Cases reported "Carcinoma in Situ"

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1/13. Gonadal histology with testicular carcinoma in situ in a 15-year-old 46,XY female patient with a premature termination in the steroidogenic acute regulatory protein causing congenital lipoid adrenal hyperplasia.

    Mutations in the steroidogenic acute regulatory protein (StAR) gene cause congenital lipoid adrenal hyperplasia, characterized by diminished or absence of adrenal and gonadal steroids, resulting in severe adrenal insufficiency and ambiguous or complete female external genitalia in genetic males. We report on a 15-yr-old 46,XY phenotypic female, referred because of lack of pubertal development. ACTH and gonadotropin concentrations were elevated; and aldosterone, cortisol and its precursors, and sex steroids before and after stimulation were below the lower limit of detection. In the StAR gene, a homozygous nonsense mutation (TGG --> TAG) in exon 7 (W250X) was identified. Histologic examination after gonadectomy showed seminiferous tubules containing immature sertoli cells and a few single germ cells with positive placental-like alkaline phosphatase immunoreactivity, indicating carcinoma in situ. This is the first report on testicular morphology, at a pubertal age, in a female patient with 46,XY karyotype and a mutation in the StAR gene, in whom gonadal neoplasia had developed.
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keywords = seminiferous tubule, tubule
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2/13. Multinucleated spermatogonia in cryptorchid boys: a possible association with an increased risk of testicular malignancy later in life?

    At birth, undescended testes contain germ cells, but after 1 year of life, a reduced number of germ cells is generally found. Microlithiasis and carcinoma-in-situ-testis occur in cryptorchid boys. Multinucleated germ cells, including at least 3 nuclei in the cell, exist in impaired spermatogenesis and in the senescent testis. AIM OF THE STUDY: We investigated whether multinucleated spermatogonia were present in undescended testes of cryptorchid boys, and if such a pattern is associated with special clinical features. RESULTS: Multinucleated spermatogonia occurred in 13/168 (8%) of 163 consecutive cryptorchid boys, who underwent surgery for cryptorchidism with simultaneous testicular biopsy showing seminiferous tubules. The patients with multinucleated spermatogonia more often exhibited a normal germ cell number (Fisher's exact test, p<0.0005), and were younger at surgery (Mann Whitney, p<0.005) than the rest of the patients. Before surgery, 3 patients underwent treatment with erythropoietin because of renal failure. An intra-abdominal testis underwent clipping and division of the spermatic vessels, and a biopsy at final surgery 7 months later, exhibited multinucleated spermatogonia. In 1 case the undescended testicular position, a fixed retraction, was acquired after surgery for an inguinal hernia. Multinucleated spermatogonia were found in cases of carcinoma-in situ-testis in 2 cryptorchid boys. No case of multinucleated germ cells appeared in our normal material. CONCLUSION: Multinucleated spermatogonia are a further abnormality present in cryptorchidism. The cryptorchid boys with multinucleated spermatogonia in general exhibited rather many germ cells. This feature may be associated with an increased risk of testicular malignancy later in life, and we propose a careful follow up regime in these cases including ultrasound examination and a testicular biopsy in cases of symptoms or clinical findings.
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keywords = seminiferous tubule, tubule
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3/13. Testicular microlithiasis--one case and four points to note.

    A 38-year-old man with non-specific scrotal complaints was found to have bilateral testicular microlithiasis (TM) sonographically. MRI of the testes failed to depict microlithiasis. Bilateral double biopsies of the testes revealed testicular intraepithelial neoplasia (TIN; carcinoma in situ of the testis) in only one of the two biopsies from the right testis. At the request of the patient the biopsies were repeated, with the same histological result. A right-sided orchiectomy was performed. histology disclosed TIN in only some tubules of the lower pole of the testis. This case highlights four interesting points: (i) TM may be associated with testicular malignancy; (ii) MRI does not depict TM; (iii) TIN is arranged focally within the testis; and (iv) a two-site biopsy may increase the sensitivity of the diagnosis of TIN.
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ranking = 0.0052655354069966
keywords = tubule
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4/13. Squamous cell carcinoma in situ involving mesonephric remnants of the uterine cervix.

    Squamous cell carcinoma in situ (CIS) involving mesonephric remnants of the uterine cervix is a very rare lesion, the existence of which is still controversial. A second case of this lesion is reported. It was found in a cone biopsy specimen from an 40-year-old patient. Besides, in surface epithelium and within cervical glands, a structure of CIS was seen in conjunction with mesonephric tubules in deeper cervical stroma. The mesonephric nature of these tubules and of tubule-appearing epithelium within islands of CIS was supported by immunohistochemical positivity for CD10 and vimentin. The lesion strongly simulated invasive carcinomas, such as adenosquamous carcinoma and adenoid basal carcinoma (epithelioma) of the cervix.
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ranking = 0.01579660622099
keywords = tubule
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5/13. Collecting duct carcinoma of the kidney: a case report and review of the literature.

    Collecting duct carcinoma of the kidney is unique and rarely reported. The histological and ultrastructural characteristics of this tumor are well described in the pathological literature. However, there are few reports documenting the clinical presentation and long-term prognosis in patients with this unusual malignancy. Collecting duct carcinoma arises from the epithelium of the collecting tubules within the medulla and secondarily invades the renal cortex. The tumor occurs in a younger age group than is typical for renal cell carcinoma and most patients appear to have metastatic disease at presentation. We describe a case of this uncommon tumor and review the literature.
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ranking = 0.0052655354069966
keywords = tubule
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6/13. Incipient germ cell tumor in Sertoli-cell-only syndrome testis, accompanied with retroperitoneal teratocarcinoma and widespread metastases.

    Incipient germ cell tumor in Sertoli-cell-only syndrome testis was examined in an autopsy case of retroperitoneal teratocarcinoma with widespread metastases. Although both testes of a 28-year-old man had clinically been small and free from tumor mass to palpation, histopathological examinations revealed a malignancy in the right testis with the appearance of Sertoli-cell-only syndrome. The left testis showed solely the histology of Sertoli-cell-only syndrome. The testicular malignancy consisted of undifferentiated, atypical germ cells mainly confined within approximately one-tenth of seminiferous tubules, and only one small cartilage nodule. Some tubules showed intratubular growth pattern suggestive of seminoma. A few syncytiotrophoblast-like giant cells occurred in the tubules. These findings seem to furnish substantial evidence to the concept that atypical germ cells are the origin of testicular germ cell tumors of different types.
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ranking = 1.010531070814
keywords = seminiferous tubule, tubule
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7/13. Bilateral carcinoma in situ of testis in infertile man.

    Abnormal seminiferous epithelium with atypical germ cells was studied in 2 previous cases. Embryonal carcinoma occurred within four and one-half years of testicular biopsy. Herein is reported another case of bilateral carcinoma in situ of the testis, presenting abnormal germinal morphology and infertility. The abnormal cells differed considerably from normal spermatogonia, presenting an increased diameter and dense chromatin masses. Apparently normal tubules were also present with normal spermatogenesis. serum gonadotropins and chromosome study were normal. After bilateral biopsy patient was submitted to a right orchiectomy and left varicocelectomy.
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ranking = 0.0052655354069966
keywords = tubule
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8/13. Incipient germ cell tumor in a cryptorchid testis.

    A 13-year-old male who had bilateral cryptorchid testes since birth underwent testicular biopsies and subsequent left orchiectomy following a diagnosis of malignant germ cell tumor. No tumor mass was noted although the malignant cells were seen within the seminiferous tubules and the interstitium. Five recorded cases of in-situ or incipient germ cell neoplasms of the testes are reviewed; three were infertile, another had a cryptorchid testis, and the fifth was both infertile and cryptorchid. Two of these patients have developed frank carcinoma, which would suggest that the process represents an early phase of invasive germ cell neoplasia.
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keywords = seminiferous tubule, tubule
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9/13. Incomplete androgen insensitivity: asymmetry in morphology and steroid profile and metabolism of the gonads. An analysis of a case.

    A patient with clinical manifestations of the incomplete androgen insensitivity syndrome was studied with respect to peripheral blood levels of steroids and steroid sulphates before, during and after gonadectomy. Steroid and steroid sulphate concentrations were also analyzed in spermatic venous blood and gonadal tissue collected during surgery. The metabolic capacity of gonadal tissue was also studied in vitro using progesterone, dehydroepiandrosterone sulphate and oestrone sulphate as substrates. Profound differences between the two gonads were noted with respect to both steroid content and release into pampiniform veins and to in vitro conversion of progesterone and oestrone sulphate. Histological examination revealed the presence of seminiferous tubules with carcinoma in situ in both gonads. It is suggested that the differences between the gonads may be due to an autonomous steroid production in the right gonad in spite of adequate or even elevated gonadotrophic stimulation resulting in a steroidogenic situation resembling the complete androgen insensitivity syndrome, while the conditions found in the left gonad more resembles the incomplete form of the disease.
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keywords = seminiferous tubule, tubule
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10/13. Carcinoma-in situ of the human testis: tumour cells are distributed focally in the seminiferous tubules.

    The distribution of carcinoma-in-situ was investigated in the longitudinal course of human seminiferous tubules. Serial sections of tubular segments, measuring 9330 microns and 1600 microns in length respectively, were analysed. The tubules exhibited a local accumulation of tumour cells. Areas with abundant tumour cells followed areas that were free of tumour cells. The original coiled configuration of the seminiferous tubules was reconstructed with the help of a three-dimensional crepe rubber model. The model showed that tumour-bearing tubular segments lay close together, even if they were actually situated far distant from each other in the longitudinal course of the tubule. Consequently, distant tubular segments can be attached to a common area of the interstitial tissue. This corresponds to the observation that histological sections frequently show clustered CIS-tubules surrounded by tubules exhibiting spermatogenesis. It is a subject for debate whether the interstitial tissue connects tubular segments to functional testicular units.
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ranking = 6.021062141628
keywords = seminiferous tubule, tubule
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