Primordial germ cells as a potential shared cell of origin for mucinous cystic neoplasms of the pancreas and mucinous ovarian tumors.

Mucinous ovarian tumors (MOTs) morphologically and epidemiologically resemble mucinous cystic neoplasms (MCNs) of the pancreas, sharing a similar stroma and both occurring disproportionately among young females. Additionally, MOTs and MCNs share similar clinical characteristics and immunohistochemical phenotypes. Exome sequencing has revealed frequent recurrent mutations in KRAS and RNF43 in both MOTs and MCNs. The cell of origin for these tumors remains unclear, but MOTs sometimes arise in the context of mature cystic teratomas and other primordial germ cell (PGC) tumors. We undertook the present study to investigate whether non-teratoma-associated MOTs and MCNs share a common cell of origin. Comparisons of the gene expression profiles of MOTs [including both the mucinous borderline ovarian tumors (MBOTs) and invasive mucinous ovarian carcinomas (MOCs)], high-grade serous ovarian carcinomas, ovarian surface epithelium, Fallopian tube epithelium, normal pancreatic tissue, pancreatic duct adenocarcinomas, MCNs, and single-cell RNA-sequencing of PGCs revealed that both MOTs and MCNs are more closely related to PGCs than to either eutopic epithelial tumors or normal epithelia. We hypothesize that MCNs may arise from PGCs that stopped in the dorsal pancreas during their descent to the gonads during early human embryogenesis, while MOTs arise from PGCs in the ovary. Together, these data suggest a common pathway for the development of MCNs and MOTs, and suggest that these tumors may be more properly classified as germ cell tumor variants. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Maternal dietary patterns during early pregnancy and the odds of childhood germ cell tumors: A Children's Oncology Group study.

Maternal diet during pregnancy may be associated with cancer in offspring. Intake of individual foods, as well as dietary patterns, can be used when examining these relations. Here, the authors examined associations between maternal dietary intake patterns and pediatric germ cell tumors (GCTs) using principal components analysis and logistic regression. Mothers of 222 GCT cases aged less than 15 years who were diagnosed at a Children's Oncology Group institution between 1993 and 2001 and those of 336 frequency-matched controls completed a self-administered food frequency questionnaire of diet during early pregnancy. Four dietary patterns were identified: "Western," "fruits and vegetables," "protein," and "healthful." With adjustment for birth weight, parity, and vitamin use, the fruits and vegetables pattern was significantly associated with a lower odds for GCTs (odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.69, 0.99; 2 sided). Upon stratification, the fruits and vegetables pattern was significantly associated with a lower odds in males (OR = 0.66, 95% CI: 0.47, 0.92) but not females (OR = 0.91, 95% CI: 0.72, 1.14). A quantitative assessment of assumed nondifferential reporting error indicated no notable deviations from unadjusted odds ratio estimates. Results of this exploratory analysis suggest that maternal prenatal dietary patterns could be considered in future studies of GCTs in offspring.

Functions of genes related to testicular germ cell tumour development.

OBJECTIVE: Testicular germ cell tumour (TGCT) is a malignancy with a high heritable component. The inherited risk is polygenic, and around 50 susceptibility genes are identified. The functional role of the gene products for TGCT development is not well understood. The focus of this review is functional studies of genetic risk factors for TGCT derived from GCNIS and the signalling pathways involved in the pathogenesis. RECENT DEVELOPMENTS: Genome-wide association studies have identified new risk loci for TGCT and confirmed previously identified susceptibility genes. Many of these risk genes are related to male germ cell development, sex determination and genomic integrity. Gain- and loss-of-function studies in animal models and TGCT cell lines, as well as gene and protein expression studies in TGCT patient samples, have contributed to the understanding of TGCT development. KITLG-KIT signalling is of crucial importance, but several other signal transduction pathways may also play a role. Many of the risk loci are in non-coding regions, and studies have revealed that non-coding RNAs may act as oncogenes or tumour suppressors in TGCT development. CONCLUSIONS: The risk of TGCT is polygenic, and the underlying molecular mechanisms are complex. Several signalling pathways are related to TGCT development, and both proteins and non-coding RNAs may act as oncogenes or tumour suppressors. Epigenetic studies are of importance to get further knowledge about how the signalling pathways are regulated.

Environment, testicular dysgenesis and carcinoma in situ testis.

The testicular dysgenesis syndrome (TDS) hypothesis proposes that a proportion of the male reproductive disorders-cryptorchidism, hypospadias, infertility and testicular cancer-may be symptoms of one underlying developmental disease, TDS, which is most likely a result of disturbed gonadal development in the embryo. TDS may be caused by genetic factors, environmental/life-style factors, or a combination of both. Some rare disorders of sex development of genetic origin are among the best-known examples of severe TDS. Among the environmental and life-style factors that are suspected to influence the hormonal milieu of the developing gonad are the endocrine disrupters. A prenatal exposure to commonly used chemicals, e.g. phthalates, may result in a TDS-like phenotype in rats. Currently, this animal model is the best model for TDS. In humans the situation is much more complex, and TDS exists in a wide range of phenotypes: from the mildest and most common form, in which impaired spermatogenesis is the only symptom, to the most severe cases, in which the patient may develop testicular cancer. It is of great importance that clinicians in different specialties treating patients with TDS are aware of the association between the different symptoms.

Primary embryonal-cell carcinoma of the parietal lobe. Case report.

A case of primary embryonal-cell carcinoma of the parietal lobe is reported. The unusually chronic presentation of such a malignant tumor is described. The atypical computerized tomography and magnetic resonance imaging characteristics of this lesion are presented. Review of the literature yielded no previous reports of a lobar embryonal-cell carcinoma. The rarity of intracranial germ-cell tumors presenting off the midline is discussed.

Pancreatoblastoma and solid and cystic papillary tumor: two tumors related to pancreatic ontogeny.

Two tumors of the pancreas are related to pancreatic ontogeny. The pancreatoblastoma is a tumor of children, more commonly boys than girls and progresses with a slow, sluggishly malignant course. Surgery successfully controls the disease in about half the cases. Morphologic and immunohistochemical studies reveal undifferentiated areas, ductular areas, acinar areas, and occasionally neuroendocrine differentiation. Very characteristic is the presence of nodules of squamous epithelium. These features reflect the potencies of the pancreatic anlage somewhat earlier than the fourteenth week of development. The solid and cystic papillary epithelial tumor of the pancreas is a tumor of adolescent and young adult females, often non-Caucasian. Surgical excision is often successful, but deaths from local persistence and metastases have been described. These tumors have features of ductulo-acinar neoplasms of uncommitted pancreatic primordia exceptionally with neuroendocrine differentiation.

Melanotic neuroectodermal tumor of infancy: review of the literature and report of case.

A characteristic case of melanotic neuroectodermal tumor of infancy is reported and the literature regarding this lesion is reviewed. The case reported shows the salient features of previously described melanotic neuroectodermal tumors of infancy; it occurs in infants of less than 1 year of age; it most commonly arises from bone (jaws and skull), has distinctive gross and histologic features, is benign, and is cured by total local excision. Since the teeth in the mandible and maxilla are undergoing development about the time that this tumor occurs, it is not surprising to find tooth buds in close proximity to the expanding neoplastic mass. When odontogenic rests are found in association with the lesion, it must be assumed that it is a collision of the two structures and not that the odontogenic epithelium is the origin for the lesion as previously thought. This is especially true since odontogenic epithelium is not found in the tumor when it occurs outside the jaws. This is the type of lesion that will most probably first be noticed by a dentist and should be managed by the oral surgeon. It is important to note that proper advice regarding future dental problems should be given to the parents of the infant. Such possibilities as crowding or absence of the deciduous or permanent teeth, malocclusion, and possible malformation of the remaining maxillary ridge should be explained. Close dental follow-up is mandatory since recurrence is possible.

[The role of embryoid bodies in the development of germinogenous tumors of complex structure and of the teratoma]. / Rol' émbrioidnykh telets v razvitii germinogennykh opukholei slozhnogo stroeniia i teratomy.

250 germinal gonadal and extragonadal tumors were studied in children and adolescents under 16 years of age. Germinal tumours of complex structure were found in 42 patients and in 36 of them embryoid bodies of various types (full, not-full, amorphous) were distinguished. Certain features were revealed indicating the development of the immature teratoma by means of maturation of preexisting embryoid bodies. The arguments in favour of complex germinal tumour development due to the loss of maturation and differentiation capacity of one or several structural elements of the embryoid bodies are presented. The observation of mature, immature embryonal tissues and proliferating elements of the embryoid bodies in the composition of one and the same tumour may be explained by different biological potency of individual clones of atypical and primordial germinal cells which are the source of the development of these tumours.

FOXL2 and SOX9 as parameters of female and male gonadal differentiation in patients with various forms of disorders of sex development (DSD).

The transcription factors SOX9 and FOXL2 are required for male and female mammalian gonadal development. We have used specific antibodies to investigate the role of these key proteins in disorders of sex development (DSD), specifically inter-sex states. In normal gonads, SOX9 was found to be restricted to the presence of (pre-)Sertoli cells, while FOXL2 was found in granulosa cells, and in stromal cells interpreted as early ovarian stroma. Both proteins were found within a single patient, when testicular and ovarian development was present; and within the same gonad, when both differentiation lineages were identified, as in ovotesticular DSD (ie hermaphrodite). Especially SOX9 was informative to support the presence of early testicular development (ie seminiferous tubules), expected based on morphological criteria only. In a limited number of DSD cases, FOXL2 was found within reasonably well-developed seminiferous tubules, but double staining demonstrated that it was never strongly co-expressed with SOX9 in the same cell. All seminiferous tubules containing carcinoma in situ (CIS), the malignant counterpart of a primordial germ cell, ie the precursor of type II germ cell tumours of the testis, seminomas and non-seminomas, showed the presence of SOX9 and not FOXL2. In contrast, gonadoblastomas (GBs), the precursor of the same type of cancer, in a dysgenetic gonad, showed expression of FOXL2 and no, or only very low, SOX9 expression. These findings indicate that gonadal differentiation, ie testicular or ovarian, determines the morphology of the precursor of type II germ cell tumours, CIS or GB, respectively. We show that in DSD patients, the formation of either ovarian or/and testicular development can be visualized using FOXL2 and SOX9 expression, respectively. In addition, it initiates a novel way to study the role of the supportive cells in the development of either CIS or GB.

Extragonadal germ cell tumors: a review with emphasis on pathologic features, clinical prognostic variables, and differential diagnostic considerations.

Extragonadal germ cell tumors (GCTs) are relatively uncommon, but represent 1% to 5% of all GCTs. Their morphology varies widely and includes mature teratoma, immature teratoma, seminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, and mixed GCTs. Noncentral nervous system extragonadal GCTs are found in a variety of anatomic locations, but most commonly affect the mediastinum and sacrococcygeal region. Predicting behavior in these tumors can be confusing because it is based on a combination of varying factors including patient age, histologic subtype, anatomic site, and clinical stage. This review attempts to dissect these issues by separating the discussion into 3 age groups: neonatal (congenital), children (prepubertal), and adult (postpubertal). Within each individual age group, we cover the significance of anatomic site, morphology, and staging parameters. In addition, we discuss the spectrum of associated secondary malignancies and their impact on patient outcome. Finally, we provide a detailed survey of differential diagnostic considerations grouped by anatomic site.

Congenital tumours of the salivary gland: a case report and review.

A congenital epithelial tumour of the submandibular salivary gland, occurring in a child of 10 months, is described. The lesion appeared benign and consisted of basal type cells, showing ductal and acinar differentiation with myoepithelial cells. The associated fibrous stroma contained blood vessels and small nerve bundles. A few similar lesions have been reported in the past, some of which showed features of malignancy. Although various names have been proposed, we suggest that these lesions represent a single group derived from a primitive cell line and advocate the use of the term sialoblastoma.

Xrel3 is required for head development in Xenopus laevis.

The Rel/NF-kappa B gene family encodes a large group of transcriptional activators involved in myriad differentiation events, including embryonic development. We have shown previously that Xrel3, a Xenopus Rel/NF-kappa B-related gene, is expressed in the forebrain, dorsal aspect of the mid- and hindbrain, the otocysts and notochord of neurula and larval stage embryos. Overexpression of Xrel3 causes formation of embryonic tumours. We now show that Xrel3-induced tumours and animal caps from embryos injected with Xrel3 RNA express Otx2, Shh and Gli1. Heterodimerisation of a C-terminally deleted mutant of Xrel3 with wild-type Xrel3 inhibits in vitro binding of wild-type Xrel3 to Rel/NF-kappa B consensus DNA sequences. This dominant interference mutant disrupts Shh, Gli1 and Otx2 mRNA patterning and inhibits anterior development when expressed in the dorsal side of zygotes, which is rescued by co-injecting wild-type Xrel3 mRNA. In chick development, Rel activates Shh signalling, which is required for normal limb formation; Shh, Gli1 and Otx2 encode important neural patterning elements in vertebrates. The activation of these genes in tumours by Xrel3 overexpression and the inhibition of their expression and head development by a dominant interference mutant of Xrel3 indicates that Rel/NF-kappa B is required for activation of these genes and for anterior neural patterning in Xenopus.

Dysontogenetic brain tumours--proposal for an improved classification.

The International World Health Organisation (WHO) classification of central nervous system tumours does not give an extensive classification of germ cell tumours and other malformative tumours and tumour-like lesions. In the same way, no consistent classification of dysontogenetic brain tumours can be found in the classical handbooks. For an eventual new edition of the WHO classification, it is proposed to reconsider and improve the classification of these tumours, based on their ontogenetic relations.

Hormones and growth factors in germ cell neoplasia: general discussion.

Fetal germ cells migrate along the dorsal mesentery to the genital ridge, and migration in the bloodstream occurs in some animals. Malignant transformation may occur before migration, and it is possible that testicular germ cell tumours have a monoclonal origin, even when bilateral. Different tumour foci have homogeneous chromosomal abnormalities. Migrating germ cells may lodge in extragonadal sites and give rise to tumours. Mouse fetuses exposed to oestrogen and testosterone in utero have an increased incidence of testicular maldescent and teratoma. Oestrogens and mullerian inhibitory substance in the fetus may influence human testicular tumour development. Testicular tumour patients may have elevated serum oestrogen levels which may be related to prognosis. Increased serum FSH may stimulate germ cell tumour growth. Ultrastructural studies indicate that malignant transformation of germ cells occurs early, but final tumour differentiation does not occur till after the malignant cells have invaded extratubular tissue.

Tissue differentiation and susceptibility to embryonal tumor induction by ethylnitrosourea in the opossum.

Opossums (Didelphis virginiana Kerr) exposed to 100 mg ENU/kg in single or incremental doses early in postnatal life developed a spectrum of epithelial and mesenchymal neoplasms including several types of embryonal neoplasms not previously induced in laboratory animals. A correlation was apparent to a varying degree between susceptibility to tumor induction and the state of morphologic maturation of the presumed target tissues at the light microscopic level for embryonal tumors of the eye, kidney, and brain. The susceptibility of the opossum eye to an ENU-induced intraocular teratoid medulloepithelioma extended over the period from 1 to between 3 and 4 weeks of age and was correlated with the differentiation of the apparent target cell, the nonpigmented ciliary epithelium of the pars ciliaris retinae. Induction of nephroblastomas was correlated with the presence in the kidney of stem cells (metanephric blastema) through the period from birth to between 6 and 8 weeks of age. Although susceptibility of the opossum brain to ENU induction of gangliogliomas was correlated with the state of differentiation of the germinal matrix from birth to 56 days of age, induction of these tumors was essentially limited to the 1st week postpartum. No definite correlation between vulnerability to tumor induction and tissue maturation was evident for a tumor of the jaw (ameloblastoma) with presumed origin from embryonic dental remnants. Our results indicated that the opossium early in postnatal life is a useful model for the induction and characterization of certain of the major dysontogenetic tumors, which have been difficult or impossible to reproduce in the traditional laboratory species.