Testicular tumor Flashcards
Stem1.A 32-year-old male presented with Rt groin lump; firm non tender for a month O/E testicle not palpable in scrotum. US. 6cm partially cystic & solid mass at internal ring extending into abdomen & local soft tissue. No other pathology seen.
Stem1.A 32-year-old male presented with Rt groin lump; firm non tender for a month O/E testicle not palpable in scrotum. US. 6cm partially cystic & solid mass at internal ring extending into abdomen & local soft tissue. No other pathology seen.
.
Q1. Deferential diagnosis?
Groin lump Inguinal LN / Femoral art aneurysm / Hematoma / Lipoma /Inguinal hernia / Teratoma / Testicular Tumor
Orchidectomy & bone biopsy from a suspicious region done & pathology report came as follows: Testicular teratoma with involved margins, local tissue, lymphatic & skeletal invasion.
.
Q2. Discus this pathology report with the family in simple lines.
Testicular Tumor but not totally removed and It’s spreading locally breaching bone and lymphatic glands. and pt might need another surgery and chemotherapy
Q3. To where dose teratoma initially spread?
By Hematogenous route / Intially to Para-aortic LNs
Q4. Types of testicular tumors according to age groups?
20-30 Teratoma
30-40 Seminoma
>60 Lymphoma
– Other classification: Germ (Seminoma and Non-Sem) and Non-Germ Cell tumor
Q6.What tissue section Immunohistochemical marker confirm diagnosis of choriocarcinoma?
Beta-HCG
Q5. What’s choriocarcinoma?
Malignant Teratomtous neoplasm with placental differentiation
Q7.Other type of malignancy at this age?
Seminomas
Q8.What’s alpha fetoprotein?
It’s a ptn produced by yolk sac of the fetus may indicate yolk sac differentiated teratomas because of that it could be an indicator for teratomas tumors
Q9. Mention another non germ tumour with high a. fetoprotein?
HCC
Q10.What’s the value of LDH in testicular cancer?
It reflects tumor load and rate of growth of testicular cancer and response to ttt
Q11. Post-Op he developed haematoma. What are the stages of haematoma resolutions?
First of one week –> lysis of hematoma by macrophages
Two week following –> growth of fibroblast
Q12. After few month he developed small pneumothorax. Cause?
Lung mets from Test. Canc.
Q13. Define metastasis?
Growth and survival of cells from a site distant form their primary origin
Stem 2: A 69 year old male presented with bilateral groin lumps; firm non tender for a month Gray scale and color Doppler ultrasound findings include diffuse testicular infiltration, enlargement with hypervascularity or multifocal areas of hypoechoic, solid and hypervascular nodules within testes . Orchidectomy done & testicles found White tan pink & fleshy.
Pathology report . Malignant cells are pleomorphic and non-cohesive with large irregular nuclei and prominent nuclcoli with vascular invasion and sclerosis of seminiferous tubules. No intratubular germ cell neoplasia. The neoplastic cells typically express CD20
Q14. On the light of the pathology report given what’s the diagnosis?
Testicular lymphoma
Q15. Talk about other classification of testicular tumours & give an example for each.
Germ Cell
-Seminoma (Classical, Spermatocystic, anaplastic)
-Non-Seminomatous (Yolk sac, Choriocarcinoma, Teratoma, Embryonal)
Non-Germ Cell
-Sex cord Stromal ( Leydig , Sertoli)
-Others (Lymphoma, Mets)
Q16. Describe the microscopic morphology of testicular teratoma Vs seminoma?
Teratoma Various diff. types of cells and could originate from any primitive tissue.
Seminoma Sheets of uniform cell divided into lobules by delicate fibrous septa, call are large and rounded nucleus and prominent nucleoli
He presented with PE a year later & found to have large mass at the region of para-aortic LNs compressing renal vessels. Debulking surgery done , but tumour can’t be totally resected.
Q17. Frozen section showed thyroid tissue. Why?
As teratoma could be differentiated from any type of tissue in the body.
Q18. Explain finding in adenocarcinoma.
Epithelial differentiation and subsequent malig. Transformation of epithelial differentiated lineage
Q19. What’s the composition of PE?
Platelets / Fibrin / circulating cells
Q20. Which clotting factor allowing polymerization of fibrin? Explain coagulation cascade.
Int. Path; Enodthelial injury – > activate F12– >F11 – > F9 – F10 –Thromboplastin into thrombin – Fibrinogen to fibrin and formation of clot.
Ext. Path; tissue injury – > sctivste F7 – > F10 in presence of F5/Ca+
Q21.What cause PE in this patient? Explain.
- Tumor affecting locally on blood vess or systemically on clotting factors (Alteration)
- Venous stasis as effect of the mass on blood vessel
-Hypercoagulability status in malignancy also
Q22. Where could a Beta-hcg found in a normal male?
In the seminal fluid in very minimal amount
