Neoplastic Diseases Of The Testies

Question 1

Testicular neoplasm demographics

Answer 1

Occur in roughly 6:100,000 males

Most common age group is 15-34 yr olds
- more common in whites than in blacks

95% of testicular tumors arise form germ cells and are all malignant
- 5% are made from sertoli or leydig cells and are benign

Intersex syndromes presence (androgen insensitivity and gonadal dysgenesis) increases risks

3-5x increase risk with cryptochidism
- Makes up roughly 10% of cases

8-10x increase risk if family history is positive for testicular cancer

Development of cancer in one testie makes the risk of getting cancer in the either one markedly increased

Question 2

What is the chromsome mutation seen in virtually all germ cell tumors in the testes?

Answer 2

Isochromosome 12

- extra copies of the chromosome 12 short arm

Question 3

Germ cell in situ

Answer 3

Most common type of testicular tumors in post-pubertal males

Can be differeniated in two sub types

1) seminomas
2) non seminomas

Most are “pure” and only contain 1 histological type
- 40% = mixed though

Question 4

Seminoma

Answer 4

Most common type of testicular cancer and are carcinoma in situ
- very rarely metastasis and gets very large before its even possible

Histologically similar to dysgerminomas which occur in ovaries

Are soft well-demarcated gray-white tumors that may or may not contain coagulative necrosis

Histology = large uniform cells with distinct cell borders

• contains glycogen rich cytoplasm with round nuceli that are often arrayed in small “lobules with fibrous septa”
• can cause granulomatous reactions and see granulomas occasionally

Question 5

Spermatic seminoma

Answer 5

Rare slow growing non seminoma germ cell tumor

Affects older males (>65)
- represents 1-2% of all testicular germ cell tumors

Prognosis is excellent since this tumor NEVER metastasis

Contains 3 types of cells

• 1) small cells: narrow rim of eosinophil cytoplasm
• 2) medium sized cells containing rounded nuceli and eosinophilic cytoplasm
• 3) scatted giant cells

Question 6

Embryonal carcinoma

Answer 6

20-30yr old usually noon seminoma germ cell tumors

Are very aggressive

Often extend through the tunica albuginea and epididymis with foci of hemorrhages or necrosis ]

Histology = shows papillary/alveolar and tubular patterns of cells

• when neoplastic may show epithelial appearance with hyperchromatic nuceli
• also often can see giant cells

Question 7

Yolk sac tumors

“Endodermal sinus tumor”

Answer 7

Non seminoma germ cell tumor of the testes that occurs in patients 3 and younger (infants and children)

**Usually very good prognosis
90% of patients have elevated alpha-feta protein levels*

Are nonencapsulated and homogeneous yellow-white tumors
- are composed of lace like network of medium sized cuboidal cells

50% of tumors show “Schiller-Duval bodies” which look like primitive glomerulonephritis

Question 8

Choriocarcinoma

Answer 8

Is a non seminoma germ cell tumor of the testes

Is highly malignant and very dangerous

Usually seen in 20-30 yr range

100% of patients elevate hCG

**almost never shows testicular enlargement and are instead only small palpable nodules

Histology shows two types of cells

• syncytiotrophoblasts = large multinucleated cells with abundant eosinophil vacuoles cytoplasm. They contain hCG vacuoles
• cytotrophoblast = polygonal clear cytoplasms with a single nuceli

Question 9

Teratoma

Answer 9

A germ cell non seminoma tumor of anywhere in the body (including testes)

Can be found at any age
- much more common in infants and children (2nd most common behind yolk sac)

Tissues contain all three germ layers with Variable differentiation

• pure teratoma =5%( no tumor markers)
• mixed teratoma = 45% (has tumor markers

Generally larger 5-10cm in diameter

Contains a “helter -skelter” collection of differentiated cells or organic structures (can be really any cell type
- also can mature and obvious what cell types or immature and looks like embryonic tissues

Question 10

Mixed tumors

Answer 10

Compose of 60% of germ cell tumors

Is a mixture of any germ cell tumor. Common species that are mixed:

• teratoma
• caricnomas
• yolk sac tumors
• seminoma

Question 11

Clincial features of testicular cancer

Answer 11

Painless testicular masses that are NONtransulcent (differs from hydrocele)

almost are never biopsy since this risks malignancy spread. Therefore if you have strong clincial suspicion = radical orchiectomy

Question 12

hCG levels are eleavted in what tumors

Answer 12

Choriocarcinoma = 100%

Seminoma = 10%

Question 13

AFP is increased in what testicular tumors?

Answer 13

Yolk sac tumor = 90%

Question 14

Cure rates for germ cell tumors

Answer 14

Seminoma = 95% chance to be cured as long as its early stage

Non-seminoma germ cell tumors = 90% chance to cure with aggressive chemo as long as its early

• **histological subtype does NOT influence treatment
• the exception is Choriocarcinoma which si always poor prognosis

Question 15

Leydig cell tumors

Answer 15

Are usually small “golden-brown” nodules less than 5 cm in diameter.
- 10% chance to metastasis but 90% ar benign

Most common ages are 20-60yrs old

Always overproduces androgens (and sometimes estrogen of corticosteroids)

• *often first symptom is gynecomastia and testicular swelling in men**
• if younger than 16 can also show precocious puberty

Tumors look very similar to actual leydig cells except some will show “reinke crystalloid structures”
- the crystalloid structures are pathogenomic

Question 16

Testicular lymphoma

Answer 16

Aggressive non-Hodgkin lymphomas that account for 5% of testicular neoplasms

• ARE THE MSOT COMMON TESTICULAR NEOPLASM OF >60YRS
• oftne is disseminated by diagnosis

Most common types

1) diffuse large B-cell
2) Burkett
3) EBV positive Extranodal NK/T cell lymphoma