135. Testicular neoplasm Flashcards
Testicular neoplasms
2 types: germ cell tumors and sex cord stromal tumors
germ cell tumors: arise in post-pubertal males, 95% of testicular tumors arise from germ cells and almost all are malignant
sex-cord stromal tumors: derived from sertoli or leydig cells, are uncommon and usually benign.
Germ cell tumors intro
Can be pure or mixed
risk factors: cryptorchidism (3-5 fold increase in the risk for cancer), intersex syndromes (androgen insensitivity, gonadal dysgenesis), family history (family members with it have 8-10 fold more risk)
genetic background: extra copy of short arm in chromosome 12, oncogenic KIT mutations
precancerous lesion: germ cell neoplasia in situ in cryptorchidism or chromosome 12 abnormality
prognosis: 95% seminoma, 90% non-seminoma; choriocarcinoma has poorest prognosis
symptoms: painless testicular mass, non-translucent
diagnosis: biopsy could lead to spillage, too risky
metastasis: some tumors might have metastasized before there is a palpable testicular lesion
subclassified: seminomas and non-seminomas germ cell tumors
Typical seminoma
most common
identical to dysgerminomas (ovary)
origin: primordial germ cell (spermatogenesis)
growth: often remain confined to testis for long periods and may reach considerable size before diagnosis
features: large cell with clear cytoplasm, no hemorrhage or necrosis
metastasis: very late, most common in iliac lymph nodes
response to treatment is good
morph: bulky mass, uniform polygonal cells with clear cytoplasm, lymphocytes in stroma
tumor marker: slight increase in HCG due to synctiotrophoblasts
subtypes:
- anaplastic: in elderly, poor prognosis
- spermatocytic: uncommon, spermatocytic accumulation
and giant cell; lack lymphocyte infiltration,
granulomas, and syncytiotrophoblasts
Non-seminoma
origin: embryonal stem cell (somatic cell)
metastasis: distant metastasis via lymph and hematogenous spread
morph: hemorrhage with necrosis and might form glands.
prognosis: aggressive and metastasis
mixed: vast majority is mixed
types: embryonal carcinoma, teratoma, yolk sac tumor, choriocarcinoma
embryonal carcinoma
20-30 y/o, undifferentiated
germ cell tumor characterized by primitive epithelial cells
metastasis: highly aggressive, local extension to epididymis and tunia albuginea, and distant spread
pattern of growth: tubular or alveolar patterns, primary lesions are mostly small even after metastasis
HCG and AFP +
teratoma
intraembryonal components from more than one germ cell layer (show full differentiation)
can form at any age
types: in pre-pubertal males its benign and in post-pubertal males its malignant
teratoma with malignant transformation: when non-germ cell tumors arise in teratoma (like squamous cell carcinoma, adenomacarcinomas)
morphology: organoid cells, heterogenous composition (neural tissue, muscle bundles, cartilage, squamous, thyroid elements), mature and immature forms
yolk sac tumor
also known as endodermal sinus tumor
most common testicular tumor in kids
schiller-duval bodies: distinct feature forming structure resembling primitive glomeruli. Consists of dual layer of epithelial cells, capillary system and a central mesodermal component
AFP and alpha-1-antitrypsin
good prognosis in kids less than 3 y/o, in adults its mized with other cancer cells
choriocarcinoma
malignant tumor of synctiotrophoblasts and cytotrophoblasts (no villous formation)
metastasis since these cells are non to be invasive and find blood vessels, with a small primary tumor
HCG
complication: HCG can lead to hyperthyroidism since they have alpha subunits similar to TSH
sex-cord stromal tumors
tumors of gonad stroma
usually benign
sertoli cells
- androblastoma
- masculinization or feminization
leydig cell tumor
- btw tubules
- produce androgens
- precocious puberty in kids or gynecomastia in adults
- histo: reinke crystals in cells (steroid synthesis)
gonadoblastoma: mixture of germ cell and stromal components
