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Repro/GU by Minnie (she/her) > 227/228 - Pathology of Testes, Testes Cancer > Flashcards

227/228 - Pathology of Testes, Testes Cancer Flashcards

1
Q

List 3 common symptoms/signs of localized testicular cancer

A
  • Scrotal mass
  • Scrotal pain
  • Acute onset of a hematocele
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2
Q

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

A

Inhibin

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3
Q

Which nerves are most at risk during a RPLND?

A

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

=> problem getting semen to the posterior urethra

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4
Q

What cells make up a choriocarcinoma?

A

Syncytiotrophoblasts + cytotrophoblasts

Syncytiotrophoblasts secrete HCG

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5
Q

List 4 non-seminomatous germ cell tumors

A
  • Embryonal carcinoma
  • Yolk sac tumor
  • Choriocarcinoma
  • Teratoma (mature and immature)
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6
Q

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

A

Cyclin D2

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

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7
Q

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

A

Yolk sac tumor

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8
Q

When should a partial orchiectomy be performed?

A

Rarely

Only in people with a solitary testicle or a benign lesion

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9
Q

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

A

Teratoma

Usually mature

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10
Q

Describe the histologic appearance of a seminoma

A
  • Large, primitive tumor cells (germ cells)
  • Relatively normal looking
  • Immune infiltrate (lymphocytes)
  • Has invaded seminiferous tubules
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11
Q

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

Why?

A

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)

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12
Q

What does testicular cancer usually look like on ultrasound?

Which tumors may look different?

A

Usually hypoechoic

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

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13
Q

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

A

Lymphoma

(Diffuse, large B cell type)

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14
Q

Which tumors will have elevated C-kit?

A

Seminoma

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15
Q
A

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

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16
Q

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

(From most to least common)

A
  • Mediastinum
  • Retroperitoneum
  • Sacrococcygeal region
  • Pineal gland
17
Q

Following orchiectomy, what is the management of:

Stage 1 seminoma:

Stage 2 seminoma

A
  • Stage 1 seminoma:
    • Observation
  • Stage 2 seminoma:
    • Radiation to the retroperitoneal lymph nodes
18
Q

Which testicular tumor is characterized by lymphocytic infiltration?

A

Classic seminoma

19
Q

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

A
  • 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
Q

Which testicular tumor can metastasize to the CNS hematogenously?

A

Choriocarcinoma

21
Q

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

A

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
Q

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

A

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
Q

Which tumor marker is never expresed by a pure seminoma?

A

AFP

Also never elevated in choriocarcinoma

24
Q

Which cells produce beta-HCG?

A

Syncytiotrophoblasts

  • Choriocarcinoma arises from syncytiotrophoblasts => high HCG*
  • May be present in all germ cell tumors, but syncytiotrophoblasts dominate in choriocarcinoma*
25
Q

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

A

PEB chemotherapy

Cisplatin + Etoposide +Bleomycin

26
Q

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

A

Leydig cell tumors

  • Leydig cells secrete testosterone*
  • Gynecomastia, loss of libido when aromatized to estrogen*
27
Q

Which lymphoma subtype most commonly involves the testis?

A

Diffuse large B-cell type

Most common testicular tumor in men >60 years old

28
Q

What is the prognoses of sex cord stromal tumors?

A

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
Q

What is the most common germ cell tumor?

Which tumor markers does it express?

A

Seminoma

HCG

LDH

30
Q

List 3 key differences between classic seminoma and spermatocytic seminoma

A
  • 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
31
Q

What is the half life of LDH?

A

10 hours - 3 days

(most variable half life of the tumor markers)

32
Q

A ____ sided testicular tumor will “land” in the para-aortic lymph nodes

A ____ sided testicular tumor will “land” in the interaortocaval nodes

A

A left sided testicular tumor will “land” in the para-aortic lymph nodes

A right sided testicular tumor will “land” in the interaortocaval nodes

Aorta is on the left side, so left testes will go to para-aortic

33
Q

How will a hydrocele affect testicular development?

A

Will cause testicular atrophy

No germ cell development; testis will be nonfunctional

34
Q

Which cells are responsible for the blood-testes barrier?

A

Sertoli cells

35
Q

Which testicular tumor may have a solid, glandular, or papillary pattern?

What will you see on gross pathology?

A

Embryonal carcinoma

Repro/GU by Minnie (she/her) (31 decks)

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