaneous regression of testicular germ cell tumors: an analysis of 42 cases. Am J Surg Pathol. 2006;30(7):858–65.

    PubMed  Google Scholar 

  58. Berney DM, Lu YJ, Shamash J, Idrees M. Postchemotherapy changes in testicular germ cell tumours: biology and morphology. Histopathology. 2017;70(1):26–39.

    PubMed  Google Scholar 

  59. Cao D, Humphrey PA, Allan RW. SALL4 is a novel sensitive and specific marker for metastatic germ cell tumors, with particular utility in detection of metastatic yolk sac tumors. Cancer. 2009;115(12):2640–51.

    CAS  PubMed  Google Scholar 

  60. Cheng L, Zhang S, MacLennan GT, Poulos CK, Sung MT, Beck SD, Foster RS. Interphase fluorescence in situ hybridization analysis of chromosome 12p abnormalities is useful for distinguishing epidermoid cysts of the testis from pure mature teratoma. Clin Cancer Res. 2006;12(19):5668–72.

    CAS  PubMed  Google Scholar 

  61. Kum JB, Ulbright TM, Williamson SR, Wang M, Zhang S, Foster RS, Grignon DJ, Eble JN, Beck SD, Cheng L. Molecular genetic evidence supporting the origin of somatic-type malignancy and teratoma from the same progenitor cell. Am J Surg Pathol. 2012;36(12):1849–56.

    PubMed  Google Scholar 

  62. Amin MB. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.

    Google Scholar 

  63. Aparicio J, Sánchez-Muñoz A, Gumà J, Domenech M, Meana JA, García-Sánchez J, Bastús R, Gironés R, González-Billalabeitia E, Sagastibelza N, Ochenduszko S, Sánchez A, Terrasa J, Germà-Lluch JR, García Del Muro X, on behalf of the Spanish Germ Cell Cancer Group. A risk-adapted approach to patients with stage I seminoma according to the status of rete testis: the fourth Spanish Germ Cell Cancer Group study. Oncology. 2018;95(1):8–12.

    CAS  PubMed  Google Scholar 

  64. Chung P, Daugaard G, Tyldesley S, Atenafu EG, Panzarella T, Kollmannsberger C, Warde P. Evaluation of a prognostic model for risk of relapse in stage I seminoma surveillance. Cancer Med. 2015;4(1):155–60.

    PubMed  Google Scholar 

  65. Sharma P, Dhillon J, Agarwal G, Zargar-Shoshtari K, Sexton WJ. Disparities in interpretation of primary testicular germ cell tumor pathology. Am J Clin Pathol. 2015;144(2):289–94.

    CAS  PubMed  Google Scholar 

  66. Farooq A, Jorda M, Whittington E, Kryvenko ON, Braunhut BL, Pavan N, Procházková K, Zhang L, Rai S, Miller T, Liu J, Szabo A, Iczkowski KA. Rete testis invasion is consistent with pathologic stage T1 in germ cell tumors. Am J Clin Pathol. 2019;151(5):479–85.

    PubMed  Google Scholar 

  67. Harari SE, Sassoon DJ, Priemer DS, Jacob JM, Eble JN, Caliò A, Grignon DJ, Idrees M, Albany C, Masterson TA, Hanna NH, Foster RS, Ulbright TM, Einhorn LH, Cheng L. Testicular cancer: the usage of central review for pathology diagnosis of orchiectomy specimens. Urol Oncol. 2017;35(10):605.e9–605.e16.

    Google Scholar 

  68. Verrill C, Yilmaz A, Srigley JR, Amin MB, Compérat E, Egevad L, Ulbright TM, Tickoo SK, Berney DM, Epstein JI, Members of the International Society of Urological Pathology Testicular Tumor Panel. Reporting and staging of testicular germ cell tumors: the International Society of Urological Pathology (ISUP) testicular cancer consultation conference recommendations. Am J Surg Pathol. 2017;41(6):e22–32.

    PubMed  Google Scholar 

  69. Sanfrancesco JM, Trevino KE, Xu H, Ulbright TM, Idrees MT. The significance of spermatic cord involvement by testicular germ cell tumors: should we be staging discontinuous invasion from involved lymphovascular spaces differently from direct extension? Am J Surg Pathol. 2018;42(3):306–11.

    PubMed  Google Scholar 

  70. McCleskey BC, Epstein JI, Albany C, Hashemi-Sadraei N, Idrees MT, Jorns JM, Lu DY, Matoso A, Rais-Bahrami S, Schwartz LE, Ulbright TM, Gordetsky J. The significance of lymphovascular invasion of the spermatic cord in the absence of cord soft tissue invasion. Arch Pathol Lab Med. 2017;141(6):824–9.

    PubMed  Google Scholar 

  71. Gordetsky J, Sanfrancesco J, Epstein JI, Trevino K, Xu H, Osunkoya A, Xiao GQ, Kao CS, Unger P, Hashemi-Sadraei N, Albany C, Jorns JM, Lu DY, Matoso A, Rais-Bahrami S, Schwartz LE, Ulbright TM, Idrees MT. Do nonseminomatous germ cell tumors of the testis with lymphovascular invasion of the spermatic cord merit staging as pT3? Am J Surg Pathol. 2017;41(10):1397–402.

    PubMed  Google Scholar 

  72. Al-Ahmadie HA, Carver BS, Cronin AM, Olgac S, Tickoo SK, Fine SW, Gopalan A, Stasi J, Rabbani F, Bosl GJ, Sheinfeld J, Reuter VE. Primary retroperitoneal lymph node dissection in low-stage testicular germ cell tumors: a detailed pathologic study with clinical outcome analysis with special emphasis on patients who did not receive adjuvant therapy. Urology. 2013;82(6):1341–6.

    PubMed  Google Scholar 

  73. Tarrant WP, Czerniak BA, Guo CC. Relationship between primary and metastatic testicular germ cell tumors: a clinicopathologic analysis of 100 cases. Hum Pathol. 2013;44(10):2220–6.

    PubMed  Google Scholar 

  74. Giannoulatou E, et al. Whole-genome sequencing of spermatocytic tumors provides insights into the mutational processes operating in the male germline. PLoS One. 2017;12(5):e0178169.

    PubMed  PubMed Central  Google Scholar 

  75. Hu R, Ulbright TM, Young RH. Spermatocytic seminoma: a report of 85 cases emphasizing its morphologic spectrum including some aspects not widely known. Am J Surg Pathol. 2019;43(1):1–11.

    PubMed  Google Scholar 

  76. Stueck AE, et al. Spermatocytic tumor with sarcoma: a rare testicular neoplasm. Int J Surg Pathol. 2017;25(6):559–62.

    PubMed  Google Scholar 

  77. Idrees MT, et al. The World Health Organization 2016 classification of testicular non-germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology. 2017;70(4):513–21.

    PubMed  Google Scholar 

  78. Ulbright TM. Pitfalls in the interpretation of specimens from patients with testicular tumours, with an emphasis on variant morphologies. Pathology. 2018;50(1):88–99.

    PubMed  Google Scholar 

  79. Ulbright TM, et al. Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the International Society of Urological Pathology consensus conference. Am J Surg Pathol. 2014;38(8):e50–9.

    PubMed  Google Scholar 

  80. Kao CS, Ulbright TM, Idrees MT. Gonadoblastoma: an immunohistochemical study and comparison to Sertoli cell nodule with intratubular germ cell neoplasia, with pathogenetic implications. Histopathology. 2014;65(6):861–7.

    PubMed  Google Scholar 

  81. Scully RE. Gonadoblastoma. A review of 74 cases. Cancer. 1970;25(6):1340–56.

    CAS  PubMed  Google Scholar 

  82. Kao CS, et al. “Dissecting gonadoblastoma” of Scully: a morphologic variant that often mimics germinoma. Am J Surg Pathol. 2016;40(10):1417–23.

    PubMed  Google Scholar 

  83. Vallangeon BD, Eble JN, Ulbright TM. Macroscopic sertoli cell nodule: a study of 6 cases that presented as testicular masses. Am J Surg Pathol. 2010;34(12):1874–80.

    PubMed  Google Scholar 

  84. Young RH, Koelliker DD, Scully RE. Sertoli cell tumors of the testis, not otherwise specified: a clinicopathologic analysis of 60 cases. Am J Surg Pathol. 1998;22(6):709–21.

    CAS  PubMed  Google Scholar 

  85. Henley JD, Young RH, Ulbright TM. Malignant Sertoli cell tumors of the testis: a study of 13 examples of a neoplasm frequently misinterpreted as seminoma. Am J Surg Pathol. 2002;26(5):541–50.

    PubMed  Google Scholar 

  86. Madsen EL, Hultberg BM. Metastasizing sertoli cell tumours of the human testis-a report of two cases and a review of the literature. Acta Oncol. 1990;29:946–9.

    Google Scholar 

  87. Kratzer SS, et al. Large cell calcifying Sertoli cell tumor of the testis: contrasting features of six malignant and six benign tumors and a review of the literature. Am J Surg Pathol. 1997;21(11):1271–80.

    CAS  PubMed  Google Scholar 

  88. Proppe KH, Scully RE. Large-cell calcifying Sertoli cell tumor of the testis. Am J Clin Pathol. 1980;74(5):607–19.

    CAS  PubMed  Google Scholar 

  89. Zhang C, Ulbright TM. Nuclear localization of beta-catenin in sertoli cell tumors and other sex cord-stromal tumors of the testis: an immunohistochemical study of 87 cases. Am J Surg Pathol. 2015;39(10):1390–4.

    PubMed  Google Scholar 

  90. Veugelers M, et al. Comparative PRKAR1A genotype-phenotype analyses in humans with Carney complex and prkar1a haploinsufficient mice. Proc Natl Acad Sci U S A. 2004;101(39):14222–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  91. Ulbright TM, Amin MB, Young RH. 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. 2007;31(6):827–35.

    PubMed  Google Scholar 

  92. Young S, et al. Feminizing Sertoli cell tumors in boys with Peutz-Jeghers syndrome. Am J Surg Pathol. 1995;19(1):50–8.

    CAS  PubMed  Google Scholar 

  93. Suardi N, et al. Leydig cell tumour of the testis: presentation, therapy, long-term follow-up and the role of organ-sparing surgery in a single-institution experience. BJU Int. 2009;103(2):197–200.

    PubMed  Google Scholar 

  94. Kim I, Young RH, Scully RE. Leydig cell tumors of the testis. A clinicopathological analysis of 40 cases and review of the literature. Am J Surg Pathol. 1985;9(3):177–92.

    CAS  PubMed  Google Scholar 

  95. Naughton CK, et al. Leydig cell hyperplasia. Br J Urol. 1998;81(2):282–9.

    CAS  PubMed  Google Scholar 

  96. Cheville JC, et al. Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. Am J Surg Pathol. 1998;22(11):1361–7.

    CAS  PubMed  Google Scholar 

  97. McCluggage WG, et al. Cellular proliferation and nuclear ploidy assessments augment established prognostic factors in predicting malignancy in testicular Leydig cell tumours. Histopathology. 1998;33(4):361–8.

    CAS  PubMed  Google Scholar 

  98. Jimenez-Quintero LP, et al. Granulosa cell tumor of the adult testis: a clinicopathologic study of seven cases and a review of the literature. Hum Pathol. 1993;24(10):1120–5.

    CAS  PubMed  Google Scholar 

  99. Hammerich KH, et al. Malignant advanced granulosa cell tumor of the adult testis: case report and review of the literature. Hum Pathol. 2008;39(5):701–9.

    PubMed  Google Scholar 

  100. Lawrence WD, Young RH, Scully RE. Juvenile granulosa cell tumor of the infantile testis. A report of 14 cases. Am J Surg Pathol. 1985;9(2):87–94.

    CAS  PubMed  Google Scholar 

  101. Young RH, Lawrence WD, Scully RE. Juvenile granulosa cell tumor--another neoplasm associated with abnormal chromosomes and ambiguous genitalia. A report of three cases. Am J Surg Pathol. 1985;9(10):737–43.

    CAS  PubMed  Google Scholar 

  102. Zhang M, et al. Testicular fibrothecoma: a morphologic and immunohistochemical study of 16 cases. Am J Surg Pathol. 2013;37(8):1208–14.

    PubMed  Google Scholar 

  103. Jones MA, Young RH, Scully RE. Benign fibromatous tumors of the testis and paratesticular region: a report of 9 cases with a proposed classification of fibromatous tumors and tumor-like lesions. Am J Surg Pathol. 1997;21(3):296–305.

    CAS  PubMed  Google Scholar 

  104. Deveci MS, et al. Testicular (gonadal stromal) fibroma: case report and review of the literature. Pathol Int. 2002;52(4):326–30.

    PubMed  Google Scholar 

  105. Chekol SS, Sun CC. Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis. Arch Pathol Lab Med. 2012;136(1):113–7.

    PubMed  Google Scholar 

  106. Perez-Ordonez B, Srigley JR. Mesothelial lesions of the paratesticular region. Semin Diagn Pathol. 2000;17(4):294–306.

    CAS  PubMed  Google Scholar 

  107. Amin MB. Selected other problematic testicular and paratesticular lesions: rete testis neoplasms and pseudotumors, mesothelial lesions and secondary tumors. Mod Pathol. 2005;18(Suppl 2):S131–45.

    PubMed  Google Scholar 

  108. Di Naro N, et al. Reactive pseudo-glandular mesothelial hyperplasia in testis tunica vaginalis: a case report. Pathologica. 2011;103(5):304–6.

    PubMed  Google Scholar 

  109. Delahunt B, et al. Immunohistochemical evidence for mesothelial origin of paratesticular adenomatoid tumour. Histopathology. 2000;36(2):109–15.

    CAS  PubMed  Google Scholar 

  110. Wachter DL, et al. Adenomatoid tumors of the female and male genital tract. A comparative clinicopathologic and immunohistochemical analysis of 47 cases emphasizing their site-specific morphologic diversity. Virchows Arch. 2011;458(5):593–602.

    PubMed  Google Scholar 

  111. Sangoi AR, et al. Adenomatoid tumors of the female and male genital tracts: a clinicopathological and immunohistochemical study of 44 cases. Mod Pathol. 2009;22(9):1228–35.

    CAS  PubMed  Google Scholar 

  112. Ulbright TM, Young RH. Metastatic carcinoma to the testis: a clinicopathologic analysis of 26 nonincidental cases with emphasis on deceptive features. Am J Surg Pathol. 2008;32(11):1683–93.

    PubMed  Google Scholar 

  113. Tiltman AJ. Metastatic tumours in the testis. Histopathology. 1979;3(1):31–7.

    CAS  PubMed  Google Scholar 

  114. Chauhan RD, et al. The natural progression of adenocarcinoma of the epididymis. J Urol. 2001;166(2):608–10.

    CAS  PubMed  Google Scholar 

  115. Ganem JP, Jhaveri FM, Marroum MC. Primary adenocarcinoma of the epididymis: case report and review of the literature. Urology. 1998;52(5):904–8.

    CAS  PubMed  Google Scholar 

  116. Ulbright TM, Amin MB, Balzer B, Berney DM, Epstein JI, Guo CC, Idrees MT, Looigenga LHJ, Paner G, Rajpert-De Meyts E, Skakkebark NE, Tickoo SK, Yilmaz A, Oosterhuis JW. Germ cell tumors. In: Moch H, Humphrey PA, Ulbright TM, Retuer VE, editors. WHO classification of tumours of the urinary system and male genital organs. 4th ed. Lyon: IARC Press; 2016.

    Google Scholar 

  117. Montgomery E, Fisher C. Paratesticular liposarcoma: a clinicopathologic study. Am J Surg Pathol. 2003;27(1):40–7.

    PubMed  Google Scholar 

  118. Schwartz SL, et al. Liposarcoma of the spermatic cord: report of 6 cases and review of the literature. J Urol. 1995;153(1):154–7.

    CAS  PubMed  Google Scholar 

  119. Srigley JR, Hartwick RW. Tumors and cysts of the paratesticular region. Pathol Annu. 1990;25 Pt 2:51–108.

    CAS  PubMed  Google Scholar 

  120. Weaver J, et al. Fluorescence in situ hybridization for MDM2 gene amplification as a diagnostic tool in lipomatous neoplasms. Mod Pathol. 2008;21(8):943–9.

    CAS  PubMed  Google Scholar 

  121. Bremmer F, et al. Leiomyoma of the tunica albuginea, a case report of a rare tumour of the testis and review of the literature. Diagn Pathol. 2012;7:140.

    PubMed  PubMed Central  Google Scholar 

  122. Fumo MJ, Assi OA, Liroff S. Leiomyoma of the epididymis treated with partial epididymectomy. Nat Clin Pract Urol. 2006;3(9):504–7; quiz 1 p following 507.

    PubMed  Google Scholar 

  123. Fisher C, et al. Leiomyosarcoma of the paratesticular region: a clinicopathologic study. Am J Surg Pathol. 2001;25(9):1143–9.

    CAS  PubMed  Google Scholar 

  124. Raspollini MR, et al. Primitive testicular leiomyosarcoma. Pathol Oncol Res. 2010;16(2):177–9.

    PubMed  Google Scholar 

  125. Varzaneh FE, Verghese M, Shmookler BM. Paratesticular leiomyosarcoma in an elderly man. Urology. 2002;60(6):1112.

    PubMed  Google Scholar 

  126. Jo VY, et al. Paratesticular rhabdomyoma: a morphologically distinct sclerosing variant. Am J Surg Pathol. 2013;37(11):1737–42.

    PubMed  Google Scholar 

  127. Cooper CL, et al. Paratesticular rhabdomyoma. Pathology. 2007;39(3):367–9.

    PubMed  Google Scholar 

  128. Keskin S, et al. Clinicopathological characteristics and treatment outcomes of adult patients with paratesticular rhabdomyosarcoma (PRMS): a 10-year single-centre experience. Can Urol Assoc J. 2012;6(1):42–5.

    PubMed  PubMed Central  Google Scholar 

  129. Reeves HM, MacLennan GT. Paratesticular rhabdomyosarcoma. J Urol. 2009;182(4):1578–9.

    PubMed  Google Scholar 

  130. Ulbright TM, Young RH. Testicular and paratesticular tumors and tumor-like lesions in the first 2 decades. Semin Diagn Pathol. 2014;31(5):323–81.

    PubMed  Google Scholar 

  131. Young RH, Scully RE. Testicular and paratesticular tumors and tumor-like lesions of ovarian common epithelial and mullerian types. A report of four cases and review of the literature. Am J Clin Pathol. 1986;86(2):146–52.

    CAS  PubMed  Google Scholar 

  132. McClure RF, et al. Serous borderline tumor of the paratestis: a report of seven cases. Am J Surg Pathol. 2001;25(3):373–8.

    CAS  PubMed  Google Scholar 

  133. Ulbright TM, Young RH. Primary mucinous tumors of the testis and paratestis: a report of nine cases. Am J Surg Pathol. 2003;27(9):1221–8.

    PubMed  Google Scholar 

  134. Tulunay O, et al. Clear cell adenocarcinoma of the tunica vaginalis of the testis with an adjacent uterus-like tissue. Pathol Int. 2004;54(8):641–7.

    PubMed  Google Scholar 

  135. Du S, et al. Myoid gonadal stromal tumor: a distinct testicular tumor with peritubular myoid cell differentiation. Hum Pathol. 2012;43(1):144–9.

    CAS  PubMed  Google Scholar 

  136. Kao CS, Ulbright TM. Myoid gonadal stromal tumor: a clinicopathologic study of three cases of a distinctive testicular tumor. Am J Clin Pathol. 2014;142(5):675–82.

    PubMed  Google Scholar 

  137. Nistal M, et al. Fusocellular gonadal stromal tumour of the testis with epithelial and myoid differentiation. Histopathology. 1996;29(3):259–64.

    CAS  PubMed  Google Scholar 

  138. Weidner N. Myoid gonadal stromal tumor with epithelial differentiation (? testicular myoepithelioma). Ultrastruct Pathol. 1991;15(4–5):409–16.

    CAS  PubMed  Google Scholar 

  139. Ferry JA, et al. Malignant lymphoma of the testis, epididymis, and spermatic cord. A clinicopathologic study of 69 cases with immunophenotypic analysis. Am J Surg Pathol. 1994;18(4):376–90.

    CAS  PubMed  Google Scholar 

  140. Wilkins BS, Williamson JM, O’Brien CJ. Morphological and immunohistological study of testicular lymphomas. Histopathology. 1989;15(2):147–56.

    CAS  PubMed  Google Scholar 

  141. Cheah CY, Wirth A, Seymour JF. Primary testicular lymphoma. Blood. 2014;123(4):486–93.

    CAS  PubMed  Google Scholar 

  142. Raspollini MR. Histologic variants of seminoma mimicking lymphatic malignancies of the testis: a literature review with a report of case series focusing on problems in differential diagnosis. Appl Immunohistochem Mol Morphol. 2014;22(5):348–57.

    PubMed  Google Scholar 

  143. Al-Abbadi MA, et al. Primary testicular and paratesticular lymphoma: a retrospective clinicopathologic study of 34 cases with emphasis on differential diagnosis. Arch Pathol Lab Med. 2007;131(7):1040–6.

    PubMed  Google Scholar 

  144. Al-Abbadi MA, et al. Primary testicular diffuse large B-cell lymphoma belongs to the nongerminal center B-cell-like subgroup: a study of 18 cases. Mod Pathol. 2006;19(12):1521–7.

    CAS  PubMed  Google Scholar 

  145. Jones MA, Young RH, Scully RE. Malignant mesothelioma of the tunica vaginalis. A clinicopathologic analysis of 11 cases with review of the literature. Am J Surg Pathol. 1995;19(7):815–25.

    CAS  PubMed  Google Scholar 

  146. Ballotta MR, Borghi L, Barucchello G. Adenocarcinoma of the rete testis. Report of two cases. Adv Clin Pathol. 2000;4(4):169–73.

    CAS  Google Scholar 

  147. Nistal M, et al. Adenomatous hyperplasia of the rete testis. A review and report of new cases. Histol Histopathol. 2003;18(3):741–52.

    CAS  PubMed  Google Scholar 

  148. Schwartz IS. Rete testis adenocarcinoma. Am J Surg Pathol. 1988;12(12):967.

    CAS  PubMed  Google Scholar 

  149. Shinmura Y, Yokoi T, Tsutsui Y. A case of clear cell adenocarcinoma of the mullerian duct in persistent mullerian duct syndrome: the first reported case. Am J Surg Pathol. 2002;26(9):1231–4.

    PubMed  Google Scholar 

  150. Thomas AZ, et al. Primary clear cell carcinoma of the rete testis: 1st report. BMJ Case Rep. 2015;2015:bcr2014209000.

    PubMed  PubMed Central  Google Scholar 

  151. Buck DA, et al. Testicular metastasis in a case of squamous cell carcinoma of the lung. Case Rep Oncol. 2015;8(1):133–7.

    PubMed  PubMed Central  Google Scholar 

  152. Ro JY, et al. Lung carcinoma with metastasis to testicular seminoma. Cancer. 1990;66(2):347–53.

    CAS  PubMed  Google Scholar 

  153. Uchida K, et al. Testicular metastasis from squamous cell carcinoma of the lung. Int J Urol. 2003;10(6):350–2.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA

    Debra L. Zynger

  2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Charles C. Guo

Authors
  1. Debra L. Zynger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles C. Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Debra L. Zynger .

Editor information

Editors and Affiliations

  1. Department of Pathology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ximing J. Yang

  2. Department of Pathology and Laboratory Medicine, Tufts Medical Center, Tufts School of Medicine, Boston, MA, USA

    Ming Zhou

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Zynger, D.L., Guo, C.C. (2021). Testis and Paratesticular Lesions. In: Yang, X.J., Zhou, M. (eds) Practical Genitourinary Pathology. Practical Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-57141-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-57141-2_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57140-5

  • Online ISBN: 978-3-030-57141-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation