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