Testicular germ cell tumors

Question 1

Seminoma

Answer 1

Malignant; painless, homogenous testicular enlargement; most common testicular tumor, mostly affecting males age 15-35. Large cells in lobules with watery cytoplasm and a “fried egg” appearance. Increased placental alkaline phosphatase. radiosensitive. late metastasis, excellent prognosis

Question 2

Yolk sac (endodermal sinus) tumor

Answer 2

Yellow, mucinous. Analogous to ovarian yolk sac tumor. Schiller-Duval bodies resemble primitive glomeruli (increased AFP)

Question 3

Choriocarcinoma

Answer 3

Malignant, increased hCG. Disordered syncytiotrophoblast and cytotrophoblastic elements. Hematogenous metastases to lungs. May produce gynecomastia as hCG is an LH analog

Question 4

Teratoma

Answer 4

Unlike in females, mature teratoma in adult males is more often malignant. Benign in children. Increased hCG and/or AFP in 50% in cases

Question 5

Embryonal carcinoma

Answer 5

Malignant; painful; worse prognosis than seminoma. Often glandular/papillary morphology. Pure embryonal carcinoma is rare; most commonly mixed with other other tumor types. May be associated with increased hCG and normal AFP levels when pure (increased AFP when mixed)