testicular tumors Flashcards
when are tumors of the testis most likely to be diagnosed>
between the ages of 25-45
what origin are the tumors most likely
germ cell
are they typically benign or malignant
malignant
are they curable and how?
surgery and chemo
what is the most important marker cytogenetically
isochromosome p12
where do they metastasize
periaortic abdominal lymph nodes
what percentage release markers into the blood?
65%
what is intratubular germ cell neoplasia
this is a testicular carcinoma in situ, a pervasive form of germ cell tumor.
characteristics of ITGCN
patchy testicular tubule involvement. tubules affected have thick basement membranes and no sperm. neoplastic germ cells attached to the basal lamina. cells are large, have finely dispersed chromatin and display prominent nucleoli. there is typically abundant clear cytoplasm full of glycogen. nuclear DNA is triploid.
how does ITGCN stain?
PLAP, OCT3/4
seminomas
never found in prepubertal children, they are the most common tumor. solid, rubbery-firm, bosselated mass. sharply demarcated from the surrounding tissue. it appears lobulated and homogeneously tan or grayish yellow. necrosis or hemorrhage can be found.
histological appearance of seminoma
uniform, polygonal cells, centrally located vesicular nuclei, ample cytoplasm with clear or eosinophilic. glycogen and lipid. the tumor is arranged in nests or sheets with fibrous septa containing lymphocytic infiltrate and occasionally granuloma with giant cells.
how do seminomas stain?
PLAP and CD117 (c-kit).
what are the different types of seminoma?
the most important is syncytiotrophoblastic seminoma. the other is anaplastic. syncytiotrophoblast are characterized by giant cells.
how to determine the synctiotrophoblastic seminoma>
it has syncytiotrophoblastic giant cells and stains for beta-hCG
what are the different types of nonseminomatous tumors?
- ) pure embryonal
- ) teratocarcinomas (mixed germ cell tumors)
- ) pure coriocarinoma
- ) pure yolk sac carcinoma
- ) growing benign teratoma.
pure embryonal carcinomas
similar to preimplantation cells, little cytoplasm, hyper chromatic large nuclei, arranged in broad solid sheets/cords/glands/tubules/acini. mets to abdominal lymph nodes, lung. these are the stem cells for teratocarcinomas
histological markers for pure embryonal tumors
PLAP, OCT3/4. express cytokeratins and CD30. NOT c-kit (CD117)
choriocarcinomas
composed exclusively of malignant chorionic epithelial cells.
what are markers for non-seminomatous
AFP and b-hCG
what tumor will produce AFP?
yolk sac tumor
what cells release b-hCG?
syncytiotrophoblasts
what tumor is found almost exclusively <4 yrs
yolk sac tumor
what tumor type is found between 4 and 12
benign teratoma
yolk sac tumor characterisitics
cells arranged into structures that look similar to fetal yolk sac. SCHILLER-DUVAL BODIES or glumeruloid like structures are characteristic. malignant.
choriocarcinoma characteristics
multinucleated syncytiotrophoblastic giant cells. there are cyncytiotrophoblastic cells that are mononuclear; the invasive growth is associated with hemorrhage
leydig tumors
yellow-brown, fibrous trabeculae giving a lobular appearance. uniform cells with round nuclei and well-developed eosinophilic or vacuolated cytoplasm. REINKE crystals -rectangular, eosinophilic inclusions. benign.
what do leydig tumors do?
typically cause precocious puberty or feminization and gynecomastia.
sertolli cell tumors
sex-cord stromal tumor. well-circumscribed, yellow-gray nodules. columnar cells arranged in tubules or cords in a fibrous trabecular framework.
