B/ 94 Tumors of testis and epididymis

Question 1

Classification of testicular neoplasms

Answer 1

Can be stromal or germ cell tumors.
Germ cell tumors can be divided into seminoma or non-seminoma.
Non-seminomas are embryonal cell carcinomas - The embryonal cell carcinomas can follow the somatic cell lines forming teratomas, or they can become extra-embryonic and form yolk sac tumors or choriocarcinoma.

Question 2

Seminoma - Gross appearance

Answer 2

Homogenous gray-white, lobulated and a bulging cut surface. Well demarcated. Necrotic foci can be present.

Question 3

Seminoma - Microscopy

Answer 3

Large uniform cells with clear glycogen-rich cytoplasm. The cells have distinct borders with round nuclei and prominent nucleolus.

Question 4

Seminoma - additional info

Answer 4

Most common germ cell tumor. May release hCG.

Question 5

Embryonal carcinoma - Gross appearance

Answer 5

Poorly demarcated borders, invasive with variable size. Might contain foci of necrosis and hemorrhage.

Question 6

Embryonal carcinoma - Microscopy

Answer 6

Large primitive cells with basophilic cytoplasm. They have indistinct cell borders and large nuclei with prominent nucleolus. Cells may form solid sheets, glandular or papillary patterns.

Question 7

Embryonal carcinoma -additional info

Answer 7

Most of them lead to elevate hCG or alpha fetoprotein concentrations.

Question 8

Yolk sac tumors - Gross appearance

Answer 8

Large and well demarcated

Question 9

Yolk sac tumors - Microscopy

Answer 9

Cuboidal-columnar cells which form cysts, glands, paillae and sheets. They are often associated with hyaline globules.
Shiller-Duval bodies: structures resembling primitive glomeruli !

Question 10

Yolk sac tumors - additional info

Answer 10

Most common primary testicular tumor in children younger than 3 years of age. In adults it is often admixed with embryonal carcinoma. They release alpha fetoprotein.

Question 11

Choriocarcinoma - Gross appearance

Answer 11

Small - lol

Question 12

Choriocarcinoma - Microscopy

Answer 12

Cyto- and syncytiotrophoblastic cell differentiation. Placental villi are seen.

Question 13

Choriocarcinoma - additional info

Answer 13

Elevated hCG

Question 14

Teratoma - Gross appearance (quite fitting)

Answer 14

Tissue from all three germ layers, with varying degrees of differentiation.

Question 15

Teratoma - additional info

Answer 15

In males: In childhood they are benign, in adults they are malignant.
In females: In childhood they are malignant, in adults they are benign.
Some teratomas give an elevated hCG and AFP

Question 16

Mixed germ cell tumors - Gross appearance

Answer 16

Combination of any of the other tumors described

Question 17

Mixed germ cell tumors - additional info

Answer 17

Many have elevated hCG

Question 18

Clinical features of tumors of the testes

Answer 18

Seminoma are often confined to the testis for a prolonged time and can reach considerable size before diagnosis. Metastasis usually to lymph nodes, hematogenous spread occurs later.
Non-seminomas tend to metastasize earlier by both the lymphatic and hematogenous routes. Hematogenous metastasis is usually to the liver and lungs.

Question 19

Staging of tumors of the testis

Answer 19

I: Tumor is confined to the testis
II: regional lymph node metastasis
III: non-regional lymph node involvement

Question 20

Treatment of germ cell neoplasms

Answer 20

Seminomas are radiosensitive, chemotherapy can also be used.

Non-seminomas can be treated with platinum-based chemotherapy regimens.

Question 21

Tumor of the epididymis

Answer 21

Adenomatoid tumor

Question 22

Adenomatoid tumor - Etiology

Answer 22

Most common tumor of the epididymis. Usually occurs at age 20-40 years. Often painful. Similar tumors can form in the spermatic cord, ejaculatory ducts, Fallopian tubes and uterus. Mesothelial origin.

Question 23

Adenomatoid tumor - treatment

Answer 23

Resection is curative

Question 24

Adenomatoid tumor - Gross appearance

Answer 24

Circumscribed gray-white mass up to 5cm, may appear cystic.

Question 25

Adenomatoid tumor - Microscopy

Answer 25

Unencapsulated, cuboidal to flat cells which form cords that are either epithelial-like or form channels with dilated lumina simulating vessels: the cells have cytoplasmic vacuoles.