Testicular Tumors

Question 1

NAme the germ cell testicular tumors

Answer 1

• Seminoma
• Embryonal Carcinoma
• Yolk sac tumors
• Choriocarcinoma
• Teratoma

Question 2

Risk factors for germ cell tumors

Answer 2

• Cryptochidism
• Prior TGCT
• Fam hx
• Infertility

Question 3

Intratubular Germ Cell Neoplasia

Answer 3

-Adj to all germ cell tumors in adults, except spermatocytic seminoma

Question 4

Seminoma

Answer 4

-Most common pure germ cell tumor composed of relatively uniform cells with abundant clear cytoplasm, well defined cell borders and nuclei with one or more prominent nucleoli

Question 5

What is seminoma analogous to in females?

Answer 5

Dysgerminoma

Question 6

Seminoma: presentation

Answer 6

• Most common painless testicular mass
• Unilateral
• Bulky mass
• Homogeneous
• Gray white
• Lobulated
• Devoid of hemorrhage and necrosis

Question 7

Seminoma: histology

Answer 7

• Sheets of uniform cells
• Divided into poorly demarcated lobules by delicate septa of fibrous tissue, septa are infiltrated by T cells
• Large and round cells
• Clear and watery cytoplasm
• Large, central nucleus
• Prominent nucleolus
• May contain granulomas*
• May have syncytiotrophoblasts so serum hCG may be elevated (less that choriocarcinoma though)

Question 8

Seminoma: treatment

Answer 8

• Good prognosis
• Stage I: orchiectomy and radiation
• Stage II: radical orchiectomy plus inguinal and radiation or combo chemo
• Stage III: Radical inguinal orchiectomy and multidrug chemo

Question 9

Embryonal Carcinoma

Answer 9

Germ cell tumor composed of cells with epithelial appearance and marked cytologic atypia

Question 10

Embryonal Carcinoma: gross

Answer 10

• Poorly demarcated
• Foci of necrosis and hemorrhage
• Extra testicular involvement

Question 11

Embryonal Carcinoma: prognosis

Answer 11

Poor

Question 12

Yolk Sac Tumor

Answer 12

Germ cell tumor characterized by variety of growth patterns that recapitulate yolk sac, allantois, and extra embryonic mesenchyme

Question 13

Yolk Sac Tumor: incidence

Answer 13

Common pediatric cancer, rare in adults

Question 14

Yolk Sac Tumor: presentation

Answer 14

• non symptomatic rapid testicular enlargement
• non encapsulated
• hemorrhagic, yellow, white, myxoid gelatinous

Question 15

Yolk Sac Tumor: histologic

Answer 15

• AFP pos tumor (alpha fetoprotein)
• Schiller duval body
• Intracellular eosinophilic globules

Question 16

Yolk Sac Tumor: treatment

Answer 16

-Take it out

Question 17

Choriocarcinoma

Answer 17

Germ cell tumor composed of mononucleated cytotrophoblast and multinucleated syncytiotrophoblast

Question 18

Choriocarcinoma: epi

Answer 18

• Usually part of a mixed tumor

- Young adults 25-30=most common

Question 19

Choriocarcinoma: presentation

Answer 19

• Aggressive, but small
• Hemorrhagic and necrotic
• Metastasis widespread

Question 20

Choriocarcinoma: Lab tests

Answer 20

High hCG levels

Question 21

Choriocarcinoma: prognosis

Answer 21

Bad, hCG levels correlate with prognosis

Question 22

Choriocarcinoma: treatment

Answer 22

Take it out and chemo

Question 23

Choriocarcinoma: histology

Answer 23

Syncytiotrophoblast make giant cells

Question 24

Teratoma

Answer 24

Tumors with more than one somatic tissue of different germinal layers. Second most common childhood germ cell tumor. Children <4 and adults between 20 and 40 get them

Question 25

Teratoma: gross

Answer 25

• Well circumscribed
• Hetergeneous
• Nodular and firm to cystic
• Cysts filled with clear white, flaky gelatinous or mucoid material
• Mature tissue often present

Question 26

Teratoma: mature

Answer 26

Can differentiate, benign

Question 27

Teratoma: immature

Answer 27

Undifferentiated/primitive, malignant

Question 28

Teratoma: secondary malignant transformation

Answer 28

Can be sarcomatous or carcinomatous

Question 29

Teratoma: treatment

Answer 29

• Take it out

- Adult teratomas are malignant