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Book - Molavi > Chapter 14 - Testis > Flashcards

Chapter 14 - Testis Flashcards

1
Q

What are the indications for orchiectomy?

A

Tumor

Torsion

Cryptorchidism

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2
Q

At what age range do most testicular tumors occur?

A

Age 20-40

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3
Q

Describe the normal morphology of the testis.

A

A tightly packed collection of tubules lined with spindly, radially arranged sertoli cells and spermatogonia.

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4
Q

Where does spermatic maturation occur?

Where do sperm leave the testis?

A

Maturation is completed near the lumen of the seminiferous tubules.

Sperm leave the testis via the rete testis.

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5
Q

Describe the morphologic appearance of the epididymis.

A

Series of tubules with columnar, pseudostratified ciliated epithelium

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6
Q

Describe the morphologic appearance of a cryptorchid testis.

A

Small atrophic seminiferous tubules with fibrosis and widened interstitial spaces.

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7
Q

What is “vanishing testis syndrome”?

A

When an undescended testis is surgically removed to reveal nothing but fibrosis and dystrophic calcification attached to an epididymal remnant.

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8
Q

What are some possible biopsy findings for infertility?

A

Aplasia (or “sertoli-only” syndrome)

Hypospermatogenesis

Maturation arrest

“End-stage testis” (sclerosis/atrophy, no tubules)

Normal spermatognesis (implies distal obstruction)

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9
Q

Name four types of germ cell tumor.

Which is most common?

A

Seminoma

Embryonal carcinoma

Yolk sac tumor

Choriocarcinoma

*Mixed is most common*

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10
Q

What testicular tumors are most common in young children? Young adults? Older adults?

A

Young children: Yolk sac tumor, teratoma

Young adults: Seminoma, embryonal carcinoma, choriocarcinoma, teratoma

Older adults: Spermatocytic seminoma, lymphoma, sex cord stromal tumors

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11
Q

Say a patient has evidence of a germ cell testicular tumor, but resection reveals a fibrotic scar. How is this explained?

A

Germ cell tumors can regress, leaving behind a fibrotic scar. They could still have metastasized, however.

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12
Q

Describe the morphologic features of seminoma.

A

Array of large, round, coarse nuclei in a network of delicate cell membranes

1-2 prominent central nucleoli

Delicate fibrovascular septae

Associated inflammation and intratubular germ cell neoplasia

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13
Q

What is the appearance and significance of intratubular germ cell neoplasia?

A

Analogous to testicular carcinoma in situ. Can appear subtle, with a few big cells in the tubule or with pagetoid spread. Often found in association with a full-blowm germ cell tumor.

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14
Q

What morphologic features can help distinguish intratubular germ cell neoplasia from spermatogonia?

A

Cytoplasm is more clear

Chromatin is coarser & chunkier

Nuclear membrane is irregular, with prominent nucleolus

Little to no spermatic maturation

c-Kit, OCT3/4, PLAP positive.

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15
Q

What is spermatocytic seminoma? What is unique about it?

A

A low-grade, indolent seminoma in older men. It lacks inflammation and PLAP positivity, and is not found in mixed tumors nor is it associated with IGCN.

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16
Q

Describe the morphologic appearance of an embryonal carcinoma.

A

“The ugly one”, with very pleomorphic cells. Looks epithelioid, and stians with keratins. Architecture is solid, glandular, or papillary.

17
Q

Describe the morphologic appearance of yolk sac tumor.

A

Has many forms, especially microcystic and reticular.

Pathognomonic finding: Schiller-Duval body, a glomeruloid form.

Nuclei are smaller and more regular than embryonal carcinoma but not as regular as seminoma. Somewhat hypocellular and myxoid.

18
Q

Describe the morphologic appearance of choriocarcinoma.

A

Two cell types (cytotrophoblast and syncytiotrophoblast), lots of blood. Very invasive.

19
Q

What are the components of teratoma?

What is the most important consideration in men?

A

Elements of primitive germ layers (ectoderm, mesoderm, endoderm), and can develop tumors

The age of the patient; they are always benign in prepubertal boys and are malignant in postpubertal or adult men.

20
Q

Describe the morphologic appearance of sertoli tumors.

Describe the morphologic appearance of leydig tumors.

A

Sertoli tumor: Collection of primitive tubules lined with spindly cells and oval nuclei.

Laydig tumor: Tumor of oncocytic pink cells with very round nuclei

21
Q

What percentage of sex cord stromal testicular tumors are malignant? How do they appear?

A

10%

Usual criteria apply (atypia, mitotic rate, necrosis, vascular or extratesticular invasion)

22
Q

What should be on your differential for a lesion that resembles a less homogeneous seminoma with vesicular chormatin and large nucleoli?

A

Diffuse large B-cell lymphoma.

23
Q

Where else can germ cell tumors be located, beyond the testis?

A

Mainly in the midline (sacrum, mediastinum, sella turcica, pineal gland).

24
Q

What term is given to a germ cell tumor in the brain?

A

Germinoma

25
Q
A

Normal seminiferous tubule

  1. Large spermatogonia with clear cytoplasm
  2. Spermatids
  3. Plump pink leydig cells in the interstitium
26
Q
A

Rete testis

(slit-like spaces with cuboidal epithelium)

27
Q
A

Normal epididymis

(columnar epithelium with cilia)

28
Q
A

Cryptorchidism (infant)

Arrow: Large, dark spermatogonia

29
Q
A

Sertoli-only syndrome; no germ cells are visible

30
Q
A

Seminoma, classic type

Arrow: Fibrovascular septae with lymphocytes

Circle: Mitoses

Arrowhead: Distinct nuclear membranes with prominent nucleoli

31
Q
A

Intratubular germ cell neoplasia

  1. Large cells with clear halos of cytoplasm
  2. Hyperchromatic nuclei
  3. Normal adjacent endothelium
32
Q
A

Embryonal carcinoma

(large epithelioid pleomorphic cells in sheets)

Arrow: Dark nuclear membranes, prominent nucleoli

33
Q
A

Yolk sac tumor, microcystic pattern

(relatively low-grade, with cuboidal cells with pink cytoplasm)

34
Q
A

Leydig cell tumor

(reminiscent of oncocytoma)

35
Q
A

Sertoli cell tumor

(tumor attempts to recapitulate the seminferous tubules, with hyalinized stroma)

36
Q
A

Diffuse large B-cell lymphoma

(sheets of discohesive tumor cells with chunky nuclear chromatin)

Book - Molavi (29 decks)

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