[Comparison of UICC and AJCC 8th edition TNM classifications in uropathology]. / Comparaison des classifications TNM des 8es éditions de l'UICC et de l'AJCC en uropathologie.

The pTNM stage is one of the most important parameters in the handling of tumor patients. The pathologist plays a major role in the determination of the stage. The classifications undergo an evolution according to the state of art. The TNM system is used worldwide and allows to precise the tumor (T) and lymph node stage and the presence of distant metastasis. This system helps to stratify patient groups and determine their prognosis. In 2017, the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) published their 8th edition. Unluckily several differences exist between both classifications. The UICC neglected to make several recommendations according to the International Society of Urological Pathology (ISUP) decisions, which organises the consensus in uropathology.

Grading of Urothelial Carcinoma and The New "World Health Organisation Classification of Tumours of the Urinary System and Male Genital Organs 2016".

CONTEXT: In the management of urothelial carcinoma, determination of the pathological grade aims at stratifying tumours into different prognostic groups to allow evaluation of treatment results, and optimise patient management. This article reviews the principles behind different grading systems for urothelial bladder carcinoma discussing their reproducibility and prognostic value. OBJECTIVE: This paper aims to show the evolution of the World Health Organisation (WHO) grading system, discussing their reproducibility and prognostic value, and evaluating which classification system best predicts disease recurrence and progression. The most optimal classification system is robust, reproducible, and transparent with comprehensive data on interobserver and intraobserver variability. The WHO published an updated tumour classification in 2016, which presents a step forward, but its performance will need validation in clinical studies. EVIDENCE ACQUISITION: Medline and EMBASE were searched using the key terms WHO 1973, WHO/International Society of Urological Pathology 1998, WHO 2004, WHO 2016, histology, reproducibility, and prognostic value, in the time frame 1973 to May 2016. The references list of relevant papers was also consulted, resulting in the selection of 48 papers. EVIDENCE SYNTHESIS: There are still inherent limitations in all available tumour classification systems. The WHO 1973 presents considerable ambiguity for classification of the G2 tumour group and grading of the G1/2 and G2/3 groups. The 2004 WHO classification introduced the concept of low-grade and high-grade tumours, as well as the papillary urothelial neoplasm of low malignant potential category which is retained in the 2016 classification. Furthermore, while molecular markers are available that have been shown to contribute to a more accurate histological grading of urothelial carcinomas, thereby improving selection of treatment for a given patient, these are not (yet) part of standard clinical practice. CONCLUSIONS: The prognosis of patients diagnosed with urothelial carcinoma greatly depends on correct histological grading of the tumour. There is still limited data regarding intraobserver and interobserver variability differences between the WHO 1973 and 2004 classification systems. Additionally, reproducibility remains a concern: histological differences between the various types of tumour may be subtle and there is still no consensus amongst pathologists. The recent WHO 2016 classification presents a further improvement on the 2004 classification, but until further data becomes available, the European Association of Urology currently recommends the use of both WHO 1973 and WHO 2004/2016 classifications. PATIENT SUMMARY: Bladder cancer, when treated in time, has a good prognosis. However, selection of the most optimal treatment is largely dependent on the information your doctor will receive from the pathologist following evaluation of the tissue resected from the bladder. It is therefore important that the classification system that the pathologist uses to grade the tissue is transparent and clear for both urologists and pathologists. A reliable classification system will ensure that aggressive tumours are not misinterpreted, and less aggressive cancer is not overtreated.

What is new in Genitourinary Pathology? Recent developments and highlights of the new 2016 World Health Organization classification of tumors of the urinary system and male genital organs

The recently published 2016 World Health Organization (WHO) Classification of Tumors of the Urinary System and Male Genital Organs stems from the accumulated knowledge and data collected during the last 12 years, since the previous edition of the WHO "blue book" 2004. The major changes in prostate pathology include the introduction of a novel grading system for prostate cancer (Grade Groups/International Society of Urological Pathology (ISUP) grades 1­5), the recognition of intraductal carcinoma as a new entity, and the terminological changes regarding the neuroendocrine prostatic neoplasms. In bladder and urothelial tract, within the spectrum of flat and non-invasive lesions, a newly introduced term "urothelial proliferation of uncertain malignant potential" replaced the term "urothelial hyperplasia", and the term "urothelial dysplasia" was better defined. A category of "invasive urothelial carcinoma with divergent differentiation" was introduced for tumors showing a component of "usual type" urothelial carcinoma combined with other morphologies. A new WHO/ISUP renal tumor grading system was recommended (Grade 1­4). The definition of renal papillary adenoma was modified and expanded to include papillary neoplasms measuring up to 1.5 cm. Several new epithelial renal tumors were recognized as new entities including: hereditary leiomyomatosis and renal cell carcinoma (RCC) syndrome­associated RCC, succinate dehydrogenase­deficient RCC, tubulocystic RCC, acquired cystic disease­associated RCC, and clear cell papillary RCC. In testis pathology, intratubular proliferations of testicular germ cell tumors were renamed as "germ cell neoplasia in-situ" (GCNIS), and the testicular neoplasms were divided into two main groups: derived from or unrelated to GCNIS. A major change in penile pathology was the introduction of a new classification of penile squamous cell carcinoma, based on the presence of human papillomavirus (HPV), which characterizes penile tumor subtypes as HPV-related or non-HPV-related. A similar distinction was introduced for the preneoplastic penile intraepithelial precursor lesion (PeIN) into non-HPV related (differentiated PeIN) and HPV-related types (undifferentiated PeIN). In this review, we provide a summary and highlight the changes in the genitourinary pathology introduced by the 2016 WHO blue book, and we also discuss some recent developments that may impact the practice of genitourinary pathology in the near future (AU)

Genital soft tissue tumors.

Mesenchymal neoplasms of the vulvovaginal and inguinoscrotal regions are among the most diagnostically challenging specimens in the pathology laboratory owing largely to their unique intersection between general soft tissue tumors and relatively genital-specific mesenchymal tumors. Genital stromal tumors are a unique subset of soft tissue tumors encountered at this location, and this group includes fibroepithelial stromal polyp, superficial (cervicovaginal) myofibroblastoma, cellular angiofibroma, mammary-type myofibroblastoma, angiomyofibroblastoma and aggressive angiomyxoma. Aside from the striking morphologic and immunophenotypic similarity that is seen with these entities, there is evidence that a subset of genital stromal tumors may be linked genetically. This review will focus on simplifying this group of tumors and provide the pathologist or dermatopathologist with practical management information. Smooth muscle tumors of the external genitalia will also be discussed.

[Rare tumors and tumor-like lesions of the testis and paratesticular structures]. / Seltene Tumoren und tumorähnliche Läsionen des Hodens und der paratestikulären Region.

Tumors and tumor-like lesions of the testes and paratesticular structures are rare neoplasms often documented solely in case reports but are morphologically similar to their counterparts in other organ systems. According to the World Health Organization (WHO) classification, miscellaneous tumors of the testis, tumors of collecting ducts and rete testis, tumors of paratesticular structures are differentiated from mesenchymal tumors of the spermatic cord and testicular adnexa. In the differential diagnostics of a space-occupying mass in the testis or paratesticular region, tumor-like lesions should be considered because these lesions represent a large collection pot and occur more often than was originally assumed.

Scrotal tumors in dogs: a retrospective study of 676 cases (1986-2010).

The objective of this study was to determine common tumor types that occur on the canine scrotum in relation to other cutaneous locations and to identify potential risk factors for specific scrotal tumor development. A retrospective study was conducted and the database of pathology reports from the Surgical Pathology Service of the Department of Pathology and Toxicology, School of Veterinary Medicine, University of Pennsylvania from 1986 to 2010 was searched for canine neoplastic scrotal and non-scrotal cutaneous lesions. Neoplastic lesions were evaluated based on diagnosis, breed, age, and number and location of tumors (scrotal versus non-scrotal cutaneous). Mast cell tumor, melanocytoma, malignant melanoma, vascular hamartoma, hemangiosarcoma, hemangioma, and cutaneous histiocytoma were the most common tumor types identified on the canine scrotum. Breed predispositions and mean age at diagnosis were identified for each tumor type and should be considered when planning surgical excision of a canine scrotal tumor.

Tumeurs scrotales chez les chiens : étude rétrospective de 676 cas (1986­2010). Cette étude avait pour objectif de déterminer les types communs de tumeurs qui se produisent sur le scrotum canin par rapport à d'autres endroits cutanés et d'identifier les facteurs de risque potentiels pour le développement de tumeurs scrotales spécifiques. Une étude rétrospective a été réalisée et une recherche a été effectuée dans la base de données des rapports de pathologie du Service de pathologie chirurgicale du Département de pathologie et de toxicologie de l'École de médecine vétérinaire de l'Université de la Pennsylvanie de 1986 à 2010 pour les lésions scrotales néoplasiques et les lésions cutanées non scrotales canines. Les lésions néoplasiques ont été évaluées en fonction du diagnostic, de la race, de l'âge ainsi que du nombre et de l'emplacement des tumeurs (scrotales par opposition à cutanées non scrotales). Les tumeurs à mastocytes, les mélanocytomes, les mélanomes malins, les hamartomes vasculaires, les hémangiosarcomes, les hémangiomes et les histiocytomes cutanés étaient les types les plus communs de tumeurs identifiées sur le scrotum canin. Les prédispositions des races et l'âge moyen lors du diagnostic ont été identifiés pour chaque type de tumeur et devraient être considérés lors de la planification de l'excision chirurgicale d'une tumeur scrotale canine.(Traduit par Isabelle Vallières).

Benign and malignant epididymal masses evaluated with scrotal sonography: clinical and pathologic review of 85 patients.

OBJECTIVE: The purpose of this study was to determine whether the clinical history and sonographic appearance of solid epididymal masses could aid in distinguishing benign and malignant disease. METHODS: We retrospectively reviewed the medical records of all patients who had solid epididymal masses evaluated by scrotal sonography at our institution between 1996 and 2004. We evaluated multiple clinical and sonographic variables, including lesion size, location, echogenicity, color Doppler characteristics, and calcifications. RESULTS: Of the 85 patients included in the study, 25 (29%) underwent surgical intervention, and 5 (6%) had malignant disease. A mass size of greater than 1.5 cm and the presence of color Doppler flow were statistically significant markers for malignancy (P < .05). Combining these 2 variables as a test for malignancy yielded sensitivity of 100%, specificity of 80%, a positive predictive value of 24%, and a negative predictive value of 100%. CONCLUSIONS: Most solid epididymal masses (94%) are benign. A size of greater than 1.5 cm and the presence of color Doppler flow may help identify possible malignant masses.

Rabdomioma de cordón espermático / Spermatic cord rhabdomyoma

Objetivo: Los rabdomiomas son tumores benignos del músculo esquelético cuya localización extracardiaca es rara. Métodos/Resultados: Presentamos un caso de rabdomioma de cordón espermático en un varón de 28 años de edad. Conclusiones: Los rabdomiomas genitales son tumores benignos poco frecuentes, y deben ser considerados en el diagnóstico diferencial de tumores del tracto genital masculino (AU)

Objective: Rhabdomyomas are benign tumors of the skeletal muscle and extracardiac rhabdomyomas are very rare. Methods/Results: We report one case of spermatic cord rhabdomyoma in a 28-year-old male. Conclusions: Genital rhabdomyomas are rare benign tumors. Rhabdomyomas should be considered in the clinicopathological differential diagnosis of tumors of the male genital tract (AU)

Angiomyxoid tumor with an intermediate feature between cellular angiofibroma and angiomyofibroblastoma in the male inguinal region.

Angiomyofibroblastoma (AMFB) and cellular angiofibroma (CA) are angiomyxoid tumors which infrequently arise in the female vulvovagina and each has been proposed to be a distinct clinicopathological entity. The former in male genitalia is exceedingly rare and has been described as its male analog or under the name of male AMFB-like tumor, while the latter in men has not been reported. We describe an angiomyxoid tumor which appeared in the inguinal region of 72-year-old man. The present case had a histopathological characteristic and immunophenotype intermediate between AMFB and CA. Male genital angiomyxoid tumors share many immunopathological features with their female counterparts, suggesting that they are male homologs rather than analogs. Immature mesenchymal cells with a potential of the multilineage differentiation might be promoted toward neoplastic myoblasts, fibroblasts and adipocytes, resulting in genital angiomyxoid tumors showing a broad spectrum in the immunopathological phenotype.

Male genital cancers.

BACKGROUND: The estimated 165,000 cancers of the male genital system that will occur in the United States during 1993 represent one fourth of the expected 600,000 newly diagnosed cancers in American males for the year. METHODS: Data were collected by the Surveillance, Epidemiology, and End Results (SEER) program. This paper examines histologic data collected by the SEER program from 1973-1987 and focuses on incidence, stage at diagnosis, and survival for the dominant histologic types of cancer that occur in the four major topographic divisions of the male genital system: prostate gland, testis, penis, and scrotum. Some less common histologic types within each organ are also discussed. RESULTS: The incidence of male genital cancer has increased rapidly over the period of study. Cancers of the prostate, most of which are adenocarcinomas, represent more than 92% of all male genital cancers. Among adolescents and young men, germ cell cancers of the testis predominate, but decline rapidly in occurrence after 40 years of age. Blacks had higher incidence rates for prostate cancer than whites; however, the situation was reversed for testicular cancer. Survival increased dramatically for testicular cancer. Cancers of the penis and scrotum of any histologic type are uncommon in the United States. CONCLUSIONS: The increased incidence of prostate adenocarcinomas and testis germ cell tumors indicates the need for further etiologic studies as a basis for prevention efforts.

[Malignant fibrohistiocytoma of the spermatic cord. Report of a case]. / Fibrohistiocitoma maligno de cordón espermático. Aportación de un caso.

A case of malignant fibrohistiocytoma of the spermatic cord is described. This rare site of tumor presentation and the histopathological features of this tumor type are briefly discussed. We underscore the importance of treatment by radical orchiectomy.

Male genital tract tumors in Punjab, India.

A total of 95,797 tissue specimens were submitted to our laboratory for histopathological examination during the 21-year period from January 1964 to December 1984. Out of 21,281 cases diagnosed as tumors, 9,254 were found in the male population, comprising 6,846 malignant neoplasms and 2,408 benign neoplasms. There were 1,175 tumors of the male genital tract of which 1,118 were malignant and 57 were benign. The incidence of male genital tract cancer represented 16.33% of male malignancies. The relative frequency of malignant tumors of various organs in the male genital tract was penis, 42.49%; prostate, 40.34%; testis, 15.92%; scrotum, 0.71%; epididymis, 0.36%; spermatic cord, 0.09%; and urethra, 0.09%. All these tumors were classified into various histopathological types and their relative frequency was determined. Some of the rare tumors diagnosed included leiomyosarcoma of the penis, transitional cell carcinoma of the prostate gland, orchioblastoma of the testis, and carcinoma of the urethra. A separate study by this department on the pattern of cancer distribution revealed that cancer of the uterine cervix is the most common malignancy in females in this geographic region. We postulate that a common carcinogenic agent, either a virus or a biochemical (smegmatic) factor, may be responsible for the high incidence of carcinoma of the penis in males and carcinoma of the cervix in females. Educating people about the importance of penile hygiene, and, in particular, educating mothers to retract the foreskin of male babies and to wash it with soap and water when bathing them, will hopefully reduce the incidence of these cancers in regions of high prevalence.

Serum tumor markers and patient allocation to good-risk and poor-risk clinical trials in patients with germ cell tumors.

The allocation of patients with advanced germ cell tumors (GCT) to different treatment programs based on clinical characteristics is standard in the design of clinical trials today. Studies have shown that substantial differences exist between entry criteria and that these differences could influence the outcome of clinical trials. The factors contributing to these differences are not clear due to patient selection biases. Two hundred five unselected and consecutive patients allocated to and treated in good-risk and poor-risk treatment programs at Memorial Sloan-Kettering Cancer Center (MSKCC) were reassigned risk status by the Indiana University (IU) Classification. The results were compared with those of the Southeastern Cancer Study Group (SECSG). The results using both criteria indicated substantial agreement in total end results and the identification of good-risk patients. The results in poor-risk patients differed substantially, with 39 patients (19%) classified as poor-risk by MSKCC criteria and 66 (32%) by Indiana criteria. The major discrepancy occurred in IU Stage 7, in which 26 of 32 patients (81%) achieved a complete response. The major factor contributing to this difference in risk assignment was the use of serum tumor markers. Serum tumor markers must be incorporated into risk assignment criteria for GCT clinical trials to minimize the number of good-risk GCT patients in poor-risk trials.

[Liposarcoma of the spermatic cord. Review of the literature. Apropos of a case of myxoid liposarcoma]. / Liposarcomes du cordon spermatique. Revue de la littérature. A propos d'un cas de liposarcome myxoïde.

Based on one case of spermatic cord liposarcoma, the authors mention the different histological types of this lesion. A review of the literature confirms this rare tumor typically occurs in the adult population; the majority of spermatic cord liposarcomas are of low grade malignancy. The treatment of choice remains radical orchidectomy with wide excision of the tumor. Because of the predilection of this lesion for local recurrence, the patients must be followed periodically.