Testicular Pathology Flashcards

1. Describe the different histological types of testicular tumors. (MKS-1b) 2. Describe the commonly used markers for testicular tumors. (MKS-1b) 3. Describe key diagnostic features of these tumors. (MKS-1d)

1
Q

What are the testicular cell components?

A
  • Developing germ cells
  • Sex cord stromal cells
    • Leydig cells
    • Sertoli cells
  • Connective tissues
  • Blood and lymphocytes
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2
Q

What is a crystal of Reinke?

A

Structure found in Leydig cells, often seen in tumors from this source

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3
Q

What are the common sources of infection and inflammation of the testis?

A
  • Epididymitis and orchitis
    • acute bacterial
      • younger men - often sexually transmitted (C. trachomatis, N gonorrhea)
      • older men - often related to urinary tract infection (E. coli, other G-rods, enterococci, staph sp.)
    • other organisms (syphilis, tuberculosis, etc.)
    • viral (mumps, etc.)
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4
Q

What are some specific findings for non-specific granulomatous orchitis?

A
  • Collagen and blood vessels, and possible necrosis
  • Granulomas are specific types of inflammation, not specific, entire testis is involved, testes is lost
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5
Q

What is cryptorchidism and what are some of the pathological findings?

A
  • Phases of testicular development
    • abdominopelvic phase
    • inguinal-scrotal phase (defects occur here)
  • Failure of one or both tesetes to move from abdomen into the scrotum after birth
  • increased risk to develop testicular cancer
  • Histology
    • Minimal spermatogenesis or not at all - leydig cell hyperplasia as well, problem with sperm production
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6
Q

What are some reactive and reparative conditions of the testes?

A
  • Atrophy
    • aging
    • therapy related
  • Infertility
  • Others
    • Maturation arrest - germ cells are there but aren’t maturing as they are supposed to be, low sperm count
    • Sperm granuloma - sperm leaking up, tubular structure will cause reaction, granulomatous reaction
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7
Q

What differentiates a hydrocele from a spermatocele?

A
  • Hydrocele
    • testis suspended in the sac filled with fluid
    • atrophic change of testis
    • histology
      • Water in a cyst, consequence is severe atrophy due to pressure, testis will not develop normally, markedly reduced spermatogenesis
      • lined with mesothelium
  • Spermatocele
    • lined with epithelium
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8
Q

What are the common vascular abnormalities of the testes?

A
  • Varicocele - abnormal dilation of the veins draining the testes
    • results in outflow obstruction and oligo- or azospermia
  • Torsion
  • Vasculitis
  • Atherosclerosis
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9
Q

What are the common types of testicular neoplasms?

A
  • Germ cell tumors (GCT)
    • intratubular germ cell neoplasia, unclassified
    • seminoma
      • classic
      • spermatocytic
    • non-seminomatous germ cell tumors
  • Others
    • sex cord stromal tumor
      • Sertoli cell tumor
      • Leydig cell tumor
    • lymphoma
    • sarcoma
    • metastatic tumor
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10
Q

What does the tumor marker LDH suggest?

A

tumor burden

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11
Q

What does beta HCG suggest as a tumor marker?

A
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12
Q

What does placental alkaline phosphatase (PLAP) suggest?

A

all GCTs

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13
Q

What does the tumor marker C-kit suggest?

A

seminoma

ITGCNU

mast cells

GIST

RCC

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14
Q

What does OCT-4 suggest as a tumor marker?

A

seminoma

embryonal carcinoma

ITGCNU

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15
Q

What does inhibin suggest as a tumor marker?

A

Leydig/Sertoli cell tumors

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16
Q

What does CD30 suggest as a tumor marker?

A

embryonal carcinoma, lymphoma

17
Q

What does glypican 3 suggest as a tumor marker?

A

yolk sac tumor

choriocarcinoma

fetal testis and liver

HCC

18
Q

What are the pathological findings of intratubular germ cell neoplasias (unclassified ITGCNU)

A
  • Neoplastic germ cells growing within tubules
  • also known as “seminoma in situ” in the past
  • diffuse lesion, no mass, noninvasive
  • present in almost all invasive GCT cases, precursor
  • C-kit, Oct-4, and PLAP positive
  • Treatment
    • US: no treatment
    • Denmark and some European countries - radiation
19
Q

Describe the pathology of ITGCN.

A
  • Normal (right) - cells relatively uniform and mostly neoplastic cells but still retained within tubule
  • If outside the tubule, often identical to seminoma cells
20
Q

Describe the age distribution of germ cell tumors of the testes?

A
  • Young age (2-15)
    • EST
  • Young adult (15-30)
    • embryonal
    • choriocarcinoma
    • teratoma
  • Older adult (30-50)
    • seminoma
21
Q

What are some pathological findings of classic seminomas?

A
  • Composed of large primitive tumor cells
  • Diffuse or sheet-like patterns
  • Presence of lymphocytes or granulomas
  • Several tissue markers
    • PLAP
    • c-kit
    • OCT-4
  • Occasionally syncytiotrophoblasts present
    • mildly inc HCC
  • Histology
    • large, fast-growing nuclei
    • very primitive
    • no differentiation and specific structures
    • may see granulomas or syncytiotrophoblasts
  • Spermatocytic seminoma
    • not related to ITGCN
    • older age
    • small, medium, and large tumors
    • good prognosis
22
Q

What are some common nonseminomatous germ cell tumors?

A
  • Embryonal carcinoma (EC)
  • Yolk sac (endodermal sinus) tumor
  • Choriocarcinoma
  • Teratoma
    • mature
    • immature
23
Q

What are nonseminomatous mixed GCTs?

A
  • Majority of cases are mixed GCTs in adults
  • embryonal carcinoma present in 87%
  • YST present in 44%
  • choriocarcinoma presentin 15%
24
Q

What are embryonal carcinomas?

A
  • Majority of cases seen in mixed GCT
  • >10% as pure form
  • tumor often shows hemorrhage and necrosis
  • primitive and pleomorphic tumor cells
  • solid, glandular or papillary pattern
25
Q

What are some common pathological findings of yolk sac tumors?

A
  • Most common GCT in children (80%) as pure form
  • Grossly myxoid or gelatinous cut surface
  • Many histological patterns
  • Most common pattern is microcystic
  • AFP, Glypican 3 positive
  • Schiller-Duval body
26
Q

What are the major pathological findings of sex cord stromal tumors?

A
  • Sex cord tumors rare
    • Leydic cell tumor
    • Sertoli cell tumor
    • other types
  • Mostly benign, small percentage malignant
  • Germ cell markers negative
  • Inhibin positive
27
Q

What are some features of testicular lymphoma?

A
  • Typically older patients (60-80)
  • No discrete mass
  • Infiltrating lymphoma cells between tubules
  • Most cases are large B cell lymphoma