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