227/228 - Pathology of Testes, Testes Cancer Flashcards Preview

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Flashcards in 227/228 - Pathology of Testes, Testes Cancer Deck (35)
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1

List 3 common symptoms/signs of localized testicular cancer

  • Scrotal mass
  • Scrotal pain
  • Acute onset of a hematocele

 

2

Which tumor marker will be increased in sex-cord stromal tumors (Leydig and Sertoli cell tumors)?

Inhibin

3

Which nerves are most at risk during a RPLND?

Post-ganglionic sympathetics (hypogastric plexus) - involved in ejaculation

 

=> problem getting semen to the posterior urethra

 

 

4

What cells make up a choriocarcinoma?

Syncytiotrophoblasts + cytotrophoblasts

 

Syncytiotrophoblasts secrete HCG

 

5

List 4 non-seminomatous germ cell tumors

  • Embryonal carcinoma
  • Yolk sac tumor
  • Choriocarcinoma
  • Teratoma (mature and immature)

 

6

What gene, located on the short arm of chromosome 12, may account for the rapid growth rate of most testes tumors?

Cyclin D2

 

Duplication of 12p is seen in >80% of germ cell tumors

7

Which germ cell tumor is associated with Schiller-Duval bodies?

Yolk sac tumor

8

When should a partial orchiectomy be performed?

Rarely

 

Only in people with a solitary testicle or a benign lesion

9

What is the most common pure germ cell tumor in children?

Teratoma

Usually mature

10

Describe the histologic appearance of a seminoma

  • Large, primitive tumor cells (germ cells)
  • Relatively normal looking
  • Immune infiltrate (lymphocytes)
  • Has invaded seminiferous tubules

 

11

In the management of testis cancer, by which approach is orchiectomy performed?

Why?

Inguinal approach 

Key: not scrotal

Inguinal approach allows the surgeon to remove all in-transit metastatic disease in the lymph channels in the spermatic cord

Also avoids contaminating the scrotal (inguinal) lymphatics (aka you don't want to create new paths for cancer to spread - just follow the one that is is already likely spreading to)

12

What does testicular cancer usually look like on ultrasound?

Which tumors may look different?

Usually hypoechoic

Teratomas may be hyperechoic because it contains a variety of different parts

13

What is the most common testicular tumor in a man >60 years old?

Lymphoma

(Diffuse, large B cell type)

14

Which tumors will have elevated C-kit?

Seminoma

15

B. Testicular calcifications

 

 

Calcifications may be seen in teratoma, but many people have calcifications; if that is the only finding and no hx of cancer, these are fine

16

What are the most common extra-gonadal sites of germ-cell neoplasia?

(From most to least common)

  • Mediastinum
  • Retroperitoneum
  • Sacrococcygeal region
  • Pineal gland

 

17

Following orchiectomy, what is the management of:

Stage 1 seminoma:

Stage 2 seminoma

  • Stage 1 seminoma:
    • Observation
       
  • Stage 2 seminoma:
    • Radiation to the retroperitoneal lymph nodes

 

18

Which testicular tumor is characterized by lymphocytic infiltration?

Classic seminoma

19

What is the most significant side effect associated with each aspect of PEB chemotherapy?

 

  • Cisplatin
    • Nephrotoxicity, neuropathy, ototoxicity, vomiting
  • Etoposide
    • Myelosuppression, leukomonogenic
  • Bleomycin
    • Pulmonary fibrosis, Raynaud's

All: DVT, secondary malignancies later in life

PEB is used to treat invasive/metastatic testicular cancer

20

Which testicular tumor can metastasize to the CNS hematogenously?

Choriocarcinoma

21

What is the precursor for all testicular germ cell tummors except spermatocytic seminoma?

Intratubular germ cell neoplasia (ITGCN)

 

Note: Germ cell neoplasia in situi is a type of ITGCN that is specifically a precursor for germ cell tumors

22

Describe the histological features of diffuse, large B cell lymphoma of the testis

Tubule-sparing growth pattern

Looks like a seminoma but without lymphocytic infiltration

 

Will present in an older patient (>50), vs seminonma in a younger pt

23

Which tumor marker is never expresed by a pure seminoma?

AFP

 

Also never elevated in choriocarcinoma

24

Which cells produce beta-HCG?

Syncytiotrophoblasts

 

 

Choriocarcinoma arises from syncytiotrophoblasts => high HCG

 

May be present in all germ cell tumors, but syncytiotrophoblasts dominate in choriocarcinoma

25

What is the first-line therapy for patinets with metastatic germ cell neoplasia?

PEB chemotherapy

Cisplatin + Etoposide +Bleomycin

26

Which testicular tumor will present with signs of virilization, gynecomastia, and/or loss of libido?

Leydig cell tumors

 

Leydig cells secrete testosterone

Gynecomastia, loss of libido when aromatized to estrogen

27

Which lymphoma subtype most commonly involves the testis?

Diffuse large B-cell type

 

Most common testicular tumor in men >60 years old

28

What is the prognoses of sex cord stromal tumors?

If local, good prognosis; often these tumors are benign

 

If malignant, they are very aggressive; refractory to radiation, chemo => bad prognosis

 

Sex cord stromal cell tumors = leydig cell, sertoli cell, fibrothecoma, granulosa cell 

29

What is the most common germ cell tumor?

Which tumor markers does it express?

Seminoma

HCG

LDH

30

List 3 key differences between classic seminoma and spermatocytic seminoma

  • Classic seminoma
    • Very common (Most common type of testicular cancer!)
    • Younger patients
    • Arises from ITGCN
       
  • Spermatocytic seminoma
    • Rare
    • Older patients
    • Does NOT arise from ITGCN