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RGU Exam 3 > Pathology of Testes > Flashcards

Pathology of Testes Flashcards

1
Q

Testicular tumors

A
  • 2 major types
  • Germ cell tumors: seminomas and non-seminomas
  • Sex cord-stromal tumors: generally benign
  • 95% arise from germ cells which are aggressive and can spread rapidly
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2
Q

Germ cell tumors

A
  • Occurs most commonly b/w 15-34
  • Cause approx. 10% of all cancer deaths
  • In the US more common in whites than in blacks
  • Testicular genesis syndrome: cryptochordism, hypospadius, and poor sperm quality
  • Cryptorchidism: is an important risk factor for testicular tumors
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3
Q

Seminomatous tumors

A
  • Germ cell tumor
  • Tumors are composed of cells that resemble primordial cells or early gonocytes
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4
Q

Non-seminomatous tumors

A
  • Germ cell tumors
  • Tumors are composed of undifferentiated cells that resemble embryonic stem cells but the malignant cells can differentiate into various lineages generating yolk sac tumors, choriocarcinomas and teratomas
  • Germ cell tumors may have a single tissue component but in ~60% of cases tumors contain mixtures of seminomatous components and non-seminomatous components
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5
Q

Germ cell tumors histological characteristics

A
  • Lesion consists of atypical germ cells w/ large nuclei and clear cytoplasm which are about twice the size of normal germ cells
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6
Q

Germ cell tumors genetic mutations

A
  • Cell retain the expression of the transcription factors OCT3/4 and NANOG which are assoc. w/ pluripotentiality and are expressed in normal embryonic stem cells
  • ITGCN share some of the genetic alterations found in germ cell tumors such as a gain of additional copies of the short arm of chromosome 12 which is a change found in invasive tumors regardless of histologic type
  • Activating mutations of c-KIT which are present in seminomas are also present in ITGCN
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7
Q

ITGCN

A
  • Intratubular germ cell neoplasia; precursor to germ cell tumors
  • Most germ cell tumors arise from these lesions
  • Believed to occur in utero and to stay dormant until pubery when it may progress into seminomatous or non-seminomatous tumors
  • ~50% of males w/ ITGCN develop invasive germ cell tumors within 5yrs after diagnosis
  • It may hold true that all pts w/ ITGCN eventually develop invasive tumors
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8
Q

Chromosome mutation that plays a role in a lot of testicular tumors

A
  • Chromosome 12 mutations
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9
Q

Seminomas

A
  • Most common type of germ cell tumor making up approx. 50% of these tumors
  • Peak incidence in 3rd decade
  • Contain an isochromosome 12p
  • Express OCT3/4 and NANOG markers
  • 25% of tumors have c-KIT activating mutations
  • Bulky masses may be 10x the size of the normal testis
  • Homogenous, white, lobulated cut surface usually w/o hemorrhage or necrosis
  • Approx. 15% contain syncytiotrophoblasts w/ elevation of serum human chorionic gonadotropin (HCG) lvls
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10
Q

Seminomas histological characteristics

A
  • Microscopically the tumor is composed of sheets of uniform cells divided into lobule by fibrous septae containing a moderate amt of lymphocytes
  • Seminoma cells are large round to polyhedral w/ a prominent nucleus, a prominent nucleolus, clear cytoplasm and well defined cell borders
  • Mitoses vary in freq.
  • Cytoplasm contains glycogen
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11
Q

Seminoma-nests separated by fibrous septae w/ lymphocytes histology slide

A
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12
Q

Seminoma-large nuclei, large nucleoli, clear cytoplasm, lymphocytes histology slide

A
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13
Q

Seminoma staining

A
  • CD 117
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14
Q

Seminoma genetic mutations

A
  • Diffusely pos. for c-KIT, OCT4, and placental alkaline phosphatase (PLAP) markers

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15
Q

Anaplastic seminoma

A
  • Has greater cellularity and nuclear irregularity w/ more freq. mitoses, and tumor giant cells but IS NOT assoc. w/ a worse prognosis
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16
Q

Seminoma-trophoblastic giant cells histology slide

A
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17
Q

Spermatocytic seminoma

A
  • Distinctly diff. from classic seminoma both histologically and clinically
  • Uncommon, about 1-2% of testicular germ cell tumors
  • Age of involvement much later in life, usually over the age of 65yrs
  • Slow growing tumor that does not cause metastasis w/ an excellent prognosis
  • Lakc lymphocytes, granulomas, syncytiotrophoblasts, extra-testicular sites of origin, admixture w/ other germ cell tumors, and assoc. w/ ITGCN
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18
Q

Spermatocytic histological appearance

A
  • Soft gray surface that sometimes has mucoid cysts
  • Contain 3 cell pop., all intermixed
  • Medium sized cells most of which have a round nucleus and eosinophilic cytoplasm
  • Smaller cells w/ a narrow rim of eosinophilic cytoplasm
  • Scattered giant cells
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19
Q

Spermatocytic seminoma intratubular growth histology slide

A
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20
Q

Spermatocytic seminoma-medium cells and giant cells histology slide

A
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21
Q

Embryonal carcinoma

A
  • Seen mostly in the 20-30’s
  • More aggressive than seminomas
  • Smaller than seminomas and does not usually replace the entire testis
  • Mass is variegated and poorly demarcated at the margins
  • Contains foci of hemorrhage and necrosis
  • Extension to the tunica albuginea into the epididymis or cord often occurs
22
Q

Embryonal carcinoma histological characteristics

A
  • Cells grow in an alveolar or tubular pattern sometimes w/ papillary convolutions
  • Lack well formed glands w/ basally situated nuceli and apical cytoplasm seen in teratoms
  • More undifferentiated lesions may have sheets of cells
  • Neoplastic cells have an epithelial apperance are large and anaplastic w/ hyperchromatic nuclei and prominent nucleoli
  • Cell borders are indistinct w/ marked variation in cell and nuclear shape
  • Mitotic figures and tumor giant cells are common
  • Markers: OCT3/4, PLAP, CD30 and cytokeratin
  • Neg. for c-KIT
23
Q

Embryonal carcinoma gross appearance image

A
  • Nodular surface w/ necrosis and hemorrhage
24
Q

Embryonal carcinoma diffuse pattern of growth histology slide

A
25
Q

Embryonal carcinoma characteristic cells histology slide

A
26
Q

Yolk sac tumor

A
  • AKA endodermal sinus tumor
  • Most common testicular tumor in infants and children up to 3
  • In the young age grp it has a good prognosis
  • In adults a pure yolk sac tumor is rare and is usually mixed w/ embryonal carcinoma
  • Tumor is nonencapsulated
27
Q

Yolk sac tumor histological characteristics

A
  • Has a homogenous yellow white mucinous appearance
  • Has a lacelike network of medium-sized cuboidal or flattened cells
  • Other patterns include papillary structures and solid cords of cells
  • In approx. 50% of cases structures resembling endodermal sinuses are seen these are called Schiller-Duval bodies
  • Present within and outside of the cytoplasm are eosinophilic, hyaline-like globules containing alpha-fetoprotein (AFP) and alpha one antitrypsin
28
Q

Schiller-Duval bodies

A
  • Present in ~50% of yolk sac tumors
  • Structures resembling endodermal sinuses
  • Consist of a mesodermal core w/ a central capillary and a visceral and parietal layer of cells resembling primtive glomeruli
  • Central blood vessel surrounded by neoplastic cells w/ a space surrounded by more neoplastic cells
29
Q

Yolk sac tumor histology slide

A
30
Q

Choriocarcinoma

A
  • Highly malignant tumor
  • Rare in its pure form
  • Often cause no testicular enlargement and form a small palpable nodule
  • Rarely larger than 5cm
  • Hemorrhage and necrosis is very common
  • Tumors contain 2 cell types: syncytiotrophoblastic cells and cytotrophoblastic cells
31
Q

Syncytiotrophoblastic cells

A
  • 1 of 2 types of cells present in choriocarcinomas
  • Large w/ many irregular and lobular hyperchromatic nuclei and abundant eosinophilic vacuolated cytoplasm w/ HCG in the cytoplasm
32
Q

Cytotrophoblastic cells

A
  • 1 of 2 types of cells present in choriocarcinomas
  • More regular, polygonal w/ distinct cell borders and clear cytoplasm growing in cords or masses w/ a single, uniform nucleus
33
Q

Choriocarcinoma histology slide

A
34
Q

Teratoma

A
  • Has various cellular and organoid components similar to more than 1 germ cell layer
  • Can occur at any age from infancy to adult life
  • Pure forms of teratoma are common in infancy and children
  • In adults pure forms are rare but may have teratomas mixed w/ other germ cell tumors
  • Usually large, from 5-10cms
35
Q

Teratoma histological characteristics

A
  • Heterogeneous gross appearance
  • Solid and cystic areas
  • Composed of cartilage, neuronal tissue, squamous cells, muscle, thyroid tissue
  • Elements may be mature resembling adult tissues or immature resembling fetal or embryonal tissue
36
Q

Mature teratoma

A
  • All tissues are well differentiated
37
Q

Immature teratoma

A
  • Immature tissue in the stroma, epithelium, or neural component
38
Q

Teratoma w/ malignant transformation

A
  • Malignancy in derivative of one or more germ cell layers such as squamous cell ca, adenocarcinoma or sarcoma
39
Q

Mature teratoma histology slide

A
40
Q

Immature teratoma histology slide

A
41
Q

Teratocarcinoma

A
  • Mixture of teratoma and embryonal carcinoma
  • Gross features may include multicystic areas, solid, hemorrhagic and necrotic foci in the areas of embryonal carcinoma
  • The teratoma may be mature or immature
  • Term is falling into misuse
  • Usually designated as a NSGCT listing the relative components
42
Q

Clinical features of germ cell tumors

A
  • Painless enlargement of the testis
  • Treatment is orchiectomy
  • Lymphatic spread to para-aortic nodes, may spread to mediastinum and supraclavicular nodes
  • Hematogenous spread to lungs, liver and brain
  • Histology of metastasis may be different from the original testicular lesion
  • Tumors are diagnosed into broad categoreis seminoma and nonseminomatous germ cell tumors (NSGCTs)
  • Most NSGCTs are more aggressive and have a poorer diagnosis compared to seminomas
43
Q

Germ cell tumor markers

A
  • May secrete biological markers such as HCG, AFP and lactate dehydrogenase
  • These markers can aid in evaluating tumor masses, staging of tumors, assessing tumor burden, monitoring response to tumor therapy
44
Q

Germ cell tumor treatment

A
  • Prognosis and therapy depend on histologic type and clinical stage
  • Seminomas are radiosensitive and remain localized for long periods
  • NSGCTs need aggressive chemotherapy
45
Q

Sex cord-gonadal tumors

A
  • Leydig cell tumors
  • Sertoli cell tumors
46
Q

Leydig cell tumors

A
  • Can arise at any age but mostly b/w 20-60
  • Most common feature is testicular swelling
  • May elaborate androgens and estrogens or corticosteroids
  • Initial sign may be gynecomastia or sexual precocity
  • Usually <5cm

- Most tumors are benign

  • ~10% are invasive
47
Q

Leydig cell tumors histological characteristics

A
  • Golden brown color w/ a homogeneous cut surface
  • Histologically similar to their normal counterparts, round, polygonal w/ an abundant granular eosinophilic cytoplasm and a round central nucleus
  • The cytoplasm has lipid granules, vacuoles or lipofuscin pigment
  • Reinke crystals: rod shaped crystals
48
Q

Leydig cell tumor histology slide

A
49
Q

Sertoli cell tumors

A
  • Most present as a testicular mass
  • Most are hormonally silent
  • Most are benign
  • Less than 10% are malignant
50
Q

Sertoli cell tumor histological characteristics

A
  • Firm, small nodules w/ a homegeneous gray-white cut surface
  • Cells arranged in trabeculae that form cordlike structures and tubules
51
Q

Setoli cell tumor histology slide

A

RGU Exam 3 (19 decks)

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