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)
What are the testicular cell components?
- Developing germ cells
- Sex cord stromal cells
- Leydig cells
- Sertoli cells
- Connective tissues
- Blood and lymphocytes
What is a crystal of Reinke?
Structure found in Leydig cells, often seen in tumors from this source
What are the common sources of infection and inflammation of the testis?
- 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.)
- acute bacterial
What are some specific findings for non-specific granulomatous orchitis?
- Collagen and blood vessels, and possible necrosis
- Granulomas are specific types of inflammation, not specific, entire testis is involved, testes is lost
What is cryptorchidism and what are some of the pathological findings?
- 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
What are some reactive and reparative conditions of the testes?
- 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
What differentiates a hydrocele from a spermatocele?
- 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
What are the common vascular abnormalities of the testes?
- Varicocele - abnormal dilation of the veins draining the testes
- results in outflow obstruction and oligo- or azospermia
- Torsion
- Vasculitis
- Atherosclerosis
What are the common types of testicular neoplasms?
- 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
- sex cord stromal tumor
What does the tumor marker LDH suggest?
tumor burden
What does beta HCG suggest as a tumor marker?
What does placental alkaline phosphatase (PLAP) suggest?
all GCTs
What does the tumor marker C-kit suggest?
seminoma
ITGCNU
mast cells
GIST
RCC
What does OCT-4 suggest as a tumor marker?
seminoma
embryonal carcinoma
ITGCNU
What does inhibin suggest as a tumor marker?
Leydig/Sertoli cell tumors
What does CD30 suggest as a tumor marker?
embryonal carcinoma, lymphoma
What does glypican 3 suggest as a tumor marker?
yolk sac tumor
choriocarcinoma
fetal testis and liver
HCC
What are the pathological findings of intratubular germ cell neoplasias (unclassified ITGCNU)
- 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
Describe the pathology of ITGCN.
- Normal (right) - cells relatively uniform and mostly neoplastic cells but still retained within tubule
- If outside the tubule, often identical to seminoma cells
Describe the age distribution of germ cell tumors of the testes?
- Young age (2-15)
- EST
- Young adult (15-30)
- embryonal
- choriocarcinoma
- teratoma
- Older adult (30-50)
- seminoma
What are some pathological findings of classic seminomas?
- 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
What are some common nonseminomatous germ cell tumors?
- Embryonal carcinoma (EC)
- Yolk sac (endodermal sinus) tumor
- Choriocarcinoma
- Teratoma
- mature
- immature
What are nonseminomatous mixed GCTs?
- Majority of cases are mixed GCTs in adults
- embryonal carcinoma present in 87%
- YST present in 44%
- choriocarcinoma presentin 15%
What are embryonal carcinomas?
- 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
What are some common pathological findings of yolk sac tumors?
- 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
What are the major pathological findings of sex cord stromal tumors?
- Sex cord tumors rare
- Leydic cell tumor
- Sertoli cell tumor
- other types
- Mostly benign, small percentage malignant
- Germ cell markers negative
- Inhibin positive
What are some features of testicular lymphoma?
- Typically older patients (60-80)
- No discrete mass
- Infiltrating lymphoma cells between tubules
- Most cases are large B cell lymphoma
