testicular histopath

Question 1

Answer 1

Question 2

Answer 2

Question 3

Answer 3

Sperm maturation arrest; do not see any 2’ spermatocytes or spermatids towards the center of the seminiferous tubule.

Question 4

Answer 4

Question 5

Answer 5

Cut surface of normal testes

Question 6

Answer 6

Testicular torsion: twisting of the spermatic cord, obstruction of thin-walled veins leads to hemorrhagic infarction; usually due to congenital failure of testes to attach to inner lining of scrotum (within processus vaginalis)

Question 7

Answer 7

Hemorrhagic necrosis seen in testicular torsion

Question 8

Answer 8

Cryptorchidism: undescended testes; fail to descend into scrotal sac;

complications: testicular atrophy, infertility, and increased risk for seminoma (CA).

Question 9

Answer 9

Cryptorchidism: see testicular atrophy (yellow arrow)

Bottom L: normal seminiferous tubule full of developing spermatogonia

Bottom R: cryptorchid seminiferous tubule; see no spermatogonia/spermatids –> infertility

Question 10

Answer 10

Seminoma:

Most common type of GCT

Large uniform “clear cell” tumor cells (red arrows)

Lymphocytic infiltration (green arrow)

Fibrous septa (yellow arrow)

Do NOT have hemorrhage or necrosis

Question 11

Answer 11

Spermatocytic seminoma: rare, seen in older pts (54+), doesn’t arise from intratubular germ cell neoplasia

3 cell types:

1) small lymphocyte-like cells: yellow arrow
2) intermediate cells: red arrow
3) giant cells w/ 1+ nuclei: green arrow

Excellent prognosis; not related to cryptorchidism, serum tumor markers not elevated, usuall bilateral

Question 12

Answer 12

Embryonal carcinoma:

gross path: hemorrhagic, necrotic, poorly circumscribed

histo: large highly pleomorphic cells; lots of pink cytoplasm; overlapping/indistince cell membranes

Poorest prognosis of all GCT’s; see elevated beta-HCG or AFP

Question 13

Answer 13

Embryonal carcinoma w/ papillary growth; large pleomorphic cells, indistince cell membrane, lots of overlap; hemorrhagic

poorest prognosis

Question 14

Answer 14

Yolk sac tumor; most common testicular tumor in kids/infants; see microcystic pattern on histo with multiple intercellular holes (“sieve-like” pattern)

tumors secrete AFP, so see elevated serum levels

Question 15

Answer 15

Yolk sac tumor: relatively uniform cells with clearish pink/vacuolated cytoplasm;

see Shiller-Duval bodies: (yellow arrow) central BV surrounded by tumor cells; looks like primitive glomeruli

Hyaline-like globules: (black arrows) contains AFP and alpha1-antitrypsin

Question 16

Answer 16

Mature teratoma: see cartilage (red “A”), ducts/glands (yellow arrow), and hair follicles (black arrows)

Made of 1+ tissues from different germinal layers

2 age peaks:

Question 17

Answer 17

Immature teratoma: undifferentiated spindle cells, primitive small round blue cells; poorly differentiate, poorer prognosis.

pre-pubertal teratoma in males is BENIGN, post-pubertal teratomas in males are MALIGNANT

Question 18

Answer 18

Choriocarcinoma: tumor of syncitiotrophoblasts and cytotrophoblasts; grossly appears as hemorrhagic tumor; on histo see areas of hemorrhage

rarely pure tumor, usually seen in mixed GCT.

Marked elevation in beta hCG

Question 19

Answer 19

Choriocarcinoma:

A) syncitiotrophoblasts: large multinucleated cells with pink cytoplasm

B) cytotrophoblasts: polygonal cells with clear cytoplasm, bland nucleus, well define border

C) beta-HCG + stain of choriocarcinoma

Question 20

Answer 20

Mixed GCT: most common after seminoma; prognosis based on worst component (i.e. embryonal)