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Reproductive-Breast > Testicular Cancers > Flashcards

Testicular Cancers Flashcards

1
Q

Etiology of testicular cancer

Congenital

A
  • 3-14 times more likely in undescended testes
  • Abnormal germ cell morphology
  • Gonadal dysgenesis
  • Elevated temperature
  • Hormonal disease
  • Interferece with blood supply
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2
Q

Etiology of testicular cancer

Aquired

A
  • Trauma
  • Hormonal fluctuation
  • Infections→MUMPS induced atrophy
    • ​in addition to non specific infections
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3
Q

Testicular tumors

Risk factors

A
  • Cryptorchidism
    • 10% of tumors with the risk increasing the higher up the testes are in the abdomen
  • Genetics
    • Whites are 5X more succeptible than blacks
  • SIblings of patients are 10X more at risk
  • Kleinfelter syndrome
  • Li-Fraumeni syndrome
  • Prior testicular germ cell/intratubular tumor
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4
Q

Genetic marker for all germ cell tumors

A

Isochrome of the short arm of ch 12 ie i12p

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5
Q

Genetic marker for Intratubular germ cell tumor

A

66% have alteration in p53 locus

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6
Q

Familial cases are linked to

A
  • Tyrosine kinase receptor→KIT and BAK
    • ​involved in gonadal development
  • Transcription factors→OCT3/4 and NANOG
    • ​maintain pluripotent stem cells
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7
Q

Incidence of testicular cancer

A

AGE

Most common solid tumor 20-30

RACE
Whites are 4-5 times more likely

SIDE

Right>left

SES

High SES are twice as likely

Geographical

Highest in Scan ger and swis

Intermediate in UK and US

Low in africa and asia

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8
Q

Lymphoma common in which age group

A

>50

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9
Q

Yolk sac tumor common in which age group

A

Infancy and childhood

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10
Q

Pure teratoma common in which age group

A

Pediatric

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11
Q

Lymphatic spread of RIGHT tumor

A

Inter aortocaval at L2 →precaval→preaortic→right common iliac→right external iliac

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12
Q

Left testicular cancer lymphatic spread

A

paraaortic at renal hilum→preaortic→common iliac→left external iliac

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13
Q

Blood metastatsis

A
  1. Lung
  2. Liver
  3. Brain
  4. Bone
  5. Kidney
  6. Adrenal
  7. GIT
  8. Spleen
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14
Q

Haematological investigatons

A
  • Hb
  • Blood urea or serum creatnine
  • LFT
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15
Q

Tumor markers

A
  • AFP (elevated in NSGCT ONLY)
  • Beta-HCG (elevated in NSGCT and SGCT)
  • LDH (elevated in NSGCT and SGCT)
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16
Q

Scrotal ultrasound in testicular cancer

A
  • Homogenous
  • Hypoechoic
  • Itratesticular mass
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17
Q

Investigations for staging

A

CXR

CT/MRI of abdomen

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18
Q

Boden and Gibbs

Stage 1(A)

A
  • Confined to testis
  • NO spread to capsule nor spermatic cord
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19
Q

Boden and Gibbs

Stage 2 (B)

A
  • Clinical/radiological evidence of spread beyond testis but WITHIN REGIONAL LN

B1 <2cm

B2 2-5cm

B3 >5cm

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20
Q

Boden and Gibbs

Stage 3 (C)

A

VIsceral disease ie above diaphragm

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21
Q

Incidenc of testicular tumors

A
  • <1% of malignancies in males; hughly curable regardless of stage
  • 95% are germ cell tumors
  • 5% sex cord stromal cells
    • bening mostly
    • maybe associated withwith hormonal syndromes
22
Q

Intratubular germ cell neoplasia

IGCN

A
  • In situ stage of germ cell neoplasia
  • Seen in 90-100% of testes adjacent to germ cell tumor
  • Less often in childhood yolk sac and teratomas
23
Q

Germ Cell Tumors

A
  • Seminoma
  • Embryonal carcinoma
  • Yolk sac tumor
  • Choriocarcinoma
24
Q

Sex cord stroma

A
  • Leydig cell tumor
  • Sertoli cell tumor
25
Q

Mixed germ cell- gonadal stromal tumors

A

Gonadoblastoma

  • rare
  • associated with testicular dysgenesis
    • cryptorchidism
    • hypospadias
    • poor sperm quality
26
Q

Seminoma

Epidemiology

A
  • Most common tumor in 25-29 yrs
  • Account for 50% of germ cell tumors
  • 1-2% bilateral
  • 15% are bilateral if both testes are undescended

NOTE: identical to ovarian dysgerminoma

27
Q

Seminoma

Origin

A

Arises from intratubular germ cell neoplasia

EXCEPT

Adult spermatocytic seminoma variant

28
Q

Seminoma

Genetics

A
  • Isochrome 12p
  • Express OCT3/4 and NANOG
  • 25% have KIT activating mutations
29
Q

Seminoma

Gross description

A
  • Bulky
  • Homogenous
  • Grey-white
  • Well circumscribed
  • Lobulated, bulging surface
  • NO (usuallly)
    • hemorrhage
    • cystic changes
    • extensive necrosis
  • INASION
    • <10% invade tunica albuginea
    • rarely extend to epididymis, spermatic cord, scrotal sac
30
Q

Seminoma

Microscopic description

A
  • Sheets of uniform tumor cells
  • Divided into poorly demarcated lobules
    • by delicate fibrous septa
    • Lobules contain lymphocytes and plasma cells
  • Cells are
    • large
    • round-polyhedral
    • distinct cell membranes
    • abundant clear/watery cytoplasm
    • large central nuclei
    • 1-2 irregular elongated nucleoli
    • minimal mitotic figures
31
Q

Seminoma

Positive for

A
  • KIT
  • OCT4
  • Placental alkaline phosphatase (PLAP)
32
Q

Embryonal Carcinoma

Epidemiology

A
  • Pure tumors: 2% of germ cell tumors
  • 85% mixed with seminoma
  • 65% already met at time of diagnosis
    • frequent extension though tunica albuginea to epidiymis and cord
33
Q

Embryonal Carcinoma

Gross appearance

A
  • Replace only small portion of testes
  • Variegated or pale gray
  • Poorly demaracted
  • Hemorrhage
  • Necrosis
34
Q

Embryological Carcinoma

Markers

A

OCT3/4

PLAP

CD30

CK

NEGATIVE FOR KIT

35
Q

Embyological Carcimoma

Histological appearance

A
  • Solid
  • Pseudoglandular, alveolar, tubular or papillary
  • Primitive epithelial type
  • HIgh grade features
    • prominent nucleoli
    • indistinct cell borders
    • nuclear overlapping
    • Pleomorphism
    • Frequent mitoses
36
Q

Yolk sac Tumor

Epidemiology

A
  • Most common testicular tumor at age _<_3
    • oftern pure→good prognosis
  • In adults→ part of mixed tumor→prognosis of embryonal carcinoma
37
Q

Yolk sac tumor

Marker

A

>95% positive for alpha feto protein

38
Q

Yolk sac tumor

Gross

A
  • Non-encapsulated
  • Homogenous
  • Yello-white
  • Mucinous
  • Soft
  • Multicystic
39
Q

Yolk sac tumor

Microscopic features

A
  • Lace like→reticular
  • Papillary
  • Cord like pattern of cuboidal/elongated cells
  • Schiller Duval Bodies
    • ​50%
    • central capillay
    • visceral and parietal layer of cells resembling primitive glomeruli
  • Eosinophilic hyaline globules
    • AFP
    • a1 antitrypsin

NOTE: Intratubular germ cel neoplasia may be seen after puberty

40
Q

Teratoma

Epidemiology

A
  • 2-3% of germ cell tumors of adults
  • 2nd to yolk sac in children
  • 45% mixed with other GCTs
  • Benign in prepubertile
  • Malignant postpubertile
41
Q

Teratoma

Gross appearance

A
  • Contain cellular components derived from 2-3 germ cell layers
    • If contains all three→mature
  • Large
  • Multinodular
  • Heterogeous
    • solid
    • cartilaginous
    • cystic
  • May have hair, bone, teeth
42
Q

Immatrure teratoma

Histo

A
  • Neuroepithelium
    • foci resembeling embryo/fetal structures
    • cytological atypia
    • includes primitive neuroectoderm
    • poorly formed cartilage
    • neuroblast
    • loose mesenchyme
    • primitive glandular structures
  • High vs low grade
    • based on cellularity and mitotic activity
43
Q

Choriocarcinoma

Epidemiology

A
  • 0.3% to 1% of GCTs
    • pure→FATAL
    • gestational CC→curable with chemo
  • mixed→98%
    *
44
Q

Choriocarcinoma

Metastasis

A
  • Present with metastasis from get go
  • liver
  • lung
  • brain
  • mediastinum
  • retroperitoneum

NORMAL TESTIS or small tumor

HIGH SERUM HCG

45
Q

Choriocarcinoma

Gross

A
  • hemorrhagic
  • necrotic mass
46
Q

Choriocarcinoma

Micro

A
  • Hemorrhage
  • Necrosis
  • Cytotrophoblast
    • polygonal/round cell
    • distict cell border
    • clear cytoplasm
    • single bland nucleus
  • Syncytiotrophoblast
    • Large
    • multinucleated
    • eosinophilic cytoplasm
  • INTRATUBULAR GERM CELL N. common in adj testis
47
Q

Clinical aspect of Sex cord-stromal tumors

A
  • Non germinative stromal cells
  • Leydig mosty common
  • Some in context of AIS
    • tumor like lesion as part of syndrome
  • Uncommon in adults
  • 30% of tumors of infants, cjildren
  • Wide range and clinically distinct
  • Biologically distinct
48
Q

Leydig cell tumor

A
  • 1-3%
  • 10% malignant
  • Produce T, DHT, Androstendione and estrogen
  • Present with precocious puberty or gynecomastia
  • Most often present with testicular swelling
  • Well circumscribed
  • encapsulated
  • homogenous yellow or mahogany
49
Q

Leydig cell tumor histo

A

Reinke crystalloids

  • Solid nests of uniform cells
  • Vesicular round nuclei
  • Prominent nucleoli
  • Well developed eosiniphilic cytoplasm
50
Q

Sertoli cell tumor

A
  • 1% in all age groups
  • Occurs in children 15% of cases and middle age adults
    • 10% malignnat
  • Part of AIS, Carney’s Complex, Peutz-Jegher’s syndrome
  • Present with feminization and gynecomastia
    • 25%
  • Gross
    • ​spherical
    • lobulated
    • well circumsribed
    • tan yellow or grey
51
Q

Sertoli cell tumor

Micro

A
  • Arranged in solid or hollow tubules separated by basement membrane
  • Cytoplasm
    • eosinophilic to vacuolated due to lipid
  • Bland and uniformly round
    • oval or elongated nucle
  • NO
    • prominent nucleoli
    • nuclea grooves
    • inclusions
    • RARE mild nuclear atypia and pleomorphism

Reproductive-Breast (4 decks)

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