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Endo Repro Exam > Testicular Tumors > Flashcards

Testicular Tumors Flashcards

1
Q

testicular tumors - epidemiology

A

*most common tumor of young men
*one of the most curable of all cancers
*no clear etiology, but 10% have history of undescended testis
*bilateral in 2-3%
*>50% of patients present with metastatic disease
*“right goes left, but left stays left” (nodal spread)
*distant mets via blood to lung, liver, brain, bones, kidney
*10% present with epididymitis

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2
Q

testicular malignancies - classifications

A
  1. germ cell tumors
    a. seminoma
    b. non seminomas (embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma)
  2. non-germ cell tumors
    a. sex cord stromal tumors (sertoli cell tumors, leydig cell tumors)
    b. secondary malignancies (lymphoma, metastases)
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3
Q

general considerations of testicular tumors

A

*typically present as a firm, painless mass (therefore, CANNOT BE TRANSILLUMINATED on physical exam)
*do NOT biopsy (risk of seeding the scrotum)
*typical age of incidence: 15-40 years
*general risk factors:
-cryptorchidism
-Klinefelter syndrome
-Down syndrome
-testicular dysgenesis syndrome

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4
Q

tumor marker: alpha fetoprotein (AFP)

A

*elevated in 50-70% of non-seminoma germ cell tumors (NSGCT)
*produced by embryonal carcinoma and yolk sac tumors
*NOT produced in pure choriocarcinoma or seminoma
*half-life of 4-6 days

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5
Q

tumor marker: human chorionic gonadotropin (hCG)

A

*elevated in all choriocarcinomas
*elevated in 40-60% of embryonal carcinoma
*elevated in 5-10% of seminomas
*half-life of 24 hrs

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6
Q

tumor marker: lactase dehydrogenase (LDH)

A

*non-specific tumor marker
*elevated in about half of the cases of testicular tumors
*attests to tumor burden

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7
Q

seminoma - overview

A

*most common germ cell testicular tumor
*originates in the germinal epithelium of the seminiferous tubules
*75% are confined to testis at presentation; 15% involve regional nodes; 10% with distant spread

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8
Q

seminoma - gross pathologic features

A

*well-demarcated, homogenous, pale mass
*no hemorrhage
*no necrosis

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9
Q

seminoma - microscopic pathologic features

A

*large cells, clear cytoplasm, central nuclei (“fried egg” appearance)
*placental alkaline phosphatase (PLAP) positive in up to 98% of seminomas

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10
Q

seminoma - 3 types

A
  1. classic seminoma (85%)
  2. anaplastic seminoma (10%) - more aggressive with higher metastatic potential
  3. spermatocytic seminoma (5%) - classically seen in OLDER patients
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11
Q

seminoma - clinical presentation

A

*painless testicular mass (some may present with testicular discomfort or swelling)
*mass CANNOT be transilluminated
*relatively slow growing
*mean age at presentation = 40 years
*6-10x higher incidence among white men
*increased PLAP

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12
Q

seminoma - tumor markers

A

*hCG produced in 5-10% of seminomas
*NO pure seminoma produces AFP
*increased placental alkaline phosphatase (PLAP)

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13
Q

seminoma - therapy considerations

A

*do NOT perform a biopsy
*discuss sperm banking
*radical inguinal orchiectomy (removal of testicle; confirms diagnosis & helps determine staging)
*management depends on stage
*good prognosis
*does respond to radiation therapy

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14
Q

embryonal carcinoma testicular tumor - overview

A

*a non-seminoma germ cell testicular cancer

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15
Q

embryonal cell testicular tumor - gross pathologic features

A

*hemorrhagic mass with necrosis
*usually smaller than seminomas (i.e. does not replace the entire testis)

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16
Q

embryonal cell testicular tumor - microscopic pathologic features

A

*immature, primitive cells (“embryo-like”) with prominent nucleoli and pleomorphic nuclei
*resemble undifferentiated stem cells
*may form glands

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17
Q

embryonal cell testicular tumor - clinical presentation

A

*painless testicular mass
*early hematogenous spread: retroperitoneum, lung, liver
*typically positive for placental alkaline phosphatase (PLAP)

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18
Q

embryonal cell testicular tumor - tumor markers

A

*may secrete alpha fetoprotein (AFP) or beta-hCG, but usually BOTH

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19
Q

embryonal cell testicular tumor - therapy considerations

A

*do NOT biopsy
*discuss sperm banking
*chemotherapy may lead to differentiation of tumor cell types (resulting in a new, more mature tumor type)

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20
Q

embryonal cell testicular tumor - prognosis

A

*determined by clinical stage
*aggressive tumors
*highest rate of lymphovascular invasion & extension into the paratesticular tissue

21
Q

yolk sac testicular tumor - overview

A

*a non-seminoma germ cell testicular cancer
*most common testicular tumor in children < 3 years old

22
Q

yolk sac testicular tumor - gross pathologic features

A

*solid gray-white tumor
*gelatinous surface
*hemorrhage, necrosis, and cystic changes often present

23
Q

yolk sac testicular tumor - microscopic pathologic features

A

*classic histology = Schiller-Duval body
-a central vessel surrounded by tumor cells residing in a cystic space
-exhibits a glomerulus-like structure
-present in 50-75% of cases
*most common pattern is a microcytic pattern

24
Q

yolk sac testicular tumor - clinical presentation

A

*painless testicular mass
*the most common testicular tumor during childhood (esp. < 3 years old)
*metastases often via hematogenous spread; most commonly spreads to the lungs
*often good prognosis

25
Q

yolk sac testicular tumor - tumor marker

A

*alpha fetoprotein (AFP) is typically elevated

26
Q

choriocarcinoma testicular tumor - overview

A

*a non-seminoma germ cell testicular cancer
*characterized by disordered syncitiotrophoblastic and cytotrophoblastic elements

27
Q

choriocarcinoma testicular tumor - gross pathologic features

A

*hemorrhagic mass with necrosis

28
Q

choriocarcinoma testicular tumor - microscopic pathologic features

A

*malignant tumor of syncytiotrophoblasts and cytotrophoblasts
*do NOT get villi (as you would have in placental tissue)

29
Q

choriocarcinoma testicular tumor - clinical presentation

A

*painless testicular mass
*rapid hematogenous spread (is placenta-like tissue and “programmed” to find blood vessels)
*may secrete hCG → hyperthyroidism (TSH-like effects) and gynecomastia (LH- and FSH-like effects
*increased risk of brain metastases
*often involves retroperitoneal lymph nodes
*POOR PROGNOSIS due to rapid metastasis

30
Q

choriocarcinoma testicular tumor - tumor markers

A

*high hCG ALWAYS present
-alpha subunit of hCG is similar to the alpha subunits of FSH/LH, so may cause gynecomastia and/or hyperthyroidism

*pure forms do NOT make AFP

31
Q

teratoma testicular tumor - overview

A

*a non-seminoma germ cell testicular cancer

32
Q

teratoma testicular tumor - gross pathologic features

A

*exhibits mature fetal tissue (teeth, hair, etc)
*lesions may be well-circumscribed

33
Q

teratoma testicular tumor - microscopic pathologic features

A

*histology may reveal a variety of tissues (organized or unorganized presentation)
*composed of cells derived from at least 2 of the 3 embryonic germ layers (endoderm, mesoderm, ectoderm)
*“immature” teratomas have tissue not seen in adult tissue elements

34
Q

teratoma testicular tumor - clinical presentation

A

*painless testicular mass
*MALIGNANT in males (benign in females) but prepubertal are benign and orchiectomy is curative
*prognosis depends on tumor stage

35
Q

teratoma testicular tumor - tumor markers

A

*pure teratomas do NOT produce hCG or AFP
*some tumors, however, may be mixed

36
Q

mixed germ cell tumors

A

*the majority of germ cell tumors are MIXED (e.g. embryonal carcinoma plus yolk sac tumor plus teratoma)
*combinations with SEMINOMAS are treated as non-seminoma germ-cell tumors (chemotherapy)
*prognosis - based upon the tumor component with the worst prognosis

37
Q

sex cord stromal tumors - overview

A

*comprise ~5% of testicular tumors
*can be Leydig Cell tumors and Sertoli Cell tumors
*usually benign
*wide age range (14-87 yrs)
*no known risk factors

38
Q

Leydig Cell tumor - overview

A

*a sex cord stromal tumor
*the most common sex cord stromal tumor
*more frequently presents in adults (40-50yrs) but can present at any age

39
Q

Leydig Cell tumor - pathologic features

A

*gross: golden brown to yellow cut surface
*micro: Leydig cells with abundant pink cytoplasm and REINKE CRYSTALS (pink-staining rod-like cytoplasmic inclusions)

40
Q

Leydig Cell tumor - clinical presentation

A

*painless testicular mass
*Leydig cells produce androgens and estrogen, so can result in precocious puberty (children) or gynecomastia (adults)

41
Q

Leydig Cell tumor - management

A

*radical inguinal orchiectomy preferred
*prognosis dependent on tumor stage (most are benign)

42
Q

Sertoli Cell tumor - overview

A

*a sex cord stromal tumor
*composed of the cells that line the seminiferous tubules
*can present at any age (avg. age = 45 yrs)

43
Q

Sertoli Cell tumor - microscopic pathologic features

A

*tumor forms tubules
*uniform cuboidal or columnar cells with moderate pale or lightly pink cytoplasm
*often with prominent cytoplasmic lipid vacuoles

44
Q

Sertoli Cell tumor - clinical presentation

A

*painless testicular mass
*rarely exhibit gynecomastia or precocious puberty
*may be seen in patients with:
-Peutz-Jeghers syndrome
-Carney syndrome
-androgen insensitivity syndrome
-testicular feminization syndrome

45
Q

Sertoli Cell tumor - management

A

*radical inguinal orchiectomy
*prognosis based on tumor stage (only 10% are malignant)

46
Q

lymphoma testicular cancer - overview

A

*a non-germ cell testicular cancer
*comprise 5% of all testicular tumors
*may be primary or secondary

47
Q

lymphoma testicular cancer - microscopic pathologic features

A

*sheets of malignant lymphoid cells infiltrate between normal testicular structures
*most common = diffuse large B cell lymphoma
*others include: MALT lymphoma, follicular lymphoma, T cell lymphoma, Burkitt lymphoma (in children)

48
Q

lymphoma testicular cancer - clinical presentation

A

*painless testicular mass
*most common cause of a testicular mass in older men over 60 yrs
*usually BILATERAL
*commonly also presents with B symptoms (fever, night sweats, weight loss)
*prognosis generally POOR

Endo Repro Exam (56 decks)

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