Chapter 1 - Histopathology of Gynaecological Cancers
Non-epithelial tumours are typically unilateral. Those that contain granulosa cells and Sertoli cells (“sex cords”), theca cells, broblasts, Leydig cells and steroid cells not otherwise speci ed form a broad category of rare tumours characterised by endocrine manifestations (SCSTs).
Granulosa cell tumours are low-grade malignant tumours with late recurrence. Most occur in adults; the rare juvenile type is aggressive when ruptured. Grading has value in Sertoli cell tumours.
Steroid cell tumours can be malignant. Staging is prognostically relevant for all of these. The other tumours are benign.
Most GCTs are benign mature teratomas (dermoid cysts); only rarely may a malignant tumour arise from somatic-type teratomatous tissues. Primitive (malignant) GCTs are similar to those occurring in males; a few occur in subjects with disorders of sexual development (most phenotypically females with Y chromosome) from a mixed germ cell–sex cord stromal tumour (gonadoblastoma).
Primitive GCTs include dysgerminoma (similar to seminoma), yolk sac tumour and rarer types (embryonal carcinoma and choriocarcinoma) alone or in combination (10%). Immature (embryonal) teratomas also are in this group. Tumour cell markers and chemosensitivity are typical.
Among undifferentiated cancers, some mimic undifferentiated carcinomas of other organs (lung); one aggressive type associated with hypercalcaemia typically arises in the first decades.
Metastatic tumours from the gastrointestinal tract may simulate primary mucinous carcinomas. Those from the stomach and breast show typical features, bilaterally and single-cell growth alone or with other features.
Tumour-like lesions may simulate malignant tumours.
- What is the most important prognostic histological feature in malignant SCSTs?
- Why is the prognosis of malignant primitive germ cell tumours favourable in most cases?
- Are bilateral mucinous (intestinal-type) carcinomas most likely to be primary or metastatic?