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GenitoUrinary Tract > Testis > Flashcards

Testis Flashcards

1
Q

Precursor lesion of most malignant germ cell tumors
Location?
Sprematogenesis?
Ihc?

A

Germ cell neoplasia in situ (GCNIS)
Often base of tubules
Often absent spermatogenesis
Ihc identical to seminoma: (+) oct3/4, ckit, CD117

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2
Q

It is the complete filling of expanded seminiferous tubule by neoplastic cells and an intermediate stage between GCNIS and invasion.
Other distinguishing features?

A

Intratubular seminoma
Unlike GCNIS, sertoli cells are usually not present in the involved tubule

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3
Q

MC germ cell tumor
Ihc?
Serum marker?
Other components that may be present
Usual location to metastasize
Molecular

A

Seminoma
(+) oct3/4, CD117, D2-40 (podoplanin),SALL-4
(-) CK
Elevated LDH, rarely hcg
May have syncytiotrophoblast or granuloma
Retroperitoneal para-aortic LNs
Isochrome 12p; c-kit mutations

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4
Q

Second MC testicular GCT
Distinct morpho
Ihc
Molecular
Prognosis

A

Embryonal carcinoma (EC)
Primitive pleomorphic cells
Frequent hemorrhage and tumor necrosis
May have intratubular EC with comedonecrosis
(+) CD30, OCT3/4, SALL4, panCK, PLAP
Isochrome 12p amplification
Aggressive but responds to chemo

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5
Q

Most aggressive GCT with extensive hemorrhage and necrosis and LVI. It has frequent early metastasis to lung.
Morpho?
Ihc?
Serum marker?

A

Choriocarcinoma
3 cell types:
Syncytiotrophoblasts: (+) inhibin, glypican3
Cytotrophoblasts: (+) sall4, p63, GATA3
intermediate trophoblasts
All: (+) beta hcg
Elevated serum hcg

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6
Q

Almost always a component of mixed GCT. It has many growth patterns that recapitulate the ___, ___, and ____
MC pattern is microcystic/reticular
Clues to dx?
Ihc?
Serum marker?

A

Yolk sac tumor, postpubertal type/ endodermal sinus tumor
Yolk sac, allantois and extraembryonic membranes
Schiller-Duval bodies, Hyaline globules (contain AFP and alpha 1 antitrypsin), band like intercellular basement membrane
(+) AFP, glypican3, CD117, SALL4
(-) oct3/4
Hepatoid areas will stain with liver markers
Elevated serum AFP

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7
Q

MC component in a treated GCT
Components?
Behavior?
Exception?
Criteria

A

Teratoma, postpubertal type - they are chemoresistant
One or more germinal layers
All malignant except rare dermoid cysts or prominent components of ciliated epithelium and smooth muscle
Must not have GCNIS, isochrome 12p, or testicular scarring

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8
Q

MC Somatic type malignancy arising in a teratoma
Criteria

A

Usually a sarcoma, MC Rhabdomyosarcoma
If a dyaplastic component forms a nodule larger than 4x field (5 mm)

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9
Q

A 60 year old man came in due to dull testicular pain. A mass was seen and resected. Microsections show with small, medium, and large cells.
IHC: (+) SALL4 and Cd117
Negative for usual seminoma markers
Prognosis
Mutation

A

Spermatocytic tumor
Excellent but can undergo sarcomatous transformation
Gain of chromosome 9
Additional copies if DMRT1 fene
Acticating mutations in FGFR3 and HRAS

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10
Q

Teratoma, pre pubertal type
Age?
Morpho?
Specialized variants?
Behavior?

A

<6 yo
One or more germ cell layers
Dermoid cyst
Epidermoid cyst
Well-differentiated neuroendocrine tumor
Benign behavior

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11
Q

Difference of pre and post pubertal
Type YST

A

Prepubertal YST: not assoc with GCNIS or isochrome 12p amplification
Excellent survival

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12
Q

GCTs that have undergone either partial or complete regression
Morpho?
Prognosis?

A

Regressed GCTs
Nodular focus of scaring fibrosis in the testis
Can see coarse calcifications within tubules, chronic inflammation, hyalinized tubular ghosts cells

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13
Q

Malignant tumors with more than one germ cell tumor component
Subtypes?

A

Mixed germ cell tumor
- clinically regarded as non-seninoma
Polyembryoma: EC + YST resembling an embryo
Diffuse embryoma: EC + YST in parallel flat layers

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14
Q

MC sex cord stromal tumor in the testis
Diffuse growth of uniform round cells with round cell nuclei and prominent nucleoli and abundant eosinophilic granular or vacuolated cytoplasm
Dx?
Behavior?
Age
Clinical
Clues to dx
Ihc?
Ddx?

A

Leydig cell tumor
Majority benign (5-10% malignant)
2 peaks: 5-10, 30-60
Usually asymptomatic but may have precocious puberty
Reinke crystals
(+) inhibin, calretinin, melanA(MART-1), SF-1, CD99
(-) CK
Leydig cell hyperplasia (<0.5 cm)

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15
Q

A 51 year old male came in due to dull testicular pain. A mass was seen and resected. Microsections show tubuloglandular and solid sheets of cuboidal to columnar cells with moderate pale to lightly eosinophilic cytoplasm with prominent vacuoles.
IHC: (+) inhibin, calretinin, melan-A, SF1, WT-1, chromo, synapto, CK, nuclear beta catenin
Dx?
Behavior?
Risk factors?

A

Sertoli cell tumor
If with extensively hyalinized stroma with cells in tight cords and clusters: Sclerosing SCT
Malignant features: >5 cm, mitosis >5/10hpfs, LVI, ETE, marked atypia and necrosis
Undescended testes, PJS, carney syndrome, androgen insensitivity, testicular feminization

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16
Q

A 42 year old man came in due to testicular pain. A mass was seen and resected. Microsection show sheets and trabeculae of pale cells with grooved nuclei with frequent microfollicles containing pink secretions
Dx?
Clues to dx?
Mutation?

A

Adult Granulosa cell tumor
Call-Exner bodies
FOXL2 point mutations

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17
Q

A 4 month old boy had palpable testicular mass. Resection was done which showed irregular cystic areas filled with basophilic to eosinophilic secretion and interspersed solid are with cells with round nuclei and NO GROOVES. Also seen are macrofollicles with mucinous secretion.
Dx?
Behavior?

A

Juvenile GCT
Features of aggressive behavior: >4 cm, mitosis >5/10 hpfs, LVI, infiltrative borders

18
Q

Variant of SCT with peculiar large plaque-like calcifications.
Dx?
Ihc?
Molecular?

A

Large cell calcifying SCT
Vs SCT: NO nuclear beta catenin
PRKAR1A mutations, assoc with Carney complex

19
Q

A 7 year old boy came in due to palpable bilateral testicular masses. Patient has a hx of colonic polyps. On PE, patient also had gynecomastia. Testicular masses were resected. Microsections show expanded seminiferous tubules with large sertoli cells with pale cytoplasm with prominent basement membrane deposits around and within the tubules.
Dx?
Pathogenesis?
Behavior?

A

Intratubular LCCSCT
Tumor with aromatase convert androgens to estrogen —> increased serum estradiol levels
Almost exclusively in Peutz-Jegher’s syndrome (like SCTAT!)
Benign

20
Q

A testicular tumor with uniform spindle to ovoid cells growing in short, intersecting fascicles and storiform growth.
Reticulin: collagen deposition around individual tumor cells
Dx?
Behavior?
Location?

A

Fibroma/Thecoma
Benign
Often in testis but can be paratesticular

21
Q

A tumor composed of a mixture of germ cells (GCNIS and spermatogonium) and immature sex cord stromal cells (granulosa cell) areanged in round nested pattern surrounded by eosinophilc basement membrane-like material. There are calcifications as well.
IHC: (+) CD117
(-) inhibin
Dx?
Behavior?
Risk factor

A

Gonadoblastoma
Premalignant lesion - if it will progress, it is often SEMINOMA
Occurs mainly in dysgenetic gonads

22
Q

Mc lymphoma in testis

A

DLBCL

23
Q

MC neoplasm of paratesticular region
Gross?
Pathogenesis?
Ihc?
Behavior?

A

Adenomatoid tumor
Small, WC, white tan firm mass typically near the upper pole of the epididymis
Benign proliferation of mesothelial cells
(+) mesothelial markers (D2-40, WT-1, CK5/6, panCK)

24
Q

2nd MC malignant tumor in paratesticular region
Key feature?
Arises from?
Association?

A

Malignant mesothelioma
Invasion
Usually from tunica vaginalis
Assoc with hydrocele (NOT ASBESTOS)

25
Q

A paratesticular tumor that shows papillary architecture with stromal cores lined by a single layer of bland cuboidal cells.
Arises from?
Association?

A

Well-differentiated papillary mesothelial tumor (WDPMT)
Tunica vaginalis
Hydrocele

26
Q

A benign tumor of the epididymis that resembles papillary clear cell carcinoma phenotypically and immunophenotypically.
Association?

A

Papillary cystadenoma of the epididymis
VHL syndrome

27
Q

MC mesenchymal tumor of paratesticular region

A

Lipoma

28
Q

MC cause of azoospermia in infertile men
Seminiferous tubules show thick basement membrane with narrow lumens and lined by only sertoli cells
Focal areas show normal spermatogenesis
Dx? Cause?

A

Sertoli cell only/ germ cell aplasia/ del castillo syndrome
Primary or secondary

29
Q

MC infectious cause of prostatitis

A

E. Coli
Enterococcus

30
Q

T or F: cryptorchidism is usually unilateral

A

True
It is bilateral in only 25%

31
Q

Presents as a painless testicular mass mimicking testicular tumor

A

Granulomatous (autoimmune) orchitis
- restricted to spermatic tubules vs mycobacterial infection

32
Q

T or F: orchitis in mumps more commonly occurs in post pubertal males than children

A

True

33
Q

Histologic hallmark of syphilis.
Which is infected first

A

Obliterative endarteritis
Can also have gumma (granulomatous inflam)
Testis

34
Q

MC malignant paratesticular tumor in children? In adults?

A

Children - rhabdomyosarcoma
Adults- liposarcoma

35
Q

This stimulates proliferation and appear to be involved in the genesis of GCNIS

A

activating mutations in the KIT receptor tyrosine kinase

36
Q

Why does GCNIS appear in post pubertal

A

Arise in utero and stay dormant until puberty —>Hormonal influences stimulate germ cell growth

37
Q

Role of OCT3/4 and NANOG

A

maintenance of pluripotent stem cells

38
Q

EC vs seminoma

A

EC (+) CK, (-) KIT and podoplanin
YST also (+) CK

39
Q

T or F: the histology of metastases and distant recurrences may differ from that of the testicular lesion

A

True

40
Q

Serum biomarker that correlates with mass of tumor cells and hence tumor burden

A

LDH

41
Q

MC testicular tumor in men older than 60

A

Non-hodgkin lymphoma

GenitoUrinary Tract (4 decks)

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