14.3 Testicular Tumors Flashcards
What are the two basic types of testicular tumors?
Germ cell or sex cord stromal
What is the classic presentation of testicular tumors?
Firm, painless testicular mass that cannot be transilluminated
Why aren’t testicular tumors biopsied?
- Risk of seeding scrotum
- Most are malignant anyways
What is the general treatment of testicular tumors?
Orchiectomy
What is the most common type of testicular tumors? What is the age range that this usually occurs at?
Germ cell tumor
15-40 years old
What are the two major risk factors for the development of germ cell tumors?
Cryptorchidism
Klinefelter
What are the two types of testicular germ cell tumors?
Seminoma and nonseminoma
What is the male equivalent of dysgerminomas?
Seminoma
What are the malignant potentials of seminomas and nonseminomas?
Seminomas meta late and respond well to treatment
Non-seminomas met early, and do not respond well to chemo
What, generally, are seminomas?
Malignant tumor of large cells with clear cytoplasm, and central nuclei
What are the gross characteristics of seminomas?
Homogenous mass without hemorrhage or necrosis
What, rarely, may seminomas produce?
beta-HCG
Pt presents with a homogenous testicular mass without hemorrhage or necrosis. Histology reveals a malignant tumor of large cells with clear cytoplasm, and central nuclei. Diagnosis?
Seminoma
What are embryonal carcinomas?
Malignant tumors of immature, primitive cells that may form glands
What are the gross characteristics of embryonal carcinomas?
Hemorrhagic mass with area of necrosis, that may form glands
What are the characteristics of embryonal carcinomas, in terms of aggressiveness and spread? How does it met?
Aggressive with early hematogenous spread
What might chemotherapy do to an embryonal carcinoma?
May cause it to differentiate into a more mature tumor
What are the labs that may be elevated with embryonal carcinomas?
AFP or beta-HCG
What is the most common testicular tumor in children?
Yolk sac tumor
What are yolk sac tumors?
Malignant tumors that resemble yolk sac elements
What is the hormone that is classically elevated in yolk sac tumors?
AFP
What are the histological characteristics of yolk sac tumors?
Schiller-Duval bodies–glomerular-like structures
Testicular tumor with glomerular-like structures on histology = ?
Schiller-Duval bodies characteristics of yolk sac tumors
What are the cells that produce beta-HCG in the developing fetus?
Syncytiotrophoblasts
What are the metastatic characteristics of choriocarcinomas? Why?
Spread early hematogenously–placental tissue is programmed to find blood vessels
What is the hormone that can be produced by choriocarcinomas? What, then, are the s/sx that result?
beta-HCG
Hyperthyroidism or gynecomastia
Why is is that high levels of beta-HCG from yolk sac tumors may cause hyperthyroidism?
Beta subunit of HCG is similar to TSH and FSH/LH
What are the cell types that comprised choriocarcinomas?
Syncytiotrophoblasts
Cytotrophoblasts (NOT vili)
What is the usual paradigm that helps determine primary vs secondary tumors? What is odd about this with choriocarcinomas of the testicle?
Primary is usually larger than mets, but this is reversed with choriocarcinomas
What is the difference between teratomas in males vs females
Males = malignant
Females =benign
What are the hormones that teratomas may produce?
beta HCG or AFP
True or false: most germ cell tumors are mixed germ cells
True
What is the prognosis of mixed germ cell tumors based on?
Worst component
What are the cells that line the seminiferous tubules?
Sertoli cells
What are sex-cord stromal tumors of the testicle? Are they usually benign or malignant?
Tumors that resemble sex cord stroma of the testicle
Usually benign
What are the pink cells that surround sertoli cells?
Leydig cells
Leydig cell tumors usually produce what hormone? What, then, are the s/sx of these tumors?
Usually produce androgen
Precocious puberty in children, or gynecomastia in adults
What are the classic histological characteristics of Leydig cell tumors?
Reinke crystals
Reinke crystals = ?
Leydig cell tumors
What are sertoli cell tumors comprised of? What are the classic clinical s/sx of sertoli cells?
Comprised of tubules
Usually clinically silent
What is the most common cause of a testicular mass in a male over the age of 60? Are these usually unilateral or bilateral?
Lymphoma
BIlateral
What type of lymphoma usually mets to the testicles?
Diffuse, large B cell lymphoma
