227/228 - Pathology of Testes, Testes Cancer Flashcards
List 3 common symptoms/signs of localized testicular cancer
- Scrotal mass
- Scrotal pain
- Acute onset of a hematocele
Which tumor marker will be increased in sex-cord stromal tumors (Leydig and Sertoli cell tumors)?
Inhibin
Which nerves are most at risk during a RPLND?
Post-ganglionic sympathetics (hypogastric plexus) - involved in ejaculation
=> problem getting semen to the posterior urethra
What cells make up a choriocarcinoma?
Syncytiotrophoblasts + cytotrophoblasts
Syncytiotrophoblasts secrete HCG
List 4 non-seminomatous germ cell tumors
- Embryonal carcinoma
- Yolk sac tumor
- Choriocarcinoma
- Teratoma (mature and immature)
What gene, located on the short arm of chromosome 12, may account for the rapid growth rate of most testes tumors?
Cyclin D2
Duplication of 12p is seen in >80% of germ cell tumors
Which germ cell tumor is associated with Schiller-Duval bodies?
Yolk sac tumor
When should a partial orchiectomy be performed?
Rarely
Only in people with a solitary testicle or a benign lesion
What is the most common pure germ cell tumor in children?
Teratoma
Usually mature
Describe the histologic appearance of a seminoma
- Large, primitive tumor cells (germ cells)
- Relatively normal looking
- Immune infiltrate (lymphocytes)
- Has invaded seminiferous tubules
In the management of testis cancer, by which approach is orchiectomy performed?
Why?
Inguinal approach
Key: not scrotal
Inguinal approach allows the surgeon to remove all in-transit metastatic disease in the lymph channels in the spermatic cord
Also avoids contaminating the scrotal (inguinal) lymphatics (aka you don’t want to create new paths for cancer to spread - just follow the one that is is already likely spreading to)
What does testicular cancer usually look like on ultrasound?
Which tumors may look different?
Usually hypoechoic
Teratomas may be hyperechoic because it contains a variety of different parts
What is the most common testicular tumor in a man >60 years old?
Lymphoma
(Diffuse, large B cell type)
Which tumors will have elevated C-kit?
Seminoma
B. Testicular calcifications
Calcifications may be seen in teratoma, but many people have calcifications; if that is the only finding and no hx of cancer, these are fine
What are the most common extra-gonadal sites of germ-cell neoplasia?
(From most to least common)
- Mediastinum
- Retroperitoneum
- Sacrococcygeal region
- Pineal gland
Following orchiectomy, what is the management of:
Stage 1 seminoma:
Stage 2 seminoma
- Stage 1 seminoma:
- Observation
- Stage 2 seminoma:
- Radiation to the retroperitoneal lymph nodes
Which testicular tumor is characterized by lymphocytic infiltration?
Classic seminoma
What is the most significant side effect associated with each aspect of PEB chemotherapy?
- Cisplatin
- Nephrotoxicity, neuropathy, ototoxicity, vomiting
- Etoposide
- Myelosuppression, leukomonogenic
- Bleomycin
- Pulmonary fibrosis, Raynaud’s
All: DVT, secondary malignancies later in life
PEB is used to treat invasive/metastatic testicular cancer
Which testicular tumor can metastasize to the CNS hematogenously?
Choriocarcinoma
What is the precursor for all testicular germ cell tummors except spermatocytic seminoma?
Intratubular germ cell neoplasia (ITGCN)
Note: Germ cell neoplasia in situi is a type of ITGCN that is specifically a precursor for germ cell tumors
Describe the histological features of diffuse, large B cell lymphoma of the testis
Tubule-sparing growth pattern
Looks like a seminoma but without lymphocytic infiltration
Will present in an older patient (>50), vs seminonma in a younger pt
Which tumor marker is never expresed by a pure seminoma?
AFP
Also never elevated in choriocarcinoma
Which cells produce beta-HCG?
Syncytiotrophoblasts
- Choriocarcinoma arises from syncytiotrophoblasts => high HCG*
- May be present in all germ cell tumors, but syncytiotrophoblasts dominate in choriocarcinoma*
What is the first-line therapy for patinets with metastatic germ cell neoplasia?
PEB chemotherapy
Cisplatin + Etoposide +Bleomycin
Which testicular tumor will present with signs of virilization, gynecomastia, and/or loss of libido?
Leydig cell tumors
- Leydig cells secrete testosterone*
- Gynecomastia, loss of libido when aromatized to estrogen*
Which lymphoma subtype most commonly involves the testis?
Diffuse large B-cell type
Most common testicular tumor in men >60 years old
What is the prognoses of sex cord stromal tumors?
If local, good prognosis; often these tumors are benign
If malignant, they are very aggressive; refractory to radiation, chemo => bad prognosis
Sex cord stromal cell tumors = leydig cell, sertoli cell, fibrothecoma, granulosa cell
What is the most common germ cell tumor?
Which tumor markers does it express?
Seminoma
HCG
LDH
List 3 key differences between classic seminoma and spermatocytic seminoma
- Classic seminoma
- Very common (Most common type of testicular cancer!)
- Younger patients
- Arises from ITGCN
- Spermatocytic seminoma
- Rare
- Older patients
- Does NOT arise from ITGCN
What is the half life of LDH?
10 hours - 3 days
(most variable half life of the tumor markers)
A ____ sided testicular tumor will “land” in the para-aortic lymph nodes
A ____ sided testicular tumor will “land” in the interaortocaval nodes
A left sided testicular tumor will “land” in the para-aortic lymph nodes
A right sided testicular tumor will “land” in the interaortocaval nodes
Aorta is on the left side, so left testes will go to para-aortic
How will a hydrocele affect testicular development?
Will cause testicular atrophy
No germ cell development; testis will be nonfunctional
Which cells are responsible for the blood-testes barrier?
Sertoli cells
Which testicular tumor may have a solid, glandular, or papillary pattern?
What will you see on gross pathology?
Embryonal carcinoma
