14.3 Testicular Tumors

Question 1

Embryonal carcinoma, testicle

-prognosis

Answer 1

• Aggressive with hematogeous spread
• chemo can result in differentation into another type of germ cell tumor!

Question 1

Reinke crystals

Answer 1

histologic finding in Leydig cell tumors

Question 2

Choriocarcinoma, testicle

-made of what cells? (2)

Answer 2

-tumor of syncytiotrophoblasts (produce hCG) and cytotrophoblasts

(placenta like tissue, but villi are absent)

Question 3

Seminoma

• histology presentation
• gross presentation

Answer 3

1. large cells with clear cytoplasm and central nuclei (resemble spermatogonia)
2. homogenous mass with no hemmorhage or necrosis

Question 3

Testicular tumors: think what type based on age:

• young adult
• elderly

Answer 3

15-40 Germ cell tumor

>60 Lymphoma

Question 5

Seminoma vs non-seminoma

• %
• general differences

Answer 5

seminoma (55%)

-respond well to radiotherapy, metastasize late, good prognosis

non-seminoma (45%)

-variable response to tx, metastasize early

Question 6

Germ cell tumors, testicle

-risk factors include what congenital problems (2)

Answer 6

1. cryptorchidism
2. Klinefelter (XXY)

Question 6

Sertoli cell tumor

-presentation

Answer 6

• usu clinically silent
• comprised of tubules

Question 7

Testicular tumors, basics:

• arise from what cell types? (2)
• clinical presentation
• why not biopsy? (2)

Answer 7

1. germ cells
2. sex-cord stroma

(no surface epithelium as in females)

• presents as testicular mass that can’t be transilluminated
• do NOT biopsy:
  1. risk of seeding scrotum
  2. most tumors are malignant germ cell tumors, so remove anyway

Question 8

Seminoma

-prognosis?

Answer 8

Excellent. responds well to radiotherapy

Question 8

What is most common testicular tumor in children?

Answer 8

Yolk sac tumor

Question 8

Secretion of AFP and B-hCG:

1. embryonal carcinoma
2. yolk sac
3. CC
4. teratoma
5. Seminoma

Answer 8

1. AFP and B-hCG may be increased
2. AFP characteristically elevated
3. B-hCG characteristically elevated (gynecomastia, hyperthyroidism)
4. AFP, B-hCG may be increased
5. rarely produce B-hCG

Question 10

You see cross section of testicular tumor. It has homogenous color with non hemorrhage or necrosis.

Think what?

Answer 10

Seminoma

Question 11

Teratoma, testicular

• made of what
• how is it different from female teratoma
• what may be increased in blood

Answer 11

• made of mature fetal tissue, derived from 2-3 embryonic layers
• Malignant in males, Benign in females
• AFP and B-hCG may be increased in blood

Question 13

Germ cell tumors, testicle:

-divided into what tumors

Answer 13

• seminoma
• non-seminoma:
  1. Embryonal
  2. Yolk sac
  3. Choriocarcinoma
  4. teratoma

Question 14

Choriocarcinoma, testicle

-what unique complications and why? (2)

Answer 14

1. hyperthyroidism (TSH)
2. gynecomastia (LH, FSH)
   - B-hCG is elevated (secreted by syncytiotrophoblasts), and its alpha-subunit is similar to LH, FSH, TSH.

Question 15

What is the most common testicular tumor?

Answer 15

Seminoma

Question 16

B-hCG

• secreted by what
• elevated levels can cause what side effects?

Answer 16

secreted by syncytiotrophoblasts of placenta (and placenta like tissue)

• characteristically elevated in choriocarcinoma
• b/c its alpha subunit is similar to LH, FSH, TSH:

LH, FSH: gynecomastia

TSH: hyperthyroidism

Question 17

Male pt presents with testicular mass, gynecomastia, and hyperthyroidism

-think what

Answer 17

Choriocarcinoma

-increased hCG results in LH, FSH, TSH activation

Question 18

Leydig cell tumor

• presentation:
  1. children
  2. adults
• Characteristic histology finding

Answer 18

• produces androgen, so it causes:
  1. precocious pubery in children
  2. gynecomastia in adults
• Reinke crystals in histology

Question 19

Sex-cord stromal tumors, testicle

• benign/malignant
• divided into what

Answer 19

Usu benign

1. Leydig cell
2. Sertoli cell

Question 21

Testicular tumor:

-on histology, you see glomerulus like structures

What tumor?

Answer 21

Yolk sac tumor

Question 22

Yolk sac tumor, testicle

• histology
• what is elevated in blood

Answer 22

• Schiller-Duval bodies (glomerulus like structures_
• AFP characteristically elevated

Question 24

You see cross section of testicular tumor. It has central hemorrhagic mass with necrosis

Think what?

Answer 24

-Embryonal carcinoma

(a non-seminoma germ cell tumor)

Question 25

Male pt presents with massive metastatic cancer throughout body, including small tumor in testicle. Think what?

Answer 25

Think choriocarcinoma - classic: small primary tumor, massive metastasis - spreads early by blood

Question 26

Don't use chemotherapy on which testicular tumor? why?

Answer 26

Embryonal carcinoma -chemo can result in differentation into another type of germ cell tumor (eg teratoma) b/c embryonal cells are immature, primitive cells

Question 27

Choriocarcinoma, testicle -classic presentation

Answer 27

- tiny primary tumor, but massive metastasis - b/c CC spreads early in blood! (these cells are programmed to invade blood)

Question 28

Testicular tumors (8) - divided into what categories - name them all

Answer 28

Germ Cell: 1. seminoma - non seminomas: 2. Embryonal 3. Yolk sac (endodermal sinus) 4. Choriocarcinoma 5. Teratoma Sex-cord stromal tumors: 6. Leydig cell 7. Sertoli cell Other: 8. Lymphoma

Question 29

Lymphoma, testicle - presentation, population - usu what type of lymphoma?

Answer 29

- most common cause of testicular mass in males \>60 - often bilateral - usu diffuse large B-cell type

Question 30

Embryonal carcinoma, testicle - composed of what - gross appearance - look for what elevated in blood?

Answer 30

- composed of immature, primitive cells that may produce glands (may secrete AFP or B-hCG) - central hemorrhage and necrosis - AFP and B-hCG often elevated. (not specific among testicular tumors)