Search

Liposarcomas of the spermatic cord are unusual and rarely reported in the literature. These tumours can sometimes be mistaken for the common scrotal swellings such as hydrocoeles and hernias. Careful clinical and radiological examination will help in appropriate preoperative planning and surgery by an experienced surgical team. We report our experience of two cases of such scrotal swellings.

Angiomyofibroblastoma-like tumor is a rare mesenchymal tumor involving the male genital tract. We report a case of an angiomyofibroblastoma-like tumor that arose in the subcutaneous tissue of the left inguinal region in a 50-year-old man. Ultrasonography of the region demonstrated a well-circumscribed subcutaneous mass. Intralesional fat was revealed on magnetic resonance images. Although these imaging features are nonspecific, radiological findings enable considering the diagnosis of angiomyofibroblastoma-like tumor.

Malacoplakia is a granulomatous disease with a histiocytic infiltrate containing calcified structures called Michaelis-Gutmann bodies. These structures are considered to represent an abnormal response to infection involving defective lysosomes and abnormal microbubular assembly. The disease most frequently involves urinary and genital tracts, but has also been described from most other organs. Here we present the first case of malacoplakia only involving the vas deferens.

The histological characteristics of 9 cases of granular cell tumors (GCTs) observed in B6C3F1 mice were examined to determine their cellular origin. Seven of the 9 cases were found in the uterus and other 2 cases were in the subcutaneous tissue. Tumor cells had abundant granules in the cytoplasm which were stained with PAS and were resistant to diastase treatment. Ultrastructurally, the granules were identified as lysosomes. The cell surface had cytoplasmic processus showing interdigitation with adjacent cells. A character feature of the tumor cells was the presence of a desmosome-like structure on their cell surface but no basal lamina was demonstrated. Although GCTs have been considered to be derived from Schwann cells on the basis of their ultrastructural features and S-100 protein-immunopositive findings, the absence of basal lamina in the present cases may raise a controversy as to their origin.

Aims: Adnexal tumours of probable Wolffian origin are rare low-grade malignant neoplasms that have been previously described in the broad ligament, ovaries and retroperitoneum of females. All are characterized by small, bland epithelial cells growing in a diffuse, trabecular, or tubular pattern. The majority of the cases reported have pursued a benign clinical course. However, recurrences and distant metastases have been described. We present a case of a male adnexal tumour of probable Wolffian origin occurring in the left seminal vesicle of a 29-year-old man with 23 years of follow-up., Results: The diagnosis is supported by immunohistochemical and electron microscopic findings: The tumour cells were immunoreactive for cytokeratin and vimentin while smooth muscle antigen and S100 protein were uniformly negative. By electron microscopy cells were arranged in an acinar pattern and surrounded flocculent, electron-dense material. Individual cells contained numerous dense bodies and free ribrosomes. The patient had recurrences at 14 and 23 years after initial diagnosis., Conclusion: This is the first report of this entity in a male. The literature on this unusual tumour is reviewed and the clinicopathological, immunohistochemical and ultrastructural features are described. The differential diagnosis of this seemingly indolent tumour is discussed with genitourinary tumours having a more aggressive clinical course.

A rare seminal vesicle adenocarcinoma was found in a 109-wk-old Fischer 344 (F344) rat. At necropsy, the right seminal vesicle was enlarged, containing a 15- x 18- x 18-mm mass. The neoplasm occupied almost the entire seminal vesicle lumen and consisted of epithelial cells arranged in papillary, glandular, and solid patterns. Tumor cells were larger than their normal counterparts in the seminal vesicles and had round nuclei and abundant cytoplasm. Clusters of macrophagelike cells with less abundant cytoplasm and indented nuclei were apparent in the lumina of the glandular structures formed by the tumor cells. No metastasis to other tissues or organs was observed. Immunohistochemically, tumor cells were positive for keratin and S-100, and the macrophagelike cells bound antibodies against vimentin and ED-1. Ultrastructurally, the tumor cells exhibited many small secretory granules, some microvilli, and intercellular junctions. The macrophagelike cells, in contrast, were characterized by lysosomes and abundant rough endoplasmic reticulum. Therefore, a diagnosis of seminal vesicle adenocarcinoma with intraluminal macrophage infiltration was made. This is the first case report of such a seminal vesicle tumor in an F344 rat.

A müllerian adenosarcomalike tumor of the seminal vesicle is described in a 49-year-old man. The tumor occupied the entire right seminal vesicle and adhered to the right lobe of the prostate, in the area adjacent to the seminal vesicle. The tumor was also adherent to the rectum. Microscopically, the cells were seen to invade the prostatic tissue. The tumor consisted of a highly cellular stroma with spindle-shaped pleomorphic cells, suggesting the diagnosis of a low-grade sarcoma. In addition, dilated cystic spaces lined by columnar epithelium were seen. Immunohistochemically, most tumor cells showed positivity for vimentin, desmin, and muscle-specific actin, suggesting smooth-muscle cell differentiation. Furthermore, electron microscopy also demonstrated smooth-muscle differentiation of the tumor cells. The patient has been disease-free for 48 months since undergoing a cystoprostatetectomy.

Elastin distribution was examined in adenomatoid tumors of the human genital tract. Two distinct patterns were identified: strongly positive or completely negative for elastin in the stroma, according to the case. Even in cases appearing to have very similar histologic features, the stroma was rich in elastin in some cases and was almost devoid of elastin in others. Electron microscopic examination with tannic acid staining revealed that the elastin in the stroma was composed mainly of amorphous material surrounded by a small amount of microfibrils and abundant collagen fibers. Fibroblasts were sparsely distributed in the stroma. Tumor cells displayed mesothelial cell-like features, such as abundant microvilli on the surface, numerous cytoplasmic organelles, several well-developed basal lamina. In some areas, elastin seemed to be formed by mesothelial cells. In some adenomatoid tumor cases, elastogenesis would be enhanced by activated mesothelial tumor cells as well as stromal fibroblasts.

A case is reported of an adenomatoid tumor of the epididymis. A discussion of the appropriate differential of mass of the epididymis as well as a review of adenomatoid tumors per se and their occurrence in the scrotum are presented.

We describe a case of paraganglioma arising in the spermatic cord, which is an extremely rare location. Immunohistochemical studies characterized two types of cells: (1) polygonal cells expressing neuron-specific enolase, chromogranin A, and synaptophysin and (2) S100 protein-positive sustentacular cells. Electron microscopy revealed that within the cytoplasm of the polygonal cells, there were electron-dense granules whose morphological appearance was consistent with that of neurosecretory granules. Paraganglioma of the spermatic cord may originate from embryonic chromaffin cells that have followed the testis into the scrotum.

The first case of carcinosarcoma in the spermatic cord is reported in a 40-year-old man. The tumor was a 2.5 X 2 cm pseudoencapsulated formation located in the connective tissue of the spermatic cord among the blood vessels. Light microscopy examination of the neoplasm revealed two different histological patterns: epithelial and sarcomatous. Mitoses and atypias were infrequent in both types of areas. The epithelial cells formed papillary and gland-like structures stained with PAS, Hale and mucicarmine stains, and showed positive reaction for immunohistochemical demonstration of both keratin and epithelial membrane antigen. The lumen content of the gland-like structures reacted positively for the carcinoembryonic antigen. Electron microscopy revealed that the epithelial cells were joined by junctional complexes and displayed numerous short microvilli. The sarcomatous areas consisted of spindle cells embedded in a ground substance that occasionally presented myxoid changes. Mast cells and focal calcifications were seen. Sarcomatous cells showed positive reaction for vimentin but not for the other histochemical and immunohistochemical techniques mentioned above. The ultrastructure of sarcomatous cells was similar to that of epithelial cells except for the occurrence of small desmosomes instead of junctional complexes. The differential diagnosis with adenomatoid tumor and malignant mixed mesothelioma is discussed.

Characteristic intracytoplasmic lamellar bodies were found in a malignant gonadal stromal tumor. These bodies consisted of the stacks of up to 200 tubular cisternae arranged in parallel. Each cisterna had a circular section in tangential view and a diameter of about 85 nm. The cisternae on the outermost side of these lamellar bodies tended to be dilated and adorned with ribosomes. The ends of cisternae were often contiguous with rough-surfaced endoplasmic reticulum. The latter feature is also seen in annulate lamellae, but periodically spaced annuli or discontinuities characteristic of annulate lamellae were never observed. Furthermore, fine ribosomal granules resembling a rosary were recognizable along the whole circumference of the outer surface of each cisterna. The unique structure we describe is a cytoplasmic organelle which, like annulate lamellae, is closely associated with the endoplasmic reticulum and is presumed to be related to the genesis of rough-surfaced endoplasmic reticulum in tumor cells.

Over the past year, we have attempted to grow both primary and metastatic urologic malignancies using a recently developed human tumor cloning system. Formation of colonies in vitro occurred in 125 of 164 primary tumors (76%), including 34 of 47 uroepithelial cancer specimens, 45 of 50 renal cell cancer specimens, 24 of 33 prostatic cancer specimens, and 22 of 34 testicular cancer specimens. A large percentage of metastatic cancers have also been successfully cultured. Growth sufficient for chemosensitivity testing ranged from 43% of the uroepithelial cancers cultured to 64% of the renal cell cancer specimens cultured. When in vitro chemosensitivity testing was performed, the in vitro chemosensitivity results show a striking similarity to clinical response rates for the same agents used for these tumors. Overall the human tumor cloning system appears to be a reasonable model for the study of human urologic malignancies.

As illustrated in this review, neoplasms of the male genital tract are markedly heterogenous, reflecting their complex embryologic derivation and histogenetic classification. Transmission electron microscopy has greatly increased our understanding of the structure of these tumors, and in doing so has greatly improved our light microscopy. Additionally, in a number of selected situations, TEM also provides important practical diagnostic information. Currently, light microscopy in conjunction with clinical information is the central tool of tumor taxonomy. However, TEM with histochemistry, immunohistology, analytic cytometry, and molecular biology provide practical and useful information in some situations. In all cases, the application of these techniques has greatly increased our overall understanding of tumor structure, pathobiology, and classification.

A case of recurrent dedifferentiated liposarcoma simulating malignant fibrous histiocytoma, with complete absence of lipoblastic differentiation, is described. The tumour cells showed strongly positive immunostaining for alpha-1-antichymotrypsin. Electron microscopy revealed a mixture of fibroblasts and histiocytes. Our findings suggest that the dedifferentiated component reflects an altered differentiation pathway of the primitive mesenchymal cells in the original liposarcoma.

A case of leiomyosarcoma of the scrotum in a 65 year old man is presented. It is, we believe, the sixth case reported in the literature. A hemiscrotectomy was performed with preservation of both testes. Three years after the operation the patient is well and free of metastases. The electron microscopy study is reported and the features are discussed.

A 225-day-old male fourth generation rat from a developing recombinant inbred line (Lewis x Brown Norway) had a bilaterally symmetrical enlargement of the scrotum. Palpation indicated the presence of a firm lobulated mass extending from the tip of the scrotum to the abdominal wall. Bilateral nodular masses totally occupied the scrotal sacs, surrounded the testicles, and extended along the spermatic cords into the abdominal cavity. Tumor nodules also were present in the intestinal mesentery, omentum, mesenteric lymph nodes, pancreas, and lung. Histologically, the neoplasm presented a spectrum of characteristics varying from that of a granuloma with giant cells to a diffuse proliferation of spindle-shaped mononuclear cells.

Results on the light- and electron microscopic studies of six cases of Buschke-Loewenstein tumour are presented. The role of chronic irritation is emphasized in the aetiology of the tumour. Fistulas and abscesses arising in the tumour are dangerous as they give rise to chronic sepsis. In two perianal tumours, in situ or invasive carcinoma developed. Electron microscopy revealed varying degrees of differentiation of keratinocytes. As a result of the defective desmosomes, the tumour cell underwent segregation, with widened intercellular spaces containing oedema, erythrocytes and leucocytes. This phenomenon is probably responsible for frequent bleeding and fistula formation. The investigations disclosed that the Buschke-Loewenstein tumour is a special form of squamous carcinoma and therefore, radical surgical excision must be attempted even in case of a benign histological picture.

Fibrous mesotheliomas of the scrotal sac are described. Similar tumors have been previously reported as fibromas and pseudofibromas and have been considered to be non-neoplastic, reactive, fibrous lesions. Ultrastructural evidence for a mesothelial origin for these tumors is presented. The value of ultrastructural study in the classification of tumors arising in or on mesothelial lined surfaces is stressed.

Sarcomas of paratesticular origin are rare tumors. They usually manifest themselves as a scrotal mass that should be differentiated from testicular tumors. There are problems regarding their pathologic diagnosis and treatment. We report a case of spindle cell sarcoma of the gubernaculum testis in a young patient. Electron microscopy was used in the histogenetic typing of this tumor.

We present 3 cases of malignant fibrous histiocytoma arising from the spermatic cord. This tumor occurs rarely in genitourinary organs and only 2 cases involving the spermatic cord have been reported previously. Recurrence rates of approximately 44 per cent of malignant fibrous histiocytoma in other sites are not improved by radiation or chemotherapy as adjuvants or primary means of treatment. Radical inguinal orchiectomy along with wide en bloc local resection is the therapy of choice.

Paratesticular mesotheliomas are uncommon tumors. We report 2 such cases and discuss their clinical and pathological findings.

A case of leiomyosarcoma of the scrotum is presented. The tumor measured 3 X 2.5 X 2 cm and had been present as a slowly enlarging mass in the right scrotum for three months prior to excision. Light microscopy demonstrated the typical interlacing fasicles of neoplastic cells with eccentric cigar-shaped nuclei and electron microscopy confirmed the neoplastic cells to be of smooth muscle origin. A review of the world's literature revealed this to be the fifth reported case of leimyosarcoma confined to the scrotal wall.

The fine structures of three fibrous hamartomas of infancy were studied. All three components of these lesions were examined. The principal cells in the fibrous and myxoid areas were fibroblasts. Cells with stellate cytoplasmic projections were more prominent in myxoid areas. Myofibroblasts were abundant in two cases and not in the other. The adipose tissue component was formed by lipocytes and occasional preadipose fibroblasts. Blood vessels were more numerous in myxoid areas. Larger vessels were accompanied by smaller vessels and by clusters of cells with primitive junctions, suggesting early blood vessel formation. Some small vessels were surrounded by concentric layers of mesenchymal cells, as if attempting to form media. Electron microscopy seems to confirm the hamartomatous nature of fibrous hamartomas of infancy. The lesion appears to recapitulate the formation of blood vessels and fat, as seen in fetal tissues. Cellular myxoid areas showed prominent vasoformative proliferation, which decreased in the adipose tissue and was least prominent in the dense fibrous component. The latter may represent the end stage of the fibrous proliferation.

Several articles have been published recently that discuss the role of electron microscopy in the diagnosis and study of gynecologic neoplasms. It becomes apparent from those works and the review just presented that, although an ultrastructural study is not necessary for reaching a diagnosis of many of these tumors, it may be necessary or supportive in identifying the more poorly differentiated ones. Furthermore, electron microscopy is valuable in providing evidence for the histogenesis of some of these neoplasms. Unfortunately for the pathologist, a certain level of morphologic differentiation (and an absence of metaplasia) in a cell is usually necessary for these goals to be achieved. For example, an adenomatoid tumor (see the article by Dr. Srigley, Mr. Toth, and Mr. Edwards in this issue) of the fallopian tube can readily be accepted as being composed of mesothelial cells, because both the neoplastic cells and normal mesothelial cells have the same highly differentiated features of long, slender microvilli, prominent intercellular junctions, and many microfilaments. On the other hand, there is very little resemblance between the granulosa cells of a granulosa-cell tumor and mature mesothelial cells. Thus, if one of the theories of histogenesis of granulosa cells were correct--namely, that they are derived ultimately from mesothelial lining--the ultrastructural evidence would rest on recognizing a similarity between the two types of cells at an earlier stage of differentiation. The neoplastic granulosa cell has differentiated along a separate, specialized line in which the ultrastructural resemblance to the parent cell is partly, if not completely, lost. Another example of the type of information that electron microscopy can provide is in relation to the common epithelial tumors. There is good evidence that the serous tumors in this group arise from mesothelium, although ultrastructurally their differentiation has veered from a mesothelial direction to one in which the cells have a complement of organelles related to secretory activity. Paradoxically, the mucinous cystic tumors, which have been classified traditionally as tumors of surface epithelial origin, are now thought to be of germ-cell origin in some cases, as examples of monophyletic teratomas. The ultrastructural evidence for this conclusion rests on the presence of anchoring filaments in the microvilli of the neoplastic cells, similar to those of normal intestinal epithelium, and on an admixture of various types of gastrointestinal cells, including those that contain dense-core granules (argentaffin cells).(ABSTRACT TRUNCATED AT 400 WORDS)

Two cases of adenomatoid tumour of the epididymis are described. Both the histochemical and ultrastructural studied support the concept that it is of mesothelial origin. The histochemical study showed the presence of acid mucopolysaccharides in the lumen of the tubular structures. The epithelial cells presented numerous microvilli in the free surface, junction complexes, wide intercellular channels and a well-developed Golgi complex. Abundant bundles of microfilaments and intracellular spaces were observed in the cytoplasm. Lymphocytes and histiocytes were identified both in the tubular lumen and between the epithelial cells. The stroma of the tumour was made up of dense connective tissue with abundant bundles of elastic fibres. The presence of intracytoplasmic spaces in the epithelial cells and elastic fibres in the stroma had not been previously observed in this tumour.

An 84-yr-old man developed a small-finger-tip sized tumor in the left inguinal area about five to six years prior to consultation with the Urology Department. Later, the tumor extended to the scrotum and the suprapubic area. Histological examination of an en block specimen showed the tumor to be a malignant fibrous histiocytoma of spermatic cord origin. Fourteen cases in the worldwide literature are reviewed, and characteristics of malignant fibrous histiocytoma at this particular site are discussed.

We report a case of giant scrotal hemangioma with azoospermia, which was 37 cm in maximum circumference and 20 cm in length along the raphe. The biopsy specimens of the testes were examined histologically and cytologically. The testicular damage was believed to be due to the heat generated by hemangioma.

Rhabdomyosarcoma is the most frequent spermatic cord tumor of infants, children, and young adults, but also occurs as a primary tumor in the testis, epididumis, and testicular tunics. In the last fifteen years, 7 patients with intrascrotal rhabdomyosarcoma were treated at our institution, and an additional 155 cases were found on review of the English literature. On the basis of these 162 cases, incidence and survival statistics were calculated with particular attention to employed forms of therapy. An over-all survival of greater than 73 per cent should be obtainable with proper utilization of surgery, radiation therapy, and combination chemotherapy.

The histogenesis of adenomatoid tumour has continued to provoke debate since Golden and Ash suggested the term in 1945 for a characteristic benign neoplasm typically found in the uterus, fallopian tube or epididymis. Endothelial, epithelial, mesonephric, müllerian and mesothelial histogenesis have been suggested. The balance of evidence suggests mesothelial derivation, but two recent studies point to endothelial origin for at least some of these tumours. Twenty-two histologically typical adenomatoid tumours were studied by electron microscopy, mucin histochemistry and immunohistochemistry. Ultrastructurally, all cases showed vacuolated cells bearing long bushy microvilli and the features were not those of endothelial cells. Glandular spaces contained acid mucopolysaccharide consistent with hyaluronic acid. Immunohistochemical double labelling techniques showed the cells lining such spaces to contain cytokeratin in the absence of factor VIII related antigen and receptors for Ulex europaeus I lectin which were expressed in the endothelium of tumour blood vessels. The evidence points to mesothelial histogenesis in all cases examined.

A cystic tumor composed of atypical glands in a cellular stroma arose in the pelvis of a 49-year-old man. Two years later an identical tumor was again excised from the pelvis. Morphologic, immunohistochemical and ultrastructural studies indicate that this neoplasm arose in the seminal vesicle, possibly from a seminal vesicle cyst. The tumor did not involve the prostate gland, and immunohistochemical stains for prostate-specific antigen and prostatic acid phosphatase were negative. Ultrastructural study showed that both the glandular and mesenchymal components of the tumor recapitulated features of normal seminal vesicle, further establishing origin from this site. This tumor resembles the rare cystadenoma of the seminal vesicle, yet the cytologic atypia suggests low grade malignant potential. Following the second excision, the patient has had a disease-free interval of 18 months. Long term follow-up and recognition of additional cases is necessary to define the biologic potential of this unusual tumor.