B/ 94 Tumors of testis and epididymis Flashcards
Classification of testicular neoplasms
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.
Seminoma - Gross appearance
Homogenous gray-white, lobulated and a bulging cut surface. Well demarcated. Necrotic foci can be present.
Seminoma - Microscopy
Large uniform cells with clear glycogen-rich cytoplasm. The cells have distinct borders with round nuclei and prominent nucleolus.
Seminoma - additional info
Most common germ cell tumor. May release hCG.
Embryonal carcinoma - Gross appearance
Poorly demarcated borders, invasive with variable size. Might contain foci of necrosis and hemorrhage.
Embryonal carcinoma - Microscopy
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.
Embryonal carcinoma -additional info
Most of them lead to elevate hCG or alpha fetoprotein concentrations.
Yolk sac tumors - Gross appearance
Large and well demarcated
Yolk sac tumors - Microscopy
Cuboidal-columnar cells which form cysts, glands, paillae and sheets. They are often associated with hyaline globules.
Shiller-Duval bodies: structures resembling primitive glomeruli !
Yolk sac tumors - additional info
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.
Choriocarcinoma - Gross appearance
Small - lol
Choriocarcinoma - Microscopy
Cyto- and syncytiotrophoblastic cell differentiation. Placental villi are seen.
Choriocarcinoma - additional info
Elevated hCG
Teratoma - Gross appearance (quite fitting)
Tissue from all three germ layers, with varying degrees of differentiation.
Teratoma - additional info
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
Mixed germ cell tumors - Gross appearance
Combination of any of the other tumors described
Mixed germ cell tumors - additional info
Many have elevated hCG
Clinical features of tumors of the testes
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.
Staging of tumors of the testis
I: Tumor is confined to the testis
II: regional lymph node metastasis
III: non-regional lymph node involvement
Treatment of germ cell neoplasms
Seminomas are radiosensitive, chemotherapy can also be used.
Non-seminomas can be treated with platinum-based chemotherapy regimens.
Tumor of the epididymis
Adenomatoid tumor
Adenomatoid tumor - Etiology
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.
Adenomatoid tumor - treatment
Resection is curative
Adenomatoid tumor - Gross appearance
Circumscribed gray-white mass up to 5cm, may appear cystic.
Adenomatoid tumor - Microscopy
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.
