XXXX of the testis. A clinicopathological analysis of 40 cases and review of the literature.

@entity1 @entity39 @entity5 @entity4 @entity247 @entity8302
The clinical and pathological features of 40 @entity8302 of the testis were analyzed. The @entity1 ranged from 2 to 90 (average 46.5) years of age. The most common initial manifestation was @entity4 , which was sometimes associated with @entity247 ; 15% of the @entity1 presented because of @entity247 and were found to have palpable @entity5 . All three @entity1 were brought to the physician because of isosexual pseudoprecocity. The @entity5 , one of which was asynchronously bilateral, ranged from 0.5 to 10.0 (average 3) cm in greatest diameter. They were usually well circumscribed, but in seven of them the margin with the adjacent testis was ill-defined. On microscopic examination the most common pattern was that of diffuse sheets of neoplastic cells, but insular, trabecular, pseudotubular, and ribbon-like patterns were also encountered. The neoplastic cells were most often large and polygonal with abundant eosinophilic, slightly granular cytoplasm; occasionally the cytoplasm was abundantly vacuolated. In @entity5 some of the cells were spindle-shaped, and in six some had scanty cytoplasm. Crystalloids of Reinke were identified in 35% of the @entity5 . Conspicuous nuclear atypicality was present in 12 @entity5 and the mitotic rate ranged from less than 1 to 32/10 high-power fields. Blood vessel invasion, lymphatic invasion, or both were identified in four @entity5 . Follow-up of 2 months to 22 years (average 4 years) was available for 30 @entity1 . Five of them died as a result of spread of their @entity5 . A comparison of the clinically @entity5 with those associated with survival for 2 or more years postoperatively revealed that the former occurred in older @entity1 and were accompanied by symptoms of shorter duration and an absence of endocrine manifestations. The @entity5 were larger, often had an infiltrative margin and had spread beyond the testis, frequently exhibited blood vessel or lymphatic invasion, and had a greater degree of cellular atypia and @entity39 and a higher mitotic rate than the @entity5 .
