Testicular Germ Cell Tumors Flashcards
Yolk sac (endodermal sinus) tumor
Most common primitive tumor in boys under 3. KIDS. Good prognosis.
Aggressive malignancy of testis, analogous to ovarian yolk sac tumor.
Schiller-Duval bodies resemble primitive glomeruli.
AFP is high.
Remember: Kids chill yellow, mucinous, tasty yolk sacs while their killer waits on a horse behind them with a free pass. (Schiller-Duval)
Seminoma
40% of testicular germ cell tumors. Most common testicular tumor, common in 3rd decade. Never in infancy!
Malignant, painless, homogenous testicular enlargement.
Uniform cells. Large, with fried egg appearance and watery cytoplasm. No hemorrhage or necrosis. Centrally located nucleus containing prominent nucleoli. Stroma with prominent lymphocytic infiltrate.
Increased placental ALP. Radiosensitive.
Late metastasis, excellent prognossis. Metastasis is lymphatic before hematogenous.
Remember: Men in uniforms cooked fried eggs with semolina in the ALPS.
Choriocarcinoma
Malignant. WORST prognosis!
Disordered syncytiotrophoblastic and cytotrophoblastic elements - must have both.
Hematogenous metastases to the lungs and brain, so may present with hemorrhagic stroke, gynecomastia, or sx of hyperthyroidism since hcg is a lh and tsh analog.
Remember: Corey has malignant hiccoughs (hcg).
Teratoma
Males of all ages affected.
Unlike in females, mature teratoma in males may be malignant. All tissue derivatives.
Increased afp or hcg in 50%.
Prognosis is good - benign in children and malignant in adults, usually scc.
Remember: teratoma –> teradoma–> adam–> bad
Embryonal carcinoma
20-25 years old.
Bulky tumor with Hemorrhage and Necrosis! Painful. Often glandular or papillary morphology. Commonly mixed with other tumor types.
Prognosis: intermediate, less radiosensitive than seminomas.
Metastasis: hematogenous before lymphatic!
May be associated with increased hcg and normal afp levels when pure (increased afp when mixed)
Remember: the teens touched the burning embers and started to bleed; some were ok, some were not.
Metastasis of testicular tumors?
Remember OAT - both ovaries and testes metastasize to the para-aortic nodes.
Risk factors for testicular germ cell tumors
Cryptorchidism, Klinefelter syndrome, Peutz-Jeghers syndrome (hamartomatous polyps in the GI Tract)
Leydig cells
Contain Reinke crystals.
Usually androgen producing. Gynecomastia in men. Precocious puberty in boys. Golden brown color.
Remember: ladies have boobs (gynecomastia). Ladies like crystals (even golden-brown ones).
Remember the original mnemonic: leydig –> ladies test men (testosterone) for their internal qualities and external deeds (DHT).
Sertoli cell
Androblastoma from sex cord stroma, has gray-white structures resembling semineferous tubules.
Testicular lymphoma
Most common testicular cancer in older men, over 60 years old.
Secondary involvement of both testes by diffuse large cell lymphoma. Prognosis is poor. Aggressive tumor.
