Testicular Tumors Flashcards
Testicular tumors
Are divided into two major categories
________ tumours
_____________ tumours
Germ cell
Sex cord stromal
Testicular tumors
Germ cell tumours
Divided into 2
List
Seminomatous
Non seminomatous tumours
Testicular tumors
Sex cord stromal tumours
Divided into 2
List
Leydig cell tumour
Sertoli cell tumour
Seminomatous tumours
________
________ seminoma
________ seminoma
Seminoma
Spermatocytic seminoma
Anaplastic seminoma
Non seminomatous tumours
_________ carcinoma
_________ (_________) tumour _________
_________
Embryonal carcinoma
Yolk sac (endodermal sinus) tumour Choriocarcinoma
Teratoma
Teratoma
_________
________
Teratoma with ______________
Mature
Immature
malignant transformation
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.
The exact etiology of testicular germ cell tumours is not known
T/F
T
____________ are the most frequent of the testicular tumours
Germ cell tumors
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
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
Congenital malformations of the male genitalia ( _____________,___________).
Cryptorchidism, hypospadias,
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
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
Seminoma
Classification
_________ or _________
_________
_________
Classical or typical
Spermatocytic
anaplastic
__________ is the commonest malignant tumour of the testis
Seminoma
_______ seminoma comprises about 95% of all seminomas
Classic seminoma
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
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
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
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
T
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
