Testicular Tumors Flashcards by Iseoluwa Ojo

Testicular tumors

Are divided into two major categories

________ tumours

_____________ tumours

Germ cell

Sex cord stromal

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Testicular tumors

Germ cell tumours
Divided into 2

List

Seminomatous
Non seminomatous tumours

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Testicular tumors

Sex cord stromal tumours
Divided into 2

List

Leydig cell tumour

Sertoli cell tumour

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Seminomatous tumours

________
________ seminoma
________ seminoma

Seminoma

Spermatocytic seminoma
Anaplastic seminoma

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Non seminomatous tumours

_________ carcinoma
_________ (_________) tumour _________
_________

Embryonal carcinoma
Yolk sac (endodermal sinus) tumour Choriocarcinoma
Teratoma

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Teratoma
_________
________
Teratoma with ______________

Mature
Immature

malignant transformation

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Germ cell tumours

Incidence shows remarkable _________ variation

The age distribution of testicular germ cell tumours is (usual or unusual?)

The incidence increases shortly after the ________and reaches a maximum in men in the ___________ and ________

Thereafter the age specific incidence rate decreases to a very low level in men in their __________.

geographical

unusual

after the onset of puberty

late twenties and thirties.

sixties.

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The exact etiology of testicular germ cell tumours is not known

T/F

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____________ are the most frequent of the testicular tumours

Germ cell tumors

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predisposing factors to testicular germ cell tumor

However several factors are known

_____________ of the male genitalia. ______________ is the most important risk factor . The high incidence is due to its exposure to ______ temperature in the _______ or _______ region compared to the scrotum

Congenital malformations

Undescended testis

high ;abdomen

inguinal region

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predisposing factors to testicular germ cell tumor

Prenatal risk factors ( _____ birth weight, _____ maternal age, neonatal ______)

Genetic/family predisposition: the cytogenetic abnormality observed is an additional fragment of chromosome _____ (_______________)

low; high

Jaundice

12; isochromosome p12

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Congenital malformations of the male genitalia ( _____________,___________).

Cryptorchidism, hypospadias,

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predisposing factors to testicular germ cell tumor

Klinefelter syndrome(XXY): is associated with ____ times greater risk than normal for the __________ germ cell tumour but they ________________________

Exposure in ____hood (low level of physical activity, high socioeconomic class)
Male _______

50; mediasternal

do not develop testicular tumours

adult; infertility

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Seminoma

They almost never occur in the _____, and they peak in the ________.

An identical tumour arises in the ovary where it is called _________

infants ; thirties.

dysgerminoma

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Seminoma

Classification

_________ or _________
_________
_________

Classical or typical
Spermatocytic
anaplastic

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__________ is the commonest malignant tumour of the testis

Seminoma

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_______ seminoma comprises about 95% of all seminomas

Classic seminoma

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Classic seminoma

Morphology

The testis may enlarge up to _____ times its normal size but tends to maintain its _____________ since the tumour rarely invades the ________

The typical seminoma has a _____genous _________ lobulated cut surface usually devoid of _________ or _________

The entire testis may _______________

10 times ; contour

tunica; homogenous

grey white

haemorrhage or necrosis

be replaced

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Morphology of classic Seminoma

Microscopically

Typical seminoma presents as ______ of fairly uniform (small or large?) ______ to _________ cells with distinct _________ , a _________ cytoplasm and a _________ central nucleus with ______________ nucleoli.

The cytoplasm contains variable amount of _________ that stains positively with _________ reaction

sheets ; large

round to polyhedral

cell membrane; clear

large ;one or two prominent

glycogen; PAS

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Morphology of classic Seminoma

Microscopically

The cells are demarcated into _______ by _______ of _______ tissue.

The _______ septa is associated with _______ infiltrate

Mitoses are (frequent or infrequent?)

lobules ; delicate septa

fibrous tissue ; fibrous

lymphocytic ;infrequent

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Spread of classic seminoma

Local spread : invasion of the _________, spread into _____ testis, invasion of the _________

Lymphatic spread: to ________ lymph nodes

Treatment: tumour is extremely _____sensitive

testicular parenchyma

rete; epididymis

abdominal; radio

Spermatocytic sperminoma

It is both clinically and morphologically a distinctive tumour from classic seminoma.

It is a/an (common or uncommon?) testicular neoplasm derived from _________ cells (_________)
It occurs in (younger or older?) patients, generally in _________ decade of life.

uncommon ;mature germ cells

spermatogonia

older ; 6th

Spermatocytic sperminoma

In contrast to classic seminoma, the prognosis of spermatocytic seminoma is ________ since it is a ____ growing tumour that ______________

excellent

slow

rarely metastasises.

Spermatocytic sperminoma

Morphology

Grossly
Spermatocytic seminoma tends to be (smaller or larger?) than classic seminoma

Cut surface is ______, (soft or hard?) and ______

larger ; pale grey

soft ; friable

Spermatocytic sperminoma Morphology Microscopically The cells vary considerably in size from the _________ like to huge _________ or ___________________ cells The cells have ______philic cytoplasm devoid of _________ The stroma lacks _________ as seen in classic seminoma

lymphocyte like mononucleate ; multinucleate giant cells eosinophilic ;glycogen lymphocytes

Anaplastic seminoma is more ______ and shows nuclear ______ with more frequent tumour ______ and many ______ figures

cellular ;pleomorphism giant cells ; mitotic figures

Anaplastic seminoma is associated with worse prognosis than classic seminoma T/F

F Its not associated with worse prognosis than classic seminoma

Nonseminomatous germ cell tumor •Embryonal carcinoma Occur mostly in the ———- year age group It is (more or less?) aggressive than seminomas More than 60% have _________ at presentation Can also be found within the _________

20 to 30 more ;metastases retroperitoneum

Nonseminomatous germ cell tumor Embryonal carcinoma Clinical Features (Painless or Painful?) swelling of the testis Occasionally testicular _____ _________ Symptoms related to _______

Painless ;pain Gynecomastia; metastasis

Embryonal carcinoma Tumour is (poorly or well?) circumscribed, size is (small or large?) and cut surface shows a ________ appearance with areas of ________ and ________ Tumour commonly extends into the ________, ________ and the ________ Histologically the tumour cells grow in ________, ________ or ________ pattern.

poorly ; small variegated ;haemorrhage and necrosis tunica albuginea, epididymis and the spermatic cord glandular, alveolar or tubular pattern.

Yolk sac tumor Also known as ___________ tumour is the most common testicular tumour in ___________ and ___________ up to ___ years of age. In this early age group it has a very ___________ prognosis

endodermal sinus tumour infants and children 3 years of age. good prognosis

Yolk sac tumor Sites _______ Also found in: _____, extragonadal (along ______ of the body

Testis; ovary midline

Yolk sac tumor ______ levels are elevated in 100% cases of yolk sac tumours

AFP

Yolk sac tumor The tumour cells form variety of patterns and may form distinctive perivascular structures resembling the yolk sac called ______________

Schiller-Duval bodies

Choriocarcinoma It is a (mildly or highly?) malignant tumour composed of elements consisting of ___________ and ___________. It occurs in association with other germ cell tumours Patients are generally in their ___________ decade Morphologically the primary tumours are (small or large?), (soft or hard?) , _________ and _________.

highly ;syncytiotrophoblasts cytotrophoblasts ; 2nd small ; soft haemorrhagic and necrotic.

Teratoma Is a group of tumours composed of tissues derived from ______________________ (_______ , _________ , __________ ) Pure teratomas constitute about ____% to ___% of germ cell tumours but teratomas mixed with other germ cell tumours form about ____% of germ cell tumours

more than one germ layer (ectoderm, mesoderm, and endoderm) 2% to 3% 45%

Teratoma Age: pure teratomas are common in _______ and _______ but rare in ______

infants and children adults

_______ is second most common germ cell tumor type in pediatrics, after ____________

Teratoma is second most common germ cell tumor type in pediatrics, after yolk sac tumor

Morphology of teratoma Grossly: Most are (small or large?) ________ masses. Cut surface may be solid or cystic. Foci of ______ and ______ may be seen

large greyish white cartilage and bone

Morphology of teratoma Microscopically Mature teratoma contains (poorly or well?) differentiated structures such as cartilage, bone, smooth muscle, intestinal and respiratory epithelium, mucus glands, cysts lined by squamous and transitional epithelium, neural tissue and fat. They have _______ prognosis

well excellent

Immature teratoma Immature is composed of _______ or _______ tissue along with some _______ element. They have _______ prognosis

primitive ; embryonic mature ; poor

Teratoma with malignant transformation : one or more of the (mature or immature?) elements undergo malignant transformation

mature

Sex cord stromal tumors They are (common or uncommon?) They originate from the primitive _______ cells that form the specialised _______ of the _______ in both sexes Since the cell of origin of primitive mesenchyme is _______, sertoli, interstitial leydig cell tumours, theca cell, granulosa cell and lutein cell tumours can occur in both sexes ie ovaries and testes. They may secrete ________________________

uncommon primitive mesenchymal cells gonads in both sexes identical androgen and estrogen

Tumor markers of testicular germ cell tumors Seminoma- ___________ , ________,———- Teratomas : ______________, ______________ Embryonal carcinoma : ______________, ______________ Yolk sac tumour: ______________ Choriocarcinoma: ______________

Placental alkaline phosphatase, CD117,HCG AFP, hCG CD30, CEA AFP beta-hCG

Tumor markers of testicular germ cell tumors __________ - Placental alkaline phosphatase, CD117 __________ : AFP, hCG __________ : CD30, CEA __________: AFP __________: beta-hCG

Seminoma Teratomas Embryonal carcinoma Yolk sac tumour Choriocarcinoma

Testicular tumor Usually present as (painful or painless?) , testicular mass Do not ___________

painless transilluminate

Seminoma may produce beta HCG T/F

Key distinctions of Embryonal carcinoma from seminoma: EC is a Mass with _________ and _______ Is (Painful or Painless?)

hemorrhage and necrosis Painful

Embryonal carcinoma May have _________ tissue Secretes _____

Syncytiotrophoblast β-hCG

Testicular germ cell tumors Clinically divided into two categories Seminomas Remain _________ for a long time 70% identified in stage ____ Metastasis to __________ first __________ spread late Non-seminomas ______ metastasis Often ________

localized ; one lymph nodes; Hematogenous Early ; hematogenous

Leydig cell tumor Produce ________________ ________ Sexual _______ (early puberty) ___________ mass (high lipid content) ___________ in cytoplasm of tumor cells

androgens and estrogens Gynecomastia; precocity Golden brown mass Reinke crystals

Sertoli cell tumor Aka ___________ Usually do not ___________ • Most are (benign or malignant?)

Androblastoma produce hormones benign