Testis and epididymis Flashcards
Testicular tumour with tubules, cysts, or slit-like spaces lined by flattened to hobnailed cuboidal cells with bland nuclei and eosinophilic cytoplasm, embedded in a fibrous stroma, which may be hyalinized.
Adenomatoid tumour
Plan:
Correlate with clinical history and radiology
IPX to support Dx: Calretinin, WT1
No specific action required for this benign diagnosis
Testicular tumour with abundant clear cytoplasm, well defined membranes, and large, angular nuclei with coarse chromatin and prominent nucleoli. Packets of cells are separated by delicate fibrovascular septa. There is lymphocytic inflammation and often granulomatous inflammation, and there can be areas of fibrosis.
Seminoma
Differential diagnosis:
Spermatocytic tumour
Testicular DLBCL
Plan:
Correlate with clinical history and radiology (?tumour markers)
Examine further blocks (extensively sample, ideally entire tumour, to identify any other germ cell tumour component)
IPX to support Dx: SALL4, CD117 PLAP, OCT3/4 (expect positive, spermatocytic tumour would be negative for PLAP and OCT3/4)
IPX to discount DDx: CD45, CD20
Next steps: Synoptic report, discuss at MDT
Testicular tumour of with solid, glandular, and papillary growth of large pleomorphic epithelioid cells with dense amphophilic cytoplasm and vesicular nuclei with macronucleoli. Mitoses, necrosis, and inflammation are frequent. Nuclei mould/overlap and there is a syncytial appearance without well-defined cell borders.
Embryonal carcinoma
Differential diagnosis:
Choriocarcinoma
Metastatic poorly differentiated carcinoma
Testicular DLBCL
Plan:
Correlate with clinical history and radiology (?tumour markers)
Examine further blocks (extensively sample, ideally entire tumour, to identify any other germ cell tumour component)
IPX to support Dx: AE1/AE3, SALL4, CD30, OCT3/4.
IPX to discount DDx: bHCG, GATA3, CD45, CD20.
Next steps: Synoptic report, discuss at MDT
A testicular tumour in which any type of tissue may be present, such as gastrointestinal glands, respiratory epithelium, cartilage, fat, squamous epithelium with keratinization, primitive undifferentiated spindle cells, or neuroepithelium. Cytological atypia is often observed in most of the tissues.
Testicular teratoma - post pubertal type
Differential diagnosis:
Epidermoid/dermoid cyst of testis
Plan:
Correlate with clinical history and radiology (?tumour markers)
Examine further blocks (extensively sample, ideally entire tumour, to identify any other germ cell tumour component)
IPX to support Dx: Not required
Next steps: Synoptic report, discuss at MDT
A microcystic testicular tumour with cords of cells enclosing microcysts, with hyaline globules (both intra and extracytoplasmic) and ‘Schiller-Duval bodies’ which refer to a fibrovascular core with a distinct central vessel, lined by cuboidal to columnar tumour cells, and surrounded by a cystic space.
Yolk sac tumour
Plan:
Correlate with clinical history and radiology (?raised AFP)
Examine further sections (extensively sample, ideally entire tumour, to identify other germ cell tumour components)
IPX to support Dx: SALL4, AFP, glypican 3
Next steps: Synoptic report, discuss at MDT
Testicular tumour of polygonal cells with abundant eosinophilic (oncocytic) cytoplasm, uniform round nuclei with prominent central nucleoli. Cells may contain cytoplasmic Reinke crystals.
Leydig cell tumour
Plan:
Correlate with clinical history and radiology (?hormone production)
Examine further sections (e.g. for size, relation to margins, malignant features)
IPX to support Dx: Inhibin, SF1
Next steps: Synoptic report, discuss at MDT
Epididymis lesion composed of a central mass of degenerating sperm surrounded by histiocytes, lymphocytes, and multinucleated giant cells, often with fibrosis. Spermatozoa are seen either within macrophages or as extracellular debris.
Spermatic granuloma
