14.3 Testicular Tumors

Question 1

What are the two basic types of testicular tumors?

Answer 1

Germ cell or sex cord stromal

Question 2

What is the classic presentation of testicular tumors?

Answer 2

Firm, painless testicular mass that cannot be transilluminated

Question 3

Why aren’t testicular tumors biopsied?

Answer 3

• Risk of seeding scrotum

- Most are malignant anyways

Question 4

What is the general treatment of testicular tumors?

Answer 4

Orchiectomy

Question 5

What is the most common type of testicular tumors? What is the age range that this usually occurs at?

Answer 5

Germ cell tumor

15-40 years old

Question 6

What are the two major risk factors for the development of germ cell tumors?

Answer 6

Cryptorchidism

Klinefelter

Question 7

What are the two types of testicular germ cell tumors?

Answer 7

Seminoma and nonseminoma

Question 8

What is the male equivalent of dysgerminomas?

Answer 8

Seminoma

Question 9

What are the malignant potentials of seminomas and nonseminomas?

Answer 9

Seminomas meta late and respond well to treatment

Non-seminomas met early, and do not respond well to chemo

Question 10

What, generally, are seminomas?

Answer 10

Malignant tumor of large cells with clear cytoplasm, and central nuclei

Question 11

What are the gross characteristics of seminomas?

Answer 11

Homogenous mass without hemorrhage or necrosis

Question 12

What, rarely, may seminomas produce?

Answer 12

beta-HCG

Question 13

Pt presents with a homogenous testicular mass without hemorrhage or necrosis. Histology reveals a malignant tumor of large cells with clear cytoplasm, and central nuclei. Diagnosis?

Answer 13

Seminoma

Question 14

What are embryonal carcinomas?

Answer 14

Malignant tumors of immature, primitive cells that may form glands

Question 15

What are the gross characteristics of embryonal carcinomas?

Answer 15

Hemorrhagic mass with area of necrosis, that may form glands

Question 16

What are the characteristics of embryonal carcinomas, in terms of aggressiveness and spread? How does it met?

Answer 16

Aggressive with early hematogenous spread

Question 17

What might chemotherapy do to an embryonal carcinoma?

Answer 17

May cause it to differentiate into a more mature tumor

Question 18

What are the labs that may be elevated with embryonal carcinomas?

Answer 18

AFP or beta-HCG

Question 19

What is the most common testicular tumor in children?

Answer 19

Yolk sac tumor

Question 20

What are yolk sac tumors?

Answer 20

Malignant tumors that resemble yolk sac elements

Question 21

What is the hormone that is classically elevated in yolk sac tumors?

Answer 21

AFP

Question 22

What are the histological characteristics of yolk sac tumors?

Answer 22

Schiller-Duval bodies–glomerular-like structures

Question 23

Testicular tumor with glomerular-like structures on histology = ?

Answer 23

Schiller-Duval bodies characteristics of yolk sac tumors

Question 24

What are the cells that produce beta-HCG in the developing fetus?

Answer 24

Syncytiotrophoblasts

Question 25

What are the metastatic characteristics of choriocarcinomas? Why?

Answer 25

Spread early hematogenously--placental tissue is programmed to find blood vessels

Question 26

What is the hormone that can be produced by choriocarcinomas? What, then, are the s/sx that result?

Answer 26

beta-HCG Hyperthyroidism or gynecomastia

Question 27

Why is is that high levels of beta-HCG from yolk sac tumors may cause hyperthyroidism?

Answer 27

Beta subunit of HCG is similar to TSH and FSH/LH

Question 28

What are the cell types that comprised choriocarcinomas?

Answer 28

Syncytiotrophoblasts | Cytotrophoblasts (NOT vili)

Question 29

What is the usual paradigm that helps determine primary vs secondary tumors? What is odd about this with choriocarcinomas of the testicle?

Answer 29

Primary is usually larger than mets, but this is reversed with choriocarcinomas

Question 30

What is the difference between teratomas in males vs females

Answer 30

Males = malignant | Females =benign

Question 31

What are the hormones that teratomas may produce?

Answer 31

beta HCG or AFP

Question 32

True or false: most germ cell tumors are mixed germ cells

Answer 32

True

Question 33

What is the prognosis of mixed germ cell tumors based on?

Answer 33

Worst component

Question 34

What are the cells that line the seminiferous tubules?

Answer 34

Sertoli cells

Question 35

What are sex-cord stromal tumors of the testicle? Are they usually benign or malignant?

Answer 35

Tumors that resemble sex cord stroma of the testicle Usually benign

Question 36

What are the pink cells that surround sertoli cells?

Answer 36

Leydig cells

Question 37

Leydig cell tumors usually produce what hormone? What, then, are the s/sx of these tumors?

Answer 37

Usually produce androgen Precocious puberty in children, or gynecomastia in adults

Question 38

What are the classic histological characteristics of Leydig cell tumors?

Answer 38

Reinke crystals

Question 39

Reinke crystals = ?

Answer 39

Leydig cell tumors

Question 40

What are sertoli cell tumors comprised of? What are the classic clinical s/sx of sertoli cells?

Answer 40

Comprised of tubules | Usually clinically silent

Question 41

What is the most common cause of a testicular mass in a male over the age of 60? Are these usually unilateral or bilateral?

Answer 41

Lymphoma | BIlateral

Question 42

What type of lymphoma usually mets to the testicles?

Answer 42

Diffuse, large B cell lymphoma