10.31 Pathology of Testes

Stage 2 vs Stage 3 mets?

2 = below diaphragm 3 = above diaphragm

Leydig Cell tumors occurs between ages

20-60

*C-Kit, OCT-4, PLAP, HCG* genetic markers suggest: a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Teratoma e. Teratocarcinoma

A

Genetic Associations include *OCT3/OCT4, PLAP, HCG, NANOG, Isochromosome 12P, C-KIT in 25% of tumors:* a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Teratoma e. Teratocarcinoma

A

This is the MOST Common Germ Cell Tumor in males: a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Teratoma e. Teratocarcinoma

A

What is this? a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Teratoma e. Teratocarcinoma

A (Seminoma Cells = large round/polyhedral cells, fibrous septae, lymphocytes)

Composed of cells that resemble primordial cells OR early gonocytes. Cells =* large round/polyhedral cells * Fibrous Septae w/ lots of *Lymphocytes and Glycogen in the cytoplasm* a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Teratoma e. Teratocarcinoma

A (Seminoma Cells: fibrous septae, lymphocytes)

(this was the truck driver case he talked about) These are related to seminomas, this subtype has a greater cellularity & Pleomorphism, but NOT associated w/ worse prognosis: a. Classic Seminoma b. Anaplastic Seminoma c. Spermatocytic Seminoma d. Non-Seminomas [Hemorrhagic]

B

Nodular Areas of *Hemorrhage & Necrosis; Cell borders are INDISTINCT, diffuse, & variable, unlike their counterparts* a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

B

The major differentiator between this tumor and another is that it is *NEGATIVE for C-Kit*: a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

B

These tumors are seen in 20-30 year olds.* More aggressive than seminomas and smaller, making them tougher to palpate.* a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

B

Dark cells with overlapping nuclei on histology suggest: a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

B (diffuse pattern, pleomorphism, overlapping nuclei)

(WILL BE ON BOARDS) These tumors are (+) for *Alpha-Fetoprotein (AFP) & A1A*: a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

C

*Schiller-Duval Bodies *(glomerular-like structures) suggest: a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

C

This is a subtype of Seminoma that is very distinct from "normal" Seminomas. *It occurs in men >65 y/o. SLOW-Growing + excellent prognosis:* a. Classic Seminoma b. Anaplastic Seminoma c. Spermatocytic Seminoma d. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic)

C

What does this histology show? a. Classic Seminoma b. Anaplastic Seminoma c. Spermatocytic Seminoma d. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic)

C (medium-sized cells, eosinophilic, giant cells)

Rare, Highly malignant tumor that's often mixed w/ other types. Contain *Syncytiotrophoblastic Cells * (large, irregular cells w/ pinkish eosinophilic cytoplasn),* HCG*, and *Cytotrophoblastic Cells *(more regular w/ distinct cell borders): a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

D

Usually *benign; Hormonally SILENT; Arranged in Cords & Trabeculae *w/ occasional *Calcification* scattered throughout the tumor a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Sertoli Cell Tumor e. Leydig Cell tumors

D

What does this biphasic histology show? a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

D

What does this grossly show? a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

D

*Calcium deposits * evident on histology a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Sertoli Cell Tumor e. Leydig Cell tumors

D (There is *certainly calcification* in *Sert*oli cells)

A mix between Teratoma + Embryonal Carcinoma; Mix of embryonal component + cartilage from Teratoma is a: a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Teratoma e. Teratocarcinoma

E

What is this gross structure? a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

E

*Granular, yellow* grossly but look like a seminoma histologically (solid growth, clear cytoplasm) but* lacks lymphocytic inflammation.* a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Sertoli Cell Tumor e. Leydig Cell tumors

E (*L*eydig *L*acks *L*ymphocytes)

(IMPORTANT) Usually* Benign,* Hormonally *ACTIVE; Reinke Crystals (rod shaped crystals)* a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Sertoli Cell Tumor e. Leydig Cell tumors

E (Mnemonic: *Leyland doing reiki* = *Ley*dig, *Reinke Crystals*)

(important) Initial sign is *gynecomastia or sexual precocity* a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Sertoli Cell Tumor e. Leydig Cell tumors

E (mnemonic: *Leyland* was going through *precious puberty and grew breasts*, before he realizied he had a *Leydig* cell tumor)

Genetic Associations of these types of tumors include: * OCT3, NANOG, C-KIT, Short Arm of Chromosome 12, LDH *

Germ Cell Tumors

Almost all patients with ____ will eventually develop invasive tumors

ITGCN (Intratubular Germ Cell Neoplasia)

Most GCTs arise from lesions called:

ITGCN (Intratubular Germ Cell Neoplasia)

____ has atypical germ cells w/ large nuclei & clear cytoplasm -- progresses to Germ Cell Tumors ITGCN occurs early --> stays dormant until puberty --> Androgens --> develops to Cancer

ITGCN (Intratubular Germ Cell Neoplasia)

Clinical Features of Germ Cell Tumors: Most spread via _____

Lymphatics

Differentiate between mature vs immature teratomas:

Mature Teratoma -- all tissues are well differentiated Immature Teratoma -- immature tissue present (embryonal)

Mature Teratoma but the squamous cell layer OR thyroid layer may have its OWN carcinoma within it describes:

Teratomas w/ malignant transformation

Tumors are "Bulky Masses" that may be up to 10x the size of the normal testes a. Seminoma b. Yolk Sac Tumor c. Choriocarcinoma d. Teratoma e. Teratocarcinoma

a

This is an important risk factor for testicular tumors:

cryptorchidism

What are the two types of testicular tumors?

germ cell sex cord-stromal

Where do germ cell tumors spread hematologically?

lungs liver brain

How do you differentiate between Seminomas and Non-seminomas?

non-seminomas are *negative for C-Kit*

Would a germ cell testicular tumor produce pain or be painless?

painless

Are seminomas or NSGCT more responsive to chemo/easier to treat?

seminomas

These germ cell tumors are composed of cells that resemble primordial cells/early gonocytes

seminomatous

Most common symptoms of Leydig Cell tumors

testicular swelling

T/F: Most germ cell tumors usually contain a mixture of Seminomatous & NON-Seminomatous features

true

Medium Sized Cells w/* Eosinophilic (Pinkish) Cytoplasm.* Small Sized Cells w/ a narrow *rim of Eosinophilic *Cytoplasm; Scattered *Giant Cells*; *Mucoid Cysts*: a. Classic Seminoma b. Anaplastic Seminoma c. Spermatocytic Seminoma d. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic)

C

Most common testicular tumor in *infants and children (up to 3 y/o*): a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

C

What is this? a. Classic Seminoma b. Anaplastic Seminoma c. Spermatocytic Seminoma d. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic)

C (intra-tubular)

These are difficult to palpate because they don't cause testicular enlargement (<5 cm usually) a. Seminoma b. Embryonal Carcinoma (Non-Seminomas/Hemorrhagic) c. Yolk Sac Tumor d. Choriocarcinoma e. Teratoma

D

Why don't we biopsy testicular tumors?

Seeding of cancer can spread it so we just remove them