227. Pathology Testes

Question 1

Cryptorchidism

• what is it, cause
• malignancy risk
• histo
• unique feature

Answer 1

Undescended testis, failure of one/both testes to move from abd to scrotum after birth (normally descend during Mo7-8 GA: abdominopelvic and inquinal-scrotal phases)

• higher risk of testicular cancer
• histo: ATROPHIC seminiferous tubules (less spermogenesis)
• may develop Cell Neoplasia in situ (intratubular germ cell neoplasia, unclassified): precursor for testicular cancer, large germ cells in periphery of tubules with halos (neoplastic but non invasive)

Question 2

Benign Conditions: Reactive/Reparative

• Testicular Atrophy: cause, histo
• Infertility: Maturation arrest vs Sertoli-cell-only pattern
• Sperm granuloma: histo
• Hydrocele: what it is, histo

Answer 2

T Atrophy: due to aging or therapy (anti-androgen tx for prostate can), no germ cell maturation in lumen

Maturation arrest: see spermatagonia - spermocytes but no spermatids/spermatozoa present
Sertoli-cell-only: no germ cells in tubules

Sperm Granuloma: sperm leak out of seminiferous tubule, recognized as foreign, induce granulomatous rxn (histiocytes ingest leaky sperm)

Hydrocele: fluid accumulation in mesothelium space with testes suspended in sac, causes ATROPHIC change - damage germ cell development

Question 3

Benign Conditions: Vascular/Idiopathic

• Varicocele: cause, effect
• Testicular Torsion: what it is, effect

Answer 3

Varicocele: abnormal dilatation of veins draining testes obstruct outflow = oligo- or azo-spermia

Testicular torsion: abnormal rotation strangulates arterial supply - severe hemorrhagic necrosis: life threatening hemorrhage/necrosis between tubules

Question 4

Germ Cell Neoplasia in Situ

• What is it
• gross
• malignancy risk
• tumor markers (3)
• tx

Answer 4

Neoplastic germ cells growing within tubules (larger, bigger halos)

• gross: diffuse lesion, no mass, non-invasive
• precursor to almost all invasive GCTs (precancer)
• markers: C-KIT, OCT-4, PLAP
• tx: surveillance in US (radiation europe)

Question 5

Seminoma

• epi
• two types
• gross
• histo
• markers
• demographics
• prognosis

Answer 5

MOST COMMON FORM OF Testicular Cancer

Seminoma Classic

• gross: single homogenous mass replacing entire testis parenchyma
• histo: large primitive tumor cells (germ cells) NOT confined to tubules and can be invasive; diffuse/sheet-like patterns; presence of lymphocytes/granulomas; occasionally syncytiotrophoblasts present (mild increase hCG)
• markers: PLAP C-KIT OCT-4
• peak age: 35-40yo
• arise from GCNIS good prognosis

Spermatocytic Seminoma

• demo: older 50-60yo, NOT related to GCNIS
• histo: 3 germ/tumor cell types (small, medium, large)
• good prognosis

Question 6

Embryonal Carcinoma

• demographic
• prognosis
• gross
• histo
• tumor markers

Answer 6

Most cases mixed GCT

• 25-35yo
• high rate mets
• gross: hemorrhage, necrosis
• histo: primitive/pleomorphic tumor cells, solid glandular or papillary pattern
• tumor markers: NONE

Question 7

Yolk Sac Tumor

• demographic
• gross
• histo
• tumor markers

Answer 7

Most common GCT in children as PURE FORM (rare to be pure in adults)

• gross: myxoid or gelatinous cut surface
• histo: microcystic (less pleomorphism) but many patterns possible; SCHILLER DUVAL BODY (central vessel, stroma, tumor cells, sac, tumor cells)
• markers: AFP, Glypican 3

Question 8

Choriocarcinoma

• demographic
• gross
• histo
• tumor marker

Answer 8

• 20-30yo, rare aggressive type
• gross: hemorrhagic mass (mimics uterus morphology)
• histo: 2 cell types: syncytiotrophoblasts (invade blood vessels and cause hemorrhage) and cytotrophoblasts
• markers: hCG (from syncytiotrophoblasts)

Question 9

Teratoma: immature vs. mature

What molecular genetics are seen in >80% of Testicular GERM CELL TUMORS?

Sex Cord Stromal Tumors: types, tumor markers

Answer 9

Immature: many poorly differentiated cells (cannot make out structure), any teratoma with immature component
Mature: malignant tissue mimicking skin/GI tract glands

Genetics: i(12p): duplication of short arm Ch12, no correlation with prognosis

Sex Cord Stomal: mostly benign, INHIBIN POSITIVE

• Leydig Cell Tumor: well defined nodules
• Sertoli Cell Tumor: yellow cut surface (high lipid content), high tumor cell nests with clear cytoplasm

Question 10

Lymphoma

• demographics
• histo
• gross

Metastasis
- common location from

Answer 10

Demo: old age (60-80yo)
Histo: tubule-sparing, no lymphocytes (usually LARGE B cell lymphoma), no clear/abundant cytoplasm (tumor cells are B cells)
Gross: no discrete mass (diffuse)

Mets: common from prostate