Testicular Tumors B&B

Question 1

how are testicular tumors most often diagnosed and treated?

Answer 1

present as painless testicular masses that do NOT transilluminate (as a cyst would)

evaluated with ultrasound - if cancer is suspected, entire testis is removed (orchiectomy)

not biopsied due to risk of tumor seeding into scrotum or inguinal nodes

Question 2

what is the most common type of testicular cancer, and what are 2 key risk factors?

Answer 2

germ cell tumors (95%) - usually occur in men 15-34yo

risk factors include cryptorchidism (undescended testes) and Kleinfelter syndrome

always malignant but highly curable, tumor is often a mix of several subtypes

Question 3

contrast the frequency of seminomas in male patients and dysgerminomas in female patients

Answer 3

both are germ cell tumors

seminomas are most common germ cell tumor in males

dysgerminomas are rare ovarian cancers

Question 4

what is the gross and histological appearance of seminomas?

Answer 4

most common germ cell tumor in males

gross: homogenous, grey-white mass with NO hemorrhage/necrosis

histological: undifferentiated nests of large cells with central nuclei/ clear cytoplasm (”fried egg”), may be positive for beta-hCG (due to syncytiotrophoblast tissue)

Question 5

Pt is a 24yo M presenting with a painless testicular mass. PMH is significant for cryptorchidism. The testis is removed and a tumor is taken for biopsy which shows a grey-white homogenous mass. Histological examination reveals undifferentiated germ cells with a “fried egg” appearance. What is the most likely diagnosis?

Answer 5

seminoma: most common germ cell tumor in males

may produce beta-hCG due to syncytiotrophoblasts in the tumor

very good prognosis, treat with surgery +/- chemo or radiation

Question 6

how can embryonal carcinoma be distinguished from seminoma?

Answer 6

seminoma - most common germ cell tumor in males, painless/ homogenous mass

embryonal carcinoma - painful mass with hemorrhage/necrosis, usually occurs as a component of a mixed tumor

Question 7

Pt is a 31yo M presenting with a painful testicular mass. The testis is removed and a tumor is biopsied. A portion of the tumor shows evidence of hemorrhage and necrosis. What type of cancer is this portion of the tumor?

Answer 7

embryonal carcinoma: painful mass with hemorrhage/necrosis, usually occurs as a component of a mixed tumor

[recall most testicular tumors are painless]

Question 8

what is the most common germ cell tumor in males under 3 years of age?

Answer 8

yolk sac tumor (aka endodermal sinus tumor): derived from extra-embryonic yolk sac cells which secrete alpha fetoprotein (AFP)

histology shows Schiller-Duval bodies (capillary surrounded by cancer cells)

Question 9

what is secreted by cancer cells of the most common germ cell tumor in very young male patients (<3yo)?

Answer 9

yolk sac tumor (aka endodermal sinus tumor): derived from extra-embryonic yolk sac cells which secrete alpha fetoprotein (AFP)

Question 10

presence of Schiller-Duval bodies (capillaries surrounded by cancer cells) is indicative of which type of cancer?

Answer 10

yolk sac tumor (aka endodermal sinus tumor): derived from extra-embryonic yolk sac cells which secrete alpha fetoprotein (AFP)

Question 11

Pt is a 2yo M presenting at their pediatric for a check-up. A testicular mass is found on PE. The testis is removed and the tumor is taken for biopsy, which shows capillaries surrounded by cancer cells. Immunostaining is positive for alpha fetoprotein. What is the diagnosis?

Answer 11

yolk sac tumor (aka endodermal sinus tumor): derived from extra-embryonic yolk sac cells which secrete alpha fetoprotein (AFP), most common germ cell tumor in males under 3yo

histology shows Schiller-Duval bodies (capillary surrounded by cancer cells)

Question 12

if a choriocarcinoma forms in the testes, which 2 cell types would be present?

Answer 12

rare malignant gestational neoplasm

contains syncytiotrophoblasts and cytotrophoblasts but without formation of villi - these will secrete hCG!

Question 13

what is the most aggressive form of germ cell tumor, and how does it spread?

Answer 13

choriocarcinoma: rare gestational mass with aggressive hematogenous spread

often in lungs, liver, bones at diagnosis

Question 14

how are germ cell tumors in males clinically divided? (2 categories)

Answer 14

1. seminomas - most common, identified early, remain localized for a long time
2. non-seminomas - metastasize early, often spread hematogenously

Question 15

what effects do Leydig cell tumors have on patients?

Answer 15

Leydig cells produce androgens and estrogens

tumors of these cells in males causes gynecomastia and sexual precocity (early puberty)

Question 16

what is the characteristic gross and histological finding of Leydig cell tumors?

Answer 16

gross - golden brown mass due to high lipid content (Leydig cells produce androgens and estrogens, which require cholesterol)

histological: Reinke crystals in cytoplasm of tumor cells

Question 17

golden-brown tumor mass + Reinke crystals in the cytoplasm of tumor cells =

Answer 17

Leydig cell tumor - secretes androgens and estrogens

color due to high lipid content

Question 18

where would an androblastoma be found?

Answer 18

aka Sertoli cell tumor

Sertoli cells are found along the edges of the seminiferous tubules and form blood-testis barrier

Question 19

what is the most common testicular tumor in men over 60yo?

Answer 19

non-Hodgkin lymphoma that has involved the testes (diffuse large B cell is most common)

Question 20

where do extragonadal germ cell tumors occur?

Answer 20

midline locations due to failure of germ cell migration to the gonads during embryogenesis

adults - anterior mediastinum is most common
children - sacrococcygeal and intracranial are most common